2022 UPDATE Aging Populations and Health Services in the West Kootenay Boundary Regional Hospital District This report is funded through the Regional District of Central Kootenay at the request of the West Kootenay Boundary Regional Hospital District Board. Project Team: Jayme Jones (Researcher), Tracey Harvey (Researcher), Robert Macquarrie (Researcher), Leeza Perehudoff (Research Intern), Beatriz Barddal Fantini (Research Intern), Faith O'Neill (Research Intern), James Shaw (Research Intern) Publication Date: August 2022 Contents Executive Summary....................................................................................................................................... 2 Introduction .................................................................................................................................................. 3 Background ............................................................................................................................................... 3 Objective ................................................................................................................................................... 3 Study Area ................................................................................................................................................. 3 Methods ........................................................................................................................................................ 5 Results ........................................................................................................................................................... 5 Demographics ........................................................................................................................................... 5 Current Demographics .......................................................................................................................... 5 Population Projections .......................................................................................................................... 7 Health Facilities ......................................................................................................................................... 9 Service Areas ........................................................................................................................................... 12 Ambulance .......................................................................................................................................... 12 Emergency Room ................................................................................................................................ 12 Diagnostic and Specialized Treatment Facilities ................................................................................. 13 Care Beds ................................................................................................................................................ 18 Hospital Care Beds .............................................................................................................................. 18 Long-Term Care Beds .......................................................................................................................... 20 Transportation ........................................................................................................................................ 23 West Boundary to Grand Forks........................................................................................................... 25 Arrow Lakes and Slocan Valley to Nelson ........................................................................................... 25 North Kootenay Lake and East Shore to Nelson ................................................................................. 26 Salmo to Nelson .................................................................................................................................. 27 Castlegar to Nelson ............................................................................................................................. 27 Multiple Communities to Trail ............................................................................................................ 28 Conclusion ................................................................................................................................................... 29 References .................................................................................................................................................. 30 Ag ing P op u la tion s a n d Hea lth S erv ices 1 A ug us t 20 22 Executive Summary The demographics in the West Kootenay Boundary Regional Hospital District (WKBRHD) have an influence on the need for a variety of health service infrastructure. As of the 2021 Census, there are approximately 89,000 residents living in the WKBRHD. Of those, the age cohorts of 60- to 64-year-olds and 65- to 69-year-olds have the largest percent of the population. However, the age cohort of 70- to 74-year-olds grew the most between the 2016 and 2021 Census years, with an increase of 34.1%. The population in the WKBRHD is projected to grow 6.7% between 2021 and 2041. The percent of the population 65 years old and older has been and continues to increase across the Local Health Areas (LHA) within the WKBRHD. In 2040, the percent of the population 65 years old and older is projected to reach 51% in the Kootenay Lake LHA and 54% in the Kettle Valley LHA. There are various types of health facilities throughout the WKBRHD. These range from the regional hospital in Trail to laboratory outpatient services in the small communities. The availability of a selection of health services throughout the region is examined. While laboratory services are most commonly available throughout the region, specialized services such as dialysis are only available in limited locations (Kootenay Boundary Regional Hospital, Boundary District Hospital, and Creston Valley Hospital & Health Centre). The drive time to a selection of health services is also mapped. Up to 95% of houses in the Regional District of Central Kootenay are within a one-hour drive of a 24-hour emergency room. The number of fully staffed hospital care beds and long-term care beds is explored. The number of hospital beds, not including long-term care beds located in hospitals, is 1.4 per 1000 people within the WKBRHD. This is fewer beds per 1000 people than found in the Interior Health Authority, Okanagan, BC, and Canada. Of the hospitals within the WKBRHD, when not counting long-term care beds, the Kootenay Boundary Regional Hospital has the most hospital beds at 2 beds per 1000 people, and the Boundary Hospital has the least at 0.9 beds per 1000 people. The number of long-term care beds in the WKBRHD has decreased 21% since 2002. As of 2021, there are 730 long-term care beds in the WKBRHD, with an additional 75 announced for Nelson and scheduled to be completed by September 2024. The number of long-term care beds varies across the region, with no long-term care beds available in the Kettle Valley LHA and the most located in the Trail LHA. When examining the number of people over 85 years old who may require care against the number of longterm care beds available, most LHA have enough beds. However, this does not take into consideration those under 85-years old who may require care. Public transportation options within the region are explored to understand accessibility of health services for those without a personal vehicle or ability to drive. While there are BC Transit routes available throughout the region, there are some areas that are disconnected from the regional hospital in Trail (i.e., Boundary and Creston Valley). There are also limited days and times where residents from certain locations could feasibly attend a health appointment when using public transportation. Ag ing P op u la tion s a n d Hea lth S erv ices 2 A ug us t 20 22 Introduction Background In January 2022, the West Kootenay Regional Hospital District (WKBRHD) Board, through the Regional District of Central Kootenay (RDCK), requested Selkirk Innovates to update the 2015 report: Aging Populations and Health Services in the West Kootenay Boundary Regional Hospital District. 1 The scope of this update is to share updated demographic data and health services data, as available, and improve data visualization. Some additional data points are shared based on identified interest by the WKBRHD Board, such as including information about service areas to Magnetic Resonance Imagery (MRI) diagnostic services and dialysis services. Objective The objective of this research is to analyze the population demographics and health services within the WKBRHD to help evaluate the infrastructure in place to accommodate the changing population demographics. Study Area This research is focused on the WKBRHD, located in the southern-interior of BC. It encompasses 78,000 km2 and has a population of approximately 89,000 residents. 2 The WKBRHD includes the entirety of the Regional District of Kootenay Boundary (RDKB) and most of the RDCK. i The WKBRHD is in the Interior Health Authority (IHA) region and encompasses all or part of eight Local Health Areas (LHA): Arrow Lakes, Castlegar, Creston, Grand Forks, Kettle Valley, Kootenay Lake, Nelson, and Trail. For much of the analysis in this report, data is available and organized by LHA. The aggregation of LHAs within the WKBRHD produce a study area boundary that differs slightly from the true WKBRHD boundary (Figure 1). For the purposes of this report and simplicity, this aggregation of LHAs is also referred to as the WKBRHD throughout the report. A summary of the municipalities and unincorporated communities within each LHA are shown in Table 1. i Only RDCK Electoral Areas B and C are not part of the WKBRHD. Ag ing P op u la tion s a n d Hea lth S erv ices 3 A ug us t 20 22 Figure 1: Study area showing LHAs, LHA aggregated boundary, and WKBRHD boundary Table 1: List of municipalities and unincorporated communities within each LHA Local Health Area Arrow Lakes Municipalities Castlegar Nakusp New Denver Silverton Castlegar Creston Creston Grand Forks Kettle Valley Grand Forks Greenwood Midway Kaslo Kootenay Lake Nelson Trail Nelson Slocan Salmo Trail Rossland Warfield Fruitvale Montrose Unincorporated Communities Edgewood Fauquier Burton Robson Ootischenia Deer Park Yahk Kitchener Christina Lake Rock Creek Bridesville Meadow Creek Crawford Bay Riondel Balfour Winlaw Ymir Genelle Trout Lake Hills Boswell Wyndel Westbridge Beaverdell Ainsworth Hot Springs Argenta Gray Creek Ag ing P op u la tion s a n d Hea lth S erv ices 4 A ug us t 20 22 Methods Data for this research was acquired from multiple sources and analyzed using summary statistics and/or geospatial analysis. The sources of the data and information are included as references found with each analysis. Demographic analysis for current population uses the recently released Census 2021 data and is analyzed to the true WKBRHD boundary. All other demographic analyses (including population projections) use data from BC Stats, which is available by LHA. Presenting demographics by LHAs allows for comparison against various health service situations. See the Study Area section above for a detailed description of the area used for analysis. Health facility data was acquired from numerous sources based on availability. The IHA was a key source of information. The Manager of Research Data at IHA confirmed the best sources for health facilities data. Footnotes are included as needed to add any additional information about information sources. Spatial data were acquired from the Regional District of Central Kootenay, BC Transit, BC Data Catalogue, and ESRI. Geospatial analysis was conducted for sections of this report using ESRI’s ArcGIS Pro software. This software was also used to generate all maps included in this report. The ArcGIS Network Analysis extension was used to calculate the travel time needed to access health services (i.e., service areas) across the WKBRHD. ArcGIS Online routing service data were utilized for these calculations. 3 All maps in this report use the topographic basemap from the Community Map of Canada. 4 The true WKBRHD boundary was visualized using census subdivision boundaries and the aggregated LHA study area uses LHA boundaries. 5,6 The community points used across several maps were published by GeoBC. 7 Results Demographics CURRENT DEMOGRAPHICS With a population of approximately 89,000 residents, the current demographics of the entire WKBRHD are shown in Figure 2. ii,2 When looking at 5-year age cohorts, the age cohorts of 60- to 64- year-olds and 65- to 69-year-olds have the largest percent of the population. The population aged 60-years old and older make up 36% of the total population in the WKBRHD. These demographics are for the true WKBRHD area, not the larger aggregated LHA study area. Gender is presented in two categories – ‘men+’ and ‘women+’, which includes non-binary and transgender persons. These gender + additions are not expected to have a significant impact on data analysis and historical comparability due to the small size of the transgender and non-binary populations. ii Ag ing P op u la tion s a n d Hea lth S erv ices 5 A ug us t 20 22 100 years and over 95 to 99 years 90 to 94 years 85 to 89 years 80 to 84 years 75 to 79 years 70 to 74 years 65 to 69 years 60 to 64 years 55 to 59 years 50 to 54 years 45 to 49 years 40 to 44 years 35 to 39 years 30 to 34 years 25 to 29 years 20 to 24 years 15 to 19 years 10 to 14 years 5 to 9 years 0 to 4 years 4.5% 4.4% 2.3% 3.7% 0.00% 0.01% 0.04% 0.1% 0.5% 0.3% 0.8% 1.0% 1.4% 1.6% 3.5% 3.1% 3.1% 3.0% 3.1% 2.8% 2.5% 2.0% 2.3% 2.6% 2.4% 1.8% 2.3% 3.7% 3.1% 3.0% 3.1% 3.1% 2.8% 4.4% 4.7% 4.0% 2.3% 1.7% 2.1% 2.5% 2.2% 1.8% Men+ Women+ Figure 2: Population pyramid for men+ and women+ by age cohorts in the WKBRHD, 2021 Census Table 2 summarizes the Census 2016 and 2021 population of the WKBRHD by age cohort, with a focus on the older cohorts.2,8 Between the 2016 and 2021 Census years, the age cohort that increased the most is 70- to 74-year-olds (+34%), followed by 75- to 79-year-olds (+22%). When looking at the population aged 65-years old and older, that demographic grew by 17% between 2016 and 2021. Table 2: WKBRHD population by age cohort, with focus on older cohorts, for Census years, 2016 and 2021 Age Cohorts 2016 Census Population % of Total Population, 2016 2021 Census Population % of Total Population, 2021 % Change 2016-2021 Under 50 42,340 50.1% 45,105 50.5% 6.5% 50-54 6,295 7.5% 5,530 6.2% -12.2% 55-59 7,610 9.0% 6,725 7.5% -11.6% 60-64 7,880 9.3% 8,095 9.1% 2.7% 65-69 7,130 8.4% 8,000 9.0% 12.2% 70-74 4,945 5.9% 6,630 7.4% 34.1% 75-79 3,420 4.1% 4,180 4.7% 22.2% 80-84 2,390 2.8% 2,675 3.0% 11.9% 85-89 1,545 1.8% 1,555 1.7% 0.6% 90-94 705 0.8% 675 0.8% -4.3% 95-99 175 0.2% 150 0.2% -14.3% 100+ 15 0.02% 15 0.02% 0.0% 65+ 20,330 24.1% 23,870 26.7% 17.4% 85+ 2,440 2.9% 2,400 2.7% -1.6% Ag ing P op u la tion s a n d Hea lth S erv ices 6 A ug us t 20 22 POPULATION PROJECTIONS The percent of the population aged 65-years old and older has been increasing over time; however, it is projected to level out. Using BC Stats population estimates for past years and population projections for future years, Table 3, Table 4 and Figure 3, show the change in the population 65-years old and older over time. 9 When looking at the aggregated LHA study area, the population 65-years old and older was only 18% of the population in 2005. This is expected to jump to 28% by 2025 and 30% by 2030, leveling out after that for the ensuing decade. The population aged 65-years old and older varies depending on the LHA. The Kettle Valley LHA is expected to have the highest percentage of the population aged 65-years old and older, ranging from 47% in 2025 to 54% in 2040. This is followed by Kootenay Lake LHA ranging from 44% in 2025 to 51% in 2040. Table 3: Percent of total population 65-years old and older by Local Heath Area, 2005, 2015, 2025, 2030, 2035, 2040 % of Total Population Aged 65+ 2025 2030 41% 45% Local Health Area Arrow Lakes 2005 19% 2015 31% 2035 42% 2040 38% Castlegar 16% 18% 22% 24% 25% 24% Creston 24% 27% Grand Forks 22% 32% 33% 34% 33% 32% 41% 45% 45% 44% Kettle Valley 18% 33% 47% 52% 53% 54% Kootenay Lake 18% 28% 44% 49% 50% 51% Nelson 14% 16% 22% 23% 23% 24% Trail 18% 19% 25% 28% 29% 29% Aggregated LHAs 18% 22% 28% 30% 30% 30% Table 4: Population 65-years old and older by Local Health Area, 2005, 2015, 2025, 2030, 2035, 2040 Local Health Area Arrow Lakes 2005 886 2015 1,442 Population Aged 65+ (#) 2025 2030 1,995 2,186 Castlegar 2,041 2,585 3,435 3,886 4,174 4,306 Creston 2,887 3,502 4,426 4,590 4,505 4,289 Grand Forks 1,943 2,817 3,614 3,764 3,562 3,236 Kettle Valley 626 1,182 1,653 1,723 1,620 1,474 2035 2,067 2040 1,841 Kootenay Lake 638 927 1,533 1,608 1,544 1,462 Nelson 3,258 4,301 6,273 7,139 7,561 8,163 Trail 3,469 3,836 5,219 5,929 6,176 6,237 Aggregated LHAs 15,748 20,592 28,148 30,825 31,209 31,008 Ag ing P op u la tion s a n d Hea lth S erv ices 7 A ug us t 20 22 Figure 3: Percent of population aged 65-years old and older, and total population, by Local Health Area, 2005 to 2040 Ag ing P op u la tion s a n d Hea lth S erv ices 8 A ug us t 20 22 As shown in Figure 4, the total population of the aggregated LHA study area (all ages) is projected to increase by 6.7% from 2021 to 2041.9 This is less than the estimated increase to the total population of BC (26.1%). The estimated change in population varies by LHA over this 20-year time period. Population increases are projected for the LHAs of Nelson (+23.4%), Castlegar (+18.6%), Trail (2.9%), Arrow Lakes (+1.1%), and Creston (+0.6%). Decreases in population are estimated for Grand Forks (-19.7%), Kootenay Lake (-21.2%), and Kettle Valley (-25.8%). Projected Population Change 2021 - 2041 (%) 26.1% 23.4% 18.6% 6.7% BC Nelson Castlegar Aggregated LHAs 2.9% Trail 1.1% Arrow Lakes 0.6% Creston -19.7% -21.2% Grand Forks Kootenay Lake -25.8% Kettle Valley Figure 4: Projected population change (%) for BC, and by Local Health Area, 2021 to 2041 Health Facilities There are various types of health facilities throughout the WKBRHD (Table 5). 10,11,12 These include: • • • • • • Regional Hospital: provides core medical and surgical specialty services. Urgent and Primary Care: addresses medical needs that require same day attention. Level 1 Community Hospital: offers surgical, inpatient, and emergency services. Community Health Centre: offers a variety of services in one location, but services vary depending on the specific centre. They do not have acute care beds but may provide basic laboratory and radiology; urgent care; community services; long-term care; and doctor’s offices. Primary Health Care: offers a comprehensive and coordinated approach to healthcare delivery and has an interdisciplinary team at a single site that matches the unique needs of the community. Laboratory: provides accessible laboratory outpatient services. Ag ing P op u la tion s a n d Hea lth S erv ices 9 A ug us t 20 22 Table 5: Health facilities within the WKBRHD, including regular hours of operation and emergency/urgent care hours iii Local Health Area Arrow Lakes Community Level 1 Community Hospital New Denver Slocan Community Health Centre Primary Health Care Centre Edgewood Edgewood Health Centre Community Health Centre Castlegar and District Community Health Centre Creston Valley Hospital & Health Centre Community Health Centre/Urgent & Primary Care Level 1 Community Hospital & Community Health Centre Boundary District Hospital Level 1 Community Hospital Boundary Community Health Centre Community Health Centre Midway Blood Lab Services Laboratory Midway Health Unit Community Health Centre Greenwood Greenwood Public Health Laboratory Rock Creek Rock Creek Health Centre Community Health Centre Creston Creston Grand Forks Grand Forks Nelson Midway Kaslo Primary Health Centre Primary Health Care Crawford Bay East Shore Community Health Centre Community Health Centre Kootenay Lake Hospital Level 1 Community Hospital Nelson Health Centre Community Health Centre Nelson Trail Rossland Salmo Health and Wellness Centre Kootenay Boundary Regional Hospital Community Health Centre Regional Hospital Trail Health Centre Laboratory Laboratory Kiro Wellness Centre Community Health Centre Associate Medical Clinic Laboratory Laboratory 24 hours/day; 7 days/week Tue, Wed, Fri: 8:00am 11:30am Mon - Fri: 8:00am 12:00pm and 1:00pm 4:00pm (closed stats) Kaslo Salmo Trail Hours of Operation Arrow Lakes Hospital Castlegar Kootenay Lake Facility Type Nakusp Castlegar Kettle Valley Facility Mon - Fri: 8:30am 4:30pm 24 hours/day; 7 days/week 24 hours/day; 7 days/week Mon - Fri: 8:30am 12pm and 1pm to 4:30pm Mon: 8 am-12:30 pm; Wed: 10:15 am - 12:30 pm Mon, Tue, Wed, Fri: 8:30am - 4:30pm Emergency/ Urgent Care Hours 24 hours/day; 7 days/week 24 hours/day; 7 days/week Monday Thursday starting at 4pm; No ER Fri 4pm to Mon 8am 8:00am - 8:00pm; 7 days/week 24 hours/day; 7 days/week 24 hours/day; 7 days/week - Wed 7:55 am - 8:45 am - N/A - Mon - Fri: 8:30am 4:30pm Mon - Fri: 8:30am 4:30pm 24 hours/day; 7 days/week 24 hours/day; 7 days/week 8:00am - 4:30pm Tue to Thu: 9am - 4pm (closed noon-1pm) 24 hours/day; 7 days/week Mon to Fri: 9:00am 3:00pm Mon to Fri: 8:30am 4:30pm 24 hours/day; 7 days/week Thurs: 8 am - 11:30 am Note that hours of operation are subject to change. For example, the Slocan Community Health Centre emergency hours are sometimes reduced depending on staffing or other reasons. - iii Ag ing P op u la tion s a n d Hea lth S erv ices 10 A ug us t 20 22 The services available at each facility differ, see Table 6. 13,iv Slocan Community Health Centre Castlegar Castlegar Creston Creston Grand Forks Grand Forks Midway Greenwood Rock Creek Kootenay Lake Nelson Kaslo Crawford Bay Nelson Salmo Trail Trail ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Edgewood Health Centre Castlegar and District Community Health Centre Creston Valley Hospital & Health Centre Boundary District Hospital ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Dialysis ✔ ECG ✔ MRI ✔ CT ✔ Nuclear Medicine ✔ Ultrasound Mental Health New Denver ✔ Laboratory Arrow Lakes Hospital Radiology (x-ray) Nakusp Edgewood Kettle Valley Facility Pulmonary Function Arrow Lakes Community Urgent Care Local Health Area 24-Hour Emergency Table 6: Availability of a selection of services at health facilities within the WKBRHD ✔ ✔ ✔ ✔ ✔ ✔ Boundary Community Health Centre ✔ Midway Blood Lab Services ✔ Midway Health Unit Greenwood Public Health ✔ Rock Creek Health Centre Kaslo Primary Health Centre East Shore Community Health Centre Kootenay Lake Hospital ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Nelson Health Centre Salmo Health and Wellness Centre Kootenay Boundary Regional Hospital Trail Health Centre Laboratory Associate Medical Clinic Laboratory ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Kiro Wellness Centre Rossland ✔ ✔ ✔ These services were captured from IHA’s website; however, some inconsistencies were noted, such as MRI and CT that were not indicated at Kootenay Boundary Regional Hospital according to the website while those services are known to be present and were therefore added. IHA was not able to provide an accurate list of services by facility. Therefore, caution should be used when referring to this list due to these inconsistencies. iv Ag ing P op u la tion s a n d Hea lth S erv ices 11 A ug us t 20 22 Service Areas Accessing health care services in rural areas like the WKBRHD can be challenging because of geographic barriers that result in increased travel distances and times. 14 Service areas were calculated to determine the travel time needed to access a variety of health care services in the WKBRHD. v AMBULANCE Service areas were calculated for all ambulance stations in the WKBRHD using ambulance stations as the point of departure and a road network for travelling times (Figure 5). 15 There are six categories of travel times, ranging between 15-minutes and 120-minutes (i.e., 2-hours). vi Unsurprisingly, the areas immediately surrounding an ambulance station fall within the 15-minute category. Response time increases as distance from an ambulance station increases. Figure 5: Service area distances to ambulance stations within the WKBRHD EMERGENCY ROOM As shown in Figure 6, service areas were calculated to determine the travel time to facilities with emergency room (ER) services. 16 All of the ERs are open 24-hours per day/seven days a week, except for the Castlegar and District Community Health Centre, which is open 12-hours per day/seven days a Service area travel times may vary depending on traffic, weather and road conditions, delays and construction, ferry dependency and availability, and discrepancies in the estimated speed limit. vi Ambulatory service areas do not account for wait times, other first responder services, the true speeds that ambulances travel, the urgency of the request for assistance, road conditions, weather, etc. v Ag ing P op u la tion s a n d Hea lth S erv ices 12 A ug us t 20 22 week. vii These hours of operation result in limited availability for the surrounding area north-east of Castlegar within one-hour of the facility. Edgewood Health Centre also has some limited emergency hours, but they are too limited to be included in this service analysis (see Table 5 for hours). As of 2022, the total service area within one-hour of an ER in the RDCK is 17,306.9 km2. viii Up to 95% of houses in the RDCK are within one-hour of an ER open 24 hours/seven days a week. 17 Figure 6: Service area distances to emergency rooms within the WKBRHD DIAGNOSTIC AND SPECIALIZED TREATMENT FACILITIES Service areas were calculated for facilities offering eight types of diagnostic and specialized treatments: pulmonary function, radiology (x-ray), ultrasound, nuclear medicine, computed tomography (CT), magnetic resonance imaging (MRI), electrocardiogram (ECG), and dialysis. ix Hours of emergency service do change occasionally. For example, as of late July 2022, the emergency room at Slocan Community Health Centre has temporarily been reduced to 12 hours per day. viii Previous results cannot be compared to current results because of more accurate methodologies applied in 2022. ix These services were captured from IHA’s website; however, some inconsistencies were noted, such as MRI and CT that were not indicated at Kootenay Boundary Regional Hospital according to the website while those services are known to be present and were therefore added. IHA was not able to provide an accurate list of services by facility. Therefore, caution should be used when referring to this list due to these inconsistencies. vii Ag ing P op u la tion s a n d Hea lth S erv ices 13 A ug us t 20 22 PULMONARY FUNCTION Figure 7 shows the service areas for the six facilities offering pulmonary diagnostics in the WKBRHD. 18 Edgewood and communities on the East Shore of Kootenay Lake are within the two-hour drive time to access facilities with these services. Figure 7: Service area distances to pulmonary function diagnostic facilities within the WKBRHD RADIOLOGY (X-RAY) As shown in Figure 8, service areas were calculated for the eight facilities offering radiology (X-Ray) services in the WKBRHD. 19 Figure 8: Service area distances to radiology (X-Ray) diagnostic facilities within the WKBRHD Ag ing P op u la tion s a n d Hea lth S erv ices 14 A ug us t 20 22 ULTRASOUND Figure 9 shows the service areas ultrasound (sonography) diagnostics in the WKBRHD. 20 There are five facilities offering this service. Communities in the northern and north-eastern parts of the study area have longer travel times to access these facilities. Figure 9: Service area distances to ultrasound (sonography) diagnostic facilities within the WKBRHD NUCLEAR MEDICINE The Kootenay Boundary Regional Hospital in Trail is the only facility offering nuclear medicine diagnostics in the WKBRHD (Figure 10). 21 Figure 10: Service area distances to nuclear medicine diagnostic facilities within the WKBRHD Ag ing P op u la tion s a n d Hea lth S erv ices 15 A ug us t 20 22 COMPUTED TOMOGRAPHY (CT) There are two facilities offering CT diagnostics in the WKBRHD, Kootenay Lake Hospital in Nelson and Kootenay Boundary Regional Hospital (Figure 11). Figure 11: Service area distances to computed tomography (CT) diagnostic facilities in the WKBRHD MAGNETIC RESONANCE IMAGING (MRI) The Kootenay Boundary Regional Hospital is the only facility offering MRI diagnostics in the WKBRHD (Figure 12). Figure 12: Service area distances to magnetic resonance imaging (MRI) diagnostic facilities in the WKBRHD Ag ing P op u la tion s a n d Hea lth S erv ices 16 A ug us t 20 22 ELECTROCARDIOGRAM (ECG) As shown in Figure 13, there are 13 facilities offering ECG diagnostic services in the WKBRHD. Most of the region is within a one-hour drive of these services. Figure 13: Service area distances to electrocardiogram (ECG) diagnostic facilities in the WKBRHD DIALYSIS There are three facilities in the WKBRHD offering dialysis services: Boundary Hospital, Kootenay Boundary Regional Hospital, and Creston Valley Hospital & Health Centre (Figure 14). Communities in the northern parts of the region have longer drive times to access these facilities. Figure 14: Service area distances to dialysis specialized treatments in the WKBRHD Ag ing P op u la tion s a n d Hea lth S erv ices 17 A ug us t 20 22 Care Beds HOSPITAL CARE BEDS Hospital Beds per 1000 People including LTC Beds (#) The total number of fully staffed hospital beds per 1000 people is examined at the regional, provincial, and national levels (Figure 15).22, 9 This number includes long term care (LTC) beds located at hospitals. As of 2021, the WKBRHD has an average of 2.9 beds per 1000 people. This is a higher bed density than the IHA (2.8) and Okanagan (2.5). x It also exceeds the hospital bed-to-population ratio in BC (2.5) and Canada (2.5). 2.9 2.8 WKBRHD Interior Health Authority 2.5 2.5 2.5 Okanagan BC Canada Figure 15: Number of hospital beds (including LTC beds) per 1000 people for Canada, BC, Interior Health Authority, Okanagan, and WKBRHD, 2021 The total number of fully staffed hospital beds per 1000 people, including LTC beds in the hospital, varies for each hospital xi in the WKBRHD (Figure 16).9,22 In 2021, Boundary Hospital has the highest ratio, with 7.2 beds per 1000 people. The Okanagan is an aggregation of the following LHAs: Central Okanagan, Keremeos, Penticton, South Okanagan, Summerland, and Vernon. xi The following assumptions were made regarding hospital catchment areas: • Arrow Lakes Hospital serves the Arrow Lakes LHA • Boundary Hospital serves the Grand Forks and Kettle Valley LHAs • Creston Valley Hospital serves the Creston LHA • Kootenay Boundary Regional Hospital serves the Castlegar and Trail LHAs • Kootenay Lake Hospital serves the Kootenay Lake and Nelson LHAs x Ag ing P op u la tion s a n d Hea lth S erv ices 18 A ug us t 20 22 Hospital Beds per 1000 People including LTC Beds (#) 7.2 4.6 3.5 Boundary Hospital Arrow Lakes Hospital 2.9 Kootenay Boundary Regional Hospital WKBRHD 1.2 1.0 Creston Valley Hospital Kootenay Lake Hospital Figure 16: Number of hospital beds per 1000 people (including LTC beds) by hospital and WKBRHD, 2021 Hospital Beds per 1000 People without LTC Beds (#) It is important to note that the IHA does not consider any of its long-term care beds located in its hospitals to be part of the hospital due to the way facilities are licensed. 23 When the count of hospital beds per 1000 people are re-analyzed without long-term care beds included, the results are quite different (Figure 17, Figure 18). For example, when long-term care beds located in hospitals are omitted from the hospital bed count, the number of hospital beds in the WKBRHD drops from 2.9 to 1.4 per 1000 people and the number of hospital beds at Boundary Hospital drops from 7.2 to 0.9 beds per 1000 people. 2.2 2.1 1.9 1.7 1.4 Canada Okanagan Interior Health Authority BC WKBRHD Figure 17: Number of hospital beds (without LTC beds) per 1000 people for Canada, BC, Interior Health Authority, Okanagan, and WKBRHD, 2021 Ag ing P op u la tion s a n d Hea lth S erv ices 19 A ug us t 20 22 Hospital Beds per 1000 People without LTC Beds (#) 2.0 0.9 1.0 Boundary Hospital Kootenay Lake Hospital 1.4 1.2 1.2 Arrow Lakes Hospital Creston Valley Hospital WKBRHD Kootenay Boundary Regional Hospital Figure 18: Number of hospital beds per 1000 people (without LTC beds) by hospital and WKBRHD, 2021 See Table 7 for the hospital bed count by care setting for hospitals within the WKBRHD in 2021.23 With a total of 124 beds, the Kootenay Boundary Regional Hospital has the highest number of beds across all types of care-settings (excluding rehabilitation). The number of hospital beds by care setting and hospital have remained the same since last examined in 2015, except for the 79 long-term care beds that have been added at the Boundary Hospital.1 Table 7: Number of hospital beds by care setting for hospitals in the WKBRHD, including WKBRHD total, 2021 Intensive Mental Rehabil- Long-Term Other Hospital Obstetrics Pediatrics Care Health itation Care Acute Care Total Arrow Lakes Hospital - - - - - 16 6 22 Boundary Hospital - - - - - 79 12 91 Creston Valley Hospital - - - - - - 16 16 Kootenay Boundary Regional Hospital 6 3 4 12 - 49 50 124 Kootenay Lake Hospital - - - - - - 30 30 WKBRHD 6 3 4 12 0 144 114 283 LONG-TERM CARE BEDS When individuals are no longer able to reside at home, long-term care facilities can help. “Long-term care is for adults with complex health care needs requiring 24-hour professional care due to physical disability, or mental or behavioural conditions, including brain injuries or dementia.” 24 The number of long-term care beds within long-term care facilities in the WKBRHD is examined using available data from 2002 to 2021 (Figure 19,Table 8).1,25 Ag ing P op u la tion s a n d Hea lth S erv ices 20 A ug us t 20 22 300 Long-Term Care Beds (#) 250 200 150 100 50 0 2002 2004 2006 2008 2015 2021 Arrow Lakes Castlegar Creston Grand Forks Kettle Valley Kootenay Lake Nelson Trail Figure 19: Number of long-term care beds by Local Health Area, 2002, 2004, 2006, 2008, 2015, and 2021 Table 8: Number of long-term care beds by Local Health Area and change over time, 2002, 2004, 2006, 2008, 2015, 2021 # Long-term Care Beds Local Health Area 2002 2004 2006 2008 2015 2021 2015-2021 2002-2021 Arrow Lakes 66 38 42 38 40 44 4 -22 Six-Year Change (20152021) 10.0% Castlegar 105 105 117 117 117 121 4 16 3.4% 15.2% Creston 173 110 139 125 121 122 1 -51 0.8% -29.5% Grand Forks 96 67 67 73 80 121 41 25 51.3% 26.0% Kettle Valley Kootenay Lake Nelson 0 0 0 0 0 0 N/A N/A N/A N/A 20 20 20 19 18 20 2 0 11.1% 0.0% 188 117 35 124 131 131 0 -57 0.0% -30.3% Trail 276 156 157 156 172 171 -1 -105 -0.6% -38.0% WKBRHD 924 613 577 652 679 730 51 -194 7.5% -21.0% Difference Difference 19-Year Change (20022021) -33.3% Between 2015 and 2021, the number of long-term care beds across the WKBRHD increased by 51 beds. The beds increased in all LHAs except for Kettle Valley (where there are no long-term care facilities) and Trail (-1 bed). The highest increase in that five-year period occurred in the Grand Forks LHA (51.3%), followed by Kootenay Lake (11.1%), Arrow Lakes (10%), Castlegar (3.4%), and Creston (0.8%). The number of long-term care beds in the Nelson LHA did not change during that time. In July 2020, the Province of British Columbia announced 75 new long-term care beds for Nelson. 26 The facility will be built at the site of the former Mount St. Francis hospital and is anticipated to be completed in September 2024. The facility is being developed by Columbia Basin Trust and Golden Life Management, and will be leased and operated by IHA upon completion. 27 Ag ing P op u la tion s a n d Hea lth S erv ices 21 A ug us t 20 22 Percent Change in Longterm Care Beds (2002 to 2021) Between 2002 and 2021, the number of long-term care beds in the WKBRHD decreased by 194 beds (-21%). During this 19-year period, the number of long-term care beds increased in the Grand Forks LHA (26%) and Castlegar LHA (15.2%) (Figure 20).1, 25 There was no difference in the Kootenay Lake LHA. During the same time period, decreases in the number of long-term care beds occurred in the following LHAs: Trail (-38%), Arrow Lakes (-33.3%), Nelson (-30.3%), and Creston (-29.5%). 15.2% 26.0% 0.0% -38.0% Trail -33.3% -30.3% -29.5% Arrow Lakes Nelson Creston -21.0% WKBRHD Kootenay Lake Castlegar Grand Forks Figure 20: Change in residential care beds by LHA and WKBRHD, 2002 to 2021 Long Term Care Beds Per 1,000 People (#) Figure 21 shows the number of long-term care beds per 1,000 people by population aged 65-years old and older and total population.9, 25 The Castlegar LHA has the largest number of beds, at 39.6 beds per 1,000 people aged 65-years old and older. The Kootenay Lake LHA has the lowest number of beds per 1,000 people aged 65-years old and older at 15.5 beds. Overall, the average for the WKBRHD is 29.3 beds per 1,000 people aged 65-years old and older. When examining the highest number of beds per total population, Grand Forks LHA has the most long-term care beds, at 13.4 beds per 1,000 people. 39.6 38.1 36.7 29.8 29.3 24.2 23.4 9.1 8.1 9.2 Arrow Lakes Castlegar Creston 15.5 13.4 5.7 4.8 Kootenay Lake Nelson Grand Forks Kettle Valley Aged 65+ Total Population 8.3 7.5 Trail WKBRHD Figure 21: Long-term care beds per 1000 people (aged 65-years old and older and total population) by LHA and WKBRHD, 2021 A 2011 study conducted by the Canadian Institute for Health and Information found that 25% of seniors aged 85-years old and older have “a moderate (15%), severe (5%) or total (5%) limitation in functional capacity.” 28 Figure 22 shows the number of seniors aged 85-years and older who may have limited Ag ing P op u la tion s a n d Hea lth S erv ices 22 A ug us t 20 22 functional capacity and require care as compared to the number of long-term care beds. xii Of all the LHAs, Kettle Valley is the only area that does not have a long-term care facility to service the estimated population of persons aged 85-years old and older who may require support. However, there may be beds available in the Grand Forks LHA to cover that need. In the Grand Forks LHA, there are an estimated 84 seniors with limited functional capacity compared to the 121 beds. For the other LHAs, the estimated number of seniors requiring care is the same or less than the number of long-term care beds presently accounted for in the WKBRHD. While this specific analysis only looks at those aged 85-years old and older needing care and does not consider those needing care under that age, it provides one lens to understand the possible need versus availability of long-term care beds. 171 121 100 34 110 122 131 131 121 140 84 44 20 20 20 0 Arrow Lakes Castlegar Creston Grand Forks Seniors Aged 85+ Requiring Care (#) Kettle Valley Kootenay Lake Nelson Trail Long-Term Care Beds (#) Figure 22: Estimated population of persons aged 85-years and older requiring long-term care versus the number of long-term care beds by Local Health Area, 2021 Transportation Transportation options for those without a personal vehicle who require transportation to health services is explored. Part of the study area is serviced by BC Transit West Kootenay Transit System. 29 Figure 23 shows the main routes in the West Kootenay Transit System that link some of the communities with health facilities. Other parts of the study area are served by smaller BC Transit systems including the Boundary Transit System 30 and Creston Valley Transit system. 31 There are no BC Transit options between the Boundary region and the Kootenay Boundary Regional Hospital in Trail or from the Creston area to the regional hospital in Trail. However, Creston does have a BC Transit route that connects to Cranbrook. See Table 9 for a summary of regional transit routes and the windows available for health service appointments.xiii More details about these routes are provided below. This analysis does not consider persons under the age of 85 requiring care and assumes 25% of seniors aged 85years and older require long-term care beds in the WKBRHD, as per the CIHI study referenced. xiii It is assumed that persons accessing health services require return transit fare. Appointment windows are calculated by taking the difference in time between the first arrival and the last departure. xii Ag ing P op u la tion s a n d Hea lth S erv ices 23 A ug us t 20 22 Figure 23: BC Transit West Kootenay Transit system main routes Table 9: BC Transit West Kootenay Transit system routes, service frequencies, and health service appointment windows Route Name Appointment Location Appointment Window Daily Frequency Service Days First Departure Last Departure (return trip) 53 Edgewood - Nakusp Nakusp 6 hrs 2x Friday Only 9:25 am 3:20 pm 74 Nakusp - Nelson Nelson 6 hrs 1x Tues, Thur 8:05 am 4:05 pm 76 Kaslo - Nelson Nelson < 15 mins 1x Tuesday Only 8:30 am 10:00 am 10 Balfour - Nelson Nelson Flexible 9x Weekdays 6:58 am 8:36 pm 1 Uphill Loop (Nelson) Nelson Flexible 25x Weekdays 6:45 am 11:18 pm 72 Salmo - Nelson Nelson 3 hrs / 8 hrs 3x Tues, Thur, Fri 8:05 am 6:45 pm 99 Castlegar - Nelson Nelson Flexible 15x Weekdays 4:45 am 5:46 pm 38 Playmor Loop (Castlegar) Castlegar 5 hrs 2x Tues, Fri 8:50 am 1:55 pm 98 Castlegar - Trail Trail Flexible 7x Weekdays 6:58 am 7:51 pm 43 Fruitvale - Trail Trail Flexible 10x Weekdays 6:08 am 8:12 pm Route # Ag ing P op u la tion s a n d Hea lth S erv ices 24 A ug us t 20 22 WEST BOUNDARY TO GRAND FORKS While there are no BC Transit routes from the Boundary Transit System to the regional hospital in Trail, there are two BC Transit options to link communities in the west Boundary to Grand Forks.30 This includes one bus route that leaves Greenwood on Friday mornings at 9:10 a.m., then leaves Grand Forks for the return trip at 1:00 p.m. This route provides one three-hour window per week for medical appointments in Grand Forks. The other option is to use the Health Connections route that leaves Rock Creek at 8:30 a.m. on Tuesdays, then leaves Grand Forks at 1:00 p.m. for the return trip. This provides a second three-hour window per week for medical appointments in Grand Forks. ARROW LAKES AND SLOCAN VALLEY TO NELSON Figure 24 and Figure 25 show two main routes that support access to health services in the Arrow Lakes and Slocan Valley regions and to Nelson. It is important to note that trips using BC Transit are very limited each week. The route between Edgewood and Nakusp only travels one day per week, but it does provide an appointment window of approximately six hours in Nakusp. Figure 24: BC Transit route (#53) between Edgewood and Nakusp Route 74: Nakusp-Nelson travels two days per week and provides an appointment window of approximately six hours in Nelson. 32 This is a Health Connections route that offers service to/from Kootenay Lake Hospital by request. Alternatively, passengers can make two connections (via Route 2: Fairview to Ward and Baker, followed by Route 1: Uphill Loop to the hospital) and have a window of just under 3.5 hours for health service appointments. Figure 25: BC Transit route (#74) between Nakusp and Nelson Ag ing P op u la tion s a n d Hea lth S erv ices 25 A ug us t 20 22 NORTH KOOTENAY LAKE AND EAST SHORE TO NELSON Figure 27 and Figure 28 show the main routes to access health services between North Kootenay Lake, the East Shore of Kootenay Lake, and Nelson. BC Transit provides limited service between North Kootenay Lake, Kaslo, and Nelson. Service is available between North Kootenay Lake communities and Kaslo on Thursdays (via Route 58: Argenta Loop), with a 12-hour window to access health services in Kaslo. 33 Passengers can also access services in Nelson on Thursdays by transferring buses twice (Kaslo to Balfour via Route 76, and Balfour to Nelson via Route 10), but there is no return fare available that day. Direct service from Kaslo to Kootenay Lake Hospital is available on Tuesday mornings (via Route 76). 34 By transferring routes, there are multiple options for passengers to travel between Kaslo and Nelson on Figure 26: BC Transit route (#76) details for direct route Tuesdays and Wednesdays. There is also a Health between Kaslo and Nelson Connections route between Kaslo and Kootenay Lake Hospital available upon request. 35 On a daily basis, passengers from the East Shore can ride the free Kootenay Lake ferry, 36 followed by taking the BC Transit bus to Nelson (via Route 10 to downtown and transferring to Route 1: Uphill Loop to get direct service to Kootenay Lake Hospital). 37, 38 This offers a nearly 13-hour window to access health services in Nelson, with the last bus arriving in Balfour at 9:30 p.m., in time for the 9:40 p.m. sailing of the ferry back to Crawford Bay. The East Shore Transportation Society offers service upon request. Passengers can arrange transportation by emailing estsbus@gmail.com or calling 250-5518800. 39 BC Transit also offers the handyDART transit service for persons with disabilities. 40 Passengers can register for service in Nelson, available weekdays from 7:30 a.m. to 4:00 p.m. Figure 27: BC Transit route details for route with connections between Kaslo and Nelson Ag ing P op u la tion s a n d Hea lth S erv ices 26 A ug us t 20 22 SALMO TO NELSON As show in Figure 28, BC Transit offers service from Salmo and Ymir to Nelson on Tuesdays, Thursdays, and Fridays. 41 This is a Health Connections route with between three and eight-hours available for health service appointments in Nelson. 42 Passengers must transfer buses (via Route 1: Uphill Loop) to get to Kootenay Lake Hospital.38 Figure 28: BC Transit route (#72) details for route with connections between Nelson and Salmo CASTLEGAR TO NELSON Figure 29 shows the transit route between Castlegar and Nelson. 43 This route, the Kootenay Connector, is available Monday to Saturday, and departs from the Selkirk College campus. There is a transit exchange at the Castlegar and District Community Complex, which connects several routes from Castlegar and surrounding area (e.g., Robson, Ootischenia) to the stop at Selkirk College. Passengers from Pass Creek and Crescent Valley can also connect at the Playmor Junction Park and Ride. 44 Connecting to Route 1: Uphill is needed to get to Kootenay Lake Hospital.38 On the last return ride of the day, there is a one-hour delay at the Ward and Baker stop before the bus leaves Nelson for Castlegar. Excluding this delay, there is a window of eight-hours to access health service appointments between the first arrival in Nelson and the last departure for Castlegar. Figure 29: BC Transit route (#99) details between Castlegar and Nelson Ag ing P op u la tion s a n d Hea lth S erv ices 27 A ug us t 20 22 MULTIPLE COMMUNITIES TO TRAIL Figure 30 shows the main routes to access health services in Trail from Castlegar, Rossland, and Fruitvale. Buses travel between Castlegar and Trail on weekdays (via Route 98: Columbia Connector). 45 Passengers can use the transit exchange at Cedar Street and Spokane Street to connect to Route 44: Sunningdale/Hospital Loop, which stops at the Kootenay Boundary Regional Hospital. 46 This option offers a window of just under eight-hours to access health services at the regional hospital. There is also one Columbia Connector bus that departs from the hospital at 3:20 p.m. and travels directly to Castlegar. BC Transit also offers the handyDART transit service for persons with disabilities.40 Passengers can register for service in the Columbia Zone (Castlegar and Trail), available weekdays from 8:00 a.m. to 4:00 p.m. Figure 30: BC Transit route details between Castlegar, Transit is available between Rossland and Trail (via Route 46: Rossland) on weekdays. 47 There is a 1.5 hour Fruitvale, and Rossland to Trail wait at the Cedar and Spokane transit exchange before passengers can transfer to the Sunningdale/Hospital Loop.46 Even taking that delay into account, this option offers a window of over eight-hours to access health services at the regional hospital. There is weekday transit service available between Fruitvale, Montrose, and Trail. 48 Passengers travelling to Trail (via Route 43: Glenmerry/Fruitvale) can use the transit exchange at Cedar and Spokane to connect to the Sunningdale/Hospital Loop, which stops at the regional hospital.46 This option provides a window of over 12-hours to access health services at the hospital. In a recent announcement, Nelson CARES has launched a medical services bus service between Nelson and Trail. This service is built around the Kootenay Boundary Regional Hospital’s dialysis schedule. It leaves Nelson at 6:30 a.m., with the return trip leaving Trail at 1:00 p.m. The route takes place on Tuesday, Thursday, and Saturdays for a fee of $35. The bus picks up passengers at their home and be arranged by calling 778-426-5247. 49 Multiple transit connections are needed to get to the Kootenay Boundary Regional Hospital from afar. For example, passengers from Kaslo can access health services in Trail on Tuesdays, if they depart from Kaslo at 8:30 a.m. and catch four connections to get to the hospital for 11:30 a.m. There is a window of just over 2.5 hours to access health services, before the bus departs from the hospital at 2:24 p.m. After catching another five connections, arrival in Kaslo occurs at 6:35 p.m. Conversely, transit riders from Nakusp would be unable to access services at the regional hospital in Trail. In total, there are 11 connections required to get to the hospital and even the earliest arrival at the hospital (2:12 p.m.) would prevent passengers from catching the necessary return fare. Ag ing P op u la tion s a n d Hea lth S erv ices 28 A ug us t 20 22 Conclusion According to the 2021 Census the population of the WKBRHD is getting older. When examined by fiveyear age cohorts, the largest percentage of the total population is aged 60- to 64-years (9.1%) and 65- to 69-years (9.0%). Over the five-year period between the 2016 and 2021 Census years, the largest population increases were seen in the 70- to 74-years age cohort (+34.1%) and the 75- to 79-years age cohort (+22.2%). Overall, persons aged 65-years old and older account for 26.7% of the total population of the WKBRHD in 2021. This is a 17.4% increase between 2016 and 2021. In 2015, the population aged 65-years old and older comprised 18% of the total population. This is projected to increase to 28% of the total population by 2025 and 30% by 2030, before leveling off for the ensuing decade. This trend is predicted to be similar at the LHA level. In 2040, the cohort aged 65years old and older is projected to account for 54% of the total population of the Kettle Valley LHA and 51% of the total population of the Kootenay Lake LHA. These demographic changes may result in differing health service needs across the WKBRHD. Currently, some diagnostic services and specialized treatments are only available in select communities. The Kootenay Boundary Regional Hospital in Trail is the only facility in the region offering nuclear medicine diagnostic services and MRI. CT scans can only be completed at Kootenay Lake Hospital in Nelson and in Trail. Dialysis is only available in Creston, Grand Forks, and Trail. As the population of the region changes, so too will the service needs. The availability of hospital and long-term care beds varies across the region. As of 2021, there are 1.4 hospital beds per 1000 people (excluding long-term care beds) in the WKBRHD, but that number decreases when examined by hospital. The Boundary Hospital has the lowest number of hospital beds per 1000 people (excluding long-term care beds), at 0.9 beds. Between 2015 and 2021, the total number of long-term care beds in the WKBRHD increased by 51 beds (+7.5%). The 75 new long-term care beds in Nelson will be a welcome addition for long-term care in the WKBRHD. There are some limitations to using transit for transportation to health services in the WKBRHD. The region’s primary public transit provider is BC Transit’s West Kootenay Transit System, but there are no connections to the Boundary Transit System (i.e., Grand Forks) or the Creston Valley Transit System (i.e., Creston). While most of the communities served by the West Kootenay Transit System have transit options to access health services, some areas have limited service (e.g., Arrow Lakes, Slocan Valley, North Shore of Kootenay Lake). There are handyDART services available for persons with disabilities, and three Health Connections routes across the region. In one unique example, communities on the East Shore of Kootenay Lake can utilize transportation services provided by the East Shore Transportation Society. This report provided an overview of population demographics and health services in the WKBHRD. This information can be used to support evidence-based decision-making when evaluating the infrastructure in place to accommodate the region’s changing population demographics. Ag ing P op u la tion s a n d Hea lth S erv ices 29 A ug us t 20 22 References Woodbeck, K., & Parfitt, I. (2015). Aging populations and health services in the West Kootenay Boundary Regional Hospital District. Selkirk College Geospatial Research Centre. Selkirk College. 2 Statistics Canada. (2022). 2021 Census program – Census of Population. https://www12.statcan.gc.ca/censusrecensement/index-eng.cfm 3 ESRI. (n.d.). Network analysis coverage. https://doc.arcgis.com/en/arcgis-online/reference/networkcoverage.htm 4 Community Map of Canada. (2022). Topographic / topographie [Data set]. https://www.arcgis.com/home/item.html?id=98652eb8458a464fa95feb9bd812b29a 5 BC Stats. (2016). Current census subdivision boundaries [Data set]. BC Data Catalogue. https://catalogue.data.gov.bc.ca/dataset/current-census-subdivision-boundaries 6 BC Ministry of Health. (2019). Local Health Area boundaries [Data set]. BC Data Catalogue. https://catalogue.data.gov.bc.ca/dataset/local-health-area-boundaries 7 GeoBC. (2003). BC major cities points 1:2,000,000 (digital baseline mapping) [Data set]. BC Data Catalogue. https://catalogue.data.gov.bc.ca/dataset/bc-major-cities-points-1-2-000-000-digital-baseline-mapping 8 Statistics Canada. (2019). 2016 Census Profile. https://www12.statcan.gc.ca/census-recensement/2016/dppd/prof/index.cfm?Lang=E 9 BC Stats. (2022). Population estimates & projections for British Columbia. https://www2.gov.bc.ca/gov/content/data/statistics/people-population-community/population/populationprojections 10 Interior Health Authority. (2022). Find a location. https://www.interiorhealth.ca/locations 11 Interior Health Authority. (2022). Slocan Community Health Centre emergency department resuming 24-hour service. https://www.interiorhealth.ca/media/slocan-community-health-centre-emergency-department-resuming24-hour-service 12 ImmunizeBC. (2020). Kiro Wellness Centre. https://immunizebc.ca/public-health-unit/kiro-wellness-centre 13 Interior Health Authority. (2022). Find a service. https://www.interiorhealth.ca/services 14 Browne, A. (2005). Issues affecting access to health services in northern, rural and remote regions of Canada. University of Northern British Columbia. https://www2.unbc.ca/sites/default/files/sections/northernstudies/issuesaffectingaccesstohealthservicesinnorthern.pdf 15 GeoBC. (2016). First responders [Data set]. BC Data Catalogue. https://catalogue.data.gov.bc.ca/dataset/firstresponders 16 Interior Health Authority. (2022). Emergency health services. https://www.interiorhealth.ca/services/emergency-health-services 17 Regional District of Central Kootenay. (2022). Civic addresses [Custom data set]. 18 Interior Health Authority. (2022). Pulmonary diagnostics. https://www.interiorhealth.ca/services/pulmonarydiagnostics 19 Interior Health Authority. (2022). Radiology (X-ray). https://www.interiorhealth.ca/services/radiology 20 Interior Health Authority. (2022). Ultrasound (sonography). https://www.interiorhealth.ca/services/ultrasoundsonography 21 Interior Health Authority. (2022). Nuclear medicine. https://www.interiorhealth.ca/services/nuclear-medicine 22 Canadian Institute for Health Information. (2022). Number of hospital beds staffed and in operation: Breakdown by care setting, 2020–2021 [Data set]. https://www.cihi.ca/en/access-data-and-reports/data-tables 23 Buhler, H. (2022, June 1). Long-term care beds [personal communication]. 24 Interior Health. (n.d.). Long-term care. https://www.interiorhealth.ca/health-and-wellness/child-communityand-home-care/long-term-care 25 Office of the Seniors Advocate of British Columbia. (2021). Long term care directory – information and reports. https://www.seniorsadvocatebc.ca/long-term-care-directory/ 26 BC Ministry of Health. (2020). Interior getting 495 new long-term care beds. BC Gov News. https://archive.news.gov.bc.ca/releases/news_releases_2017-2021/2020HLTH0220-001270.htm 27 BC Ministry of Health. (2022). Construction starts on 75 new long-term care beds in Nelson. BC Gov News. https://news.gov.bc.ca/releases/2022HLTH0166-001119 1 Ag ing P op u la tion s a n d Hea lth S erv ices 30 A ug us t 20 22 Canadian Institute for Health Information. (2011). Health care in Canada, 2011: A focus on seniors and aging. https://www.homecareontario.ca/docs/default-source/publications-mo/hcic_2011_seniors_report_en.pdf 29 BC Transit. (2022). Welcome to the West Kootenay transit system. https://www.bctransit.com/westkootenay/home 30 BC Transit. (2022). Boundary transit system. https://www.bctransit.com/boundary/home 31 BC Transit. (2022). Welcome to the Creston Valley transit system. https://www.bctransit.com/crestonvalley/home 32 BC Transit. (2022). Health connections: Nakusp / Nelson. https://www.bctransit.com/west-kootenay/schedulesand-maps/health-connections/nakusp-nelson 33 BC Transit. (2022). Route 58: Kaslo-Argenta. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=58 34 BC Transit. (2022). Route 76: Kaslo-Nelson. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=76 35 BC Transit. (2022). Health connections: Kaslo / Nelson. https://www.bctransit.com/west-kootenay/schedulesand-maps/health-connections/kaslo-nelson 36 Government of BC. (2022). Kootenay Lake Ferry. https://www2.gov.bc.ca/gov/content/transportation/passenger-travel/water-travel/inland-ferries/kootenay-lakeferry 37 BC Transit. (2022). Route 10: North Shore. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=10 38 BC Transit. (2022). Route 1: Uphill. https://www.bctransit.com/west-kootenay/schedules-and-maps/routeoverview?route=1 39 East Shore Transportation Society. (n.d.) Information. https://eastshoretransit.com/information/ 40 BC Transit. (20220. handyDART. https://www.bctransit.com/west-kootenay/schedules-and-maps/handydart 41 BC Transit. (2022). Route 72: Salmo-Nelson via Ymir. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=72 42 BC Transit. (2022). Health connections: Salmo / Nelson. https://www.bctransit.com/west-kootenay/schedulesand-maps/health-connections/salmo-nelson 43 BC Transit. (2022). Route 99: Kootenay connector. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=99 44 BC Transit. (2022). Route 38: Playmor via Pass Creek. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=38 45 BC Transit. (2022). Route 98: Columbia Connector. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=98 46 BC Transit. (2022). Route 44: Sunningdale. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=44 47 BC Transit. (2022). Route 46: Rossland. https://www.bctransit.com/west-kootenay/schedules-and-maps/routeoverview?route=46 48 BC Transit. (2022). Route 43: Glenmerry/Fruitvale. https://www.bctransit.com/west-kootenay/schedules-andmaps/route-overview?route=43 49 Metcalfe, B. (2022). Nelson CARES launches medical bus service to Trail. https://www.castlegarnews.com/news/nelson-cares-launches-medical-bus-service-to-trail/ 28 Ag ing P op u la tion s a n d Hea lth S erv ices 31 A ug us t 20 22 301 Frank Beinder Way, Castlegar, BC V1N 4L3 phone 250.365.7292 toll free 1.888.953.1133 email info@selkirk.ca selkirk.ca