ASSIGNMENT #2 TESTIMONY

Attention: Terry Lake, BC Minister of Health.

Judy Darcy, NDP Health Critic
From: Tania Lesurf, BC Centre for Elder Advocacy and Support
I am speaking on behalf of the BC Centre for Elder Advocacy and Support. I would like
to address an important gap in our current provincial health care system, specifically the
prevention and treatment of pressure ulcers in the elderly. Pressure ulcers are areas of localized
damage to the skin and underlying tissue due to pressure, shear or friction (McInnes, Bell,
Dumville, & Jammali, 2008). They are expensive to treat and are associated with increased
length of stay in acute care as well as decreased quality of life in residential and community
settings (Jenkins & O'Neal, 2010).

Pressure ulcers are a growing and persistent problem in community, residential and acute
care settings in Canada. It is estimated that 29% of acute care patients and 15% of community
care patients currently have pressure ulcers (Woodbury & Houghton, 2004). In British Columbia
specifically the numbers indicate a rise in the prevalence of pressure ulcers, which is expected
with an aging and increasingly less mobile population (Woodbury & Houghton, 2004). These
ulcers can be caused by pressure, shear, friction and moisture. If left untreated they result in poor
quality of life, hospitalization and even death. The frail elderly are at higher risk to develop these
ulcers. One of the challenges in home and residential care in British Columbia is a shortage of
supplies and equipment for preventing and treating these ulcers. Currently the provinces
Medical Services Plan (MSP) does not cover these treatments and devices. Due to prohibitive

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costs this leaves some of our most vulnerable citizens at high risk for pressure ulcers without the
preventative tools for treatment readily available for our front line staff.
Some of the treatments for pressure ulcers include therapeutic surfaces, offloading
devices and wound care supplies. Research supports early intervention and the use of these
surfaces for prevention and early intervention of these ulcers (Inman, Sibbald, Rutledge, &
Clark, 1993). Pressure-relieving beds, mattresses and seat cushions are widely used as aids to
prevention in both institutional and non-institutional settings (McInnes et al.). The use of
therapeutic surfaces in high risk patients has led to improved outcomes and cost savings (Inman
et al.) Dressings are also major component of pressure ulcer management (Lyder, 2003).Lack of
mobility devices also contributes to pressure ulcer prevalence as bedbound patients are at higher
risk for ulcers (Bergstrom, Braden, Laguzza, & Holman, 1987). Unfortunately none of these
items are currently covered under BCs MSP. Due to funding restrictions health authorities such
as Fraser Health require residents at facilities and home care clients to purchase their own
offloading and mobility devices. In addition home care clients must purchase their own wound
care supplies. Statistics Canada indicates that British Columbia and Quebec have the highest
incidence of low income among seniors (Statistics Canada, n.d) For seniors who have no CPP or
other income the maximum OAS and GIS is $1170/month (Unknown, Seniors in Vancouver,
2010). Many pressure relieving devices can cost up to $10,000 to purchase and hundreds of
dollars a month to rent. Wound care supplies can also be very expensive with daily costs
exceeding $10 a day in some cases. These costs are clearly out of reach for many of the most
vulnerable seniors. We have recently seen the impact of this lack of provincial equipment
funding in the media recently with Fraser Health requiring residents to pay a rental fee for
wheelchairs (Unknown, BC Senior's Coalition, n.d). This is due to the fact that there is no

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provincial funding structure to assist seniors in need and health authorities do not have funding
allocated for these items. As indicated the financial barrier prevents our low income frail elderly
in home and residential settings from receiving proper treatment and prevention of pressure
ulcers.
There are solutions to this gap in our provincial health care system. In other provinces
there are funding structures in place to reduce the impact of these costs on frail seniors and
ensure that they have the proper resources and equipment in place to address these issue. One
example of a province that addresses this critical equipment and wound care supply problem is
Alberta
The province of Alberta has a program called the Alberta Aids to Daily Living. This
program helps Albertans with a long-term disability, chronic illness or terminal illness to
maintain their independence at home, in lodges or group homes by providing financial assistance
to buy medical equipment and supplies (Unknown, Client Information, n.d). The purpose of
this program is to assist clients with a long term disability, chronic or terminal illness. This
program covers individuals not covered by private insurance or a federal insurer such as Veterans
or Indian Affairs. In essence this applies to the majority of low income seniors. Albertans pay up
to 25% of the cost up to a maximum of $500 but can apply for an exemption if they are low
income. Wound care supplies are also provided under this program. Registered nurses in
community care are able to authorize dressings after an assessment of the wounds causal factors.
This allows clients to receive proper treatment at home. Wounds must be reviewed and supplies
are authorized for up to 2 years after which they can be extended. Having timely access to
appropriate wound care products without a financial barrier would greatly assist nurses in

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providing the best care for the treatment of wounds and preventing complications such as sepsis
and hospitalization (Unknown, Client Information, n.d).
In British Columbia a potential solution to this problem would be that the provincial
government expand MSP coverage to include wound care products, therapeutic surfaces and
mobility devices the cost of treating a stage 3 or IV pressure ulcer can be more than $40,000.
(Young, Evans, & Davis, 2003). To contain our ever increasing healthcare costs the focus must
be on prevention. By providing our front line staff and patients with the tools to prevent and
treat decubitus ulcers we can act proactively and improve our patients quality of life and keep
them out of expensive acute care settings. A program in BC such as that in Alberta which would
focus on preventative measures and provide health care providers with the tools to treat clients in
homes or residential settings could reduce hospital admissions and overall healthcare costs in the
long run. In addition it would greatly reduce the financial burden on low income seniors, families
and improve their quality of life.
Having a provincial funding structure in place would ensure that frail seniors receive the
proper treatment needed to promote healing or maintain decubitus ulcers. Since we know that
these treatments work and that early intervention is crucial in reducing the impact of pressure
ulcers it is critical that government policy adapt to meet the needs of the elderly in residential
and community settings. This would also reduce the financial impact on them and reduce stress
on patients, family members and staff who are often forced to make difficult decisions to allocate
scarce resources. This would assist in reducing hospital admissions, health care provider time
and improve client quality of life.

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References
Bergstrom, N., Braden, B., Laguzza, A., & Holman, A. (1987). The Braden Scale for Predicting
Pressure Sore Risk. Retrieved from
http://www.healthcare.uiowa.edu/igec/tools/pressureulcers/bradenscale.pdf
Inman, K., Sibbald, W., Rutledge, F., & Clark, B. (1993). Retrieved from JAMA:
http://jama.jamanetwork.com/article.aspx?articleid=403949
Jenkins, M., & O'Neal, E. (2010, December 23). Pressure Ulcer Prevalence and Incidence in
Acute Care. Retrieved from NCBI: http://www.ncbi.nlm.nih.gov/pubmed/21084878
Lyder, C. (2003, January 08). Pressure Ulcer Prevention and Management. American Medical
Association.
McInnes, G., Bell, S., Dumville, J., & Jammali, B. (2008). Support Surfaces for Pressure Ulcer
Prevention. Retrieved from :file:///C:/Users/chris/Downloads/Support%20surfaces
%20for%20pressure%20ulcer%20pre
Statistics Canada. (n.d). Retrieved from http://www41.statcan.gc.ca/2008/70000/ceb70000_000eng.htm
Unknown. (2010). Seniors in Vancouver. Retrieved from http://vancouver.ca/files/cov/SeniorsBackgrounder.pdf
Unknown. (n.d). BC Senior's Coalition. Retrieved from http://www.bchealthcoalition.ca/whatyou-can-do/improve-seniors-care-0
Unknown. (n.d). Client Information. Retrieved from Health Alberta:
http://www.health.alberta.ca/services/AADL-clients.html
Woodbury, G., & Houghton, P. (2004). Prevalence of pressure Ulcers in Canadian Healthcare
Settings. Retrieved from http://cawc.net/images/uploads/resources/Woodbury
%282%29.pdf
Young, Z., Evans, A., & Davis, J. (2003). Retrieved from
http://www.nursingcenter.com/lnc/JournalIssue?Journal_ID=54024&issue_ID=420236

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