Re: Residential care disparities

I recently came across a report while on a public health elective in my fourth year of medical school. Admittedly, I am new to medicine, but I was truly shocked by the data presented by the Office of the Seniors Advocate BC. These provincial data were powerful, concluding, “if you are a resident living in a licensed care facility operated by a contracted provider versus one operated by a health authority, you are 32% more likely to be sent to the emergency department, 34% more likely to be hospitalized, have a 32% longer length of stay, have a 47% greater likelihood that you will become an ‘Alternate Level of Care’ (ALC) patient, and be 54% more likely to die in hospital.”[1

I went looking for these data because of a trend I had been seeing throughout my hospital-based electives. In my short career in medicine to date, I have encountered a number of patients with preventable admissions and have seen many negative consequences of the designated ALC label, something I’m sure more experienced physicians could relate to. Preventable transfers from contracted care facilities to hospital not only increase the demand on hospital physician and health authority resources ($17 million and over 16 000 beds annually),[1] but also result in poor outcomes for BC’s vulnerable senior population. Contracted care facilities are not performing at the level of health authority facilities, and the Seniors Advocate report provides an excellent analysis attempting to get to the root cause. This is an important issue with hospital costs and congestion increasing. Reducing unnecessary hospitalization for seniors by decreasing the disparity between health authority and contracted care facilities is a worthy goal both for the taxpayer and for improving the lives of seniors.
—Sarah Fraser, BSc


1.    Office of the Seniors Advocate BC. From residential care to hospital: An emerging pattern. August 2018. Accessed 14 January 2019.

Sarah Fraser, BSc. Re: Residential care disparities. BCMJ, Vol. 61, No. 1, January, February, 2019, Page(s) 8-9 - Letters.

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