Elderly and their caregivers need support to remain at home

At the Health Council of Canada, we’re developing a report on home and community care for seniors in Canada – a topic of national interest in the current media, most recently discussed in CBC’s Metro Morning.radio show.

We’re finding that the majority of care for seniors who are disabled, have multiple chronic conditions, or dementia is provided by family and friends. Not surprisingly, as the needs of the senior increase, so does caregiver distress. Although each province and territory offers publicly-funded home care services, eligibility, types of services, and hours of care vary across the country. 

We’re speaking to family caregivers to add real-life stories to our report. What we’re hearing is that home care services (primarily provided by personal/home support workers) are helpful, but often insufficient. In some cases even the maximum allotment (14 hrs/week in one province) is not enough to be able to run necessary errands and rush back before the time elapses.

In addition, night care can be exhausting if the care recipient wakes frequently. More opportunities for caregiver respite provide much needed breaks so that caregivers can carry out their responsibilities while maintaining their own health and wellbeing. Those who can afford to fill the gap, do so by purchasing additional services. Those who can’t may rely on occasional help from family and friends, but more often will become overburdened and distressed, both physically and mentally.

Shifting resources to home care can help seniors stay healthier in their homes for longer. Research shows how home care services can help alleviate pressures on the system by avoiding hospitalizations and delaying entrance into long-term care homes – a subject of interest to us, as are the specific practices and programs that are making a difference. Supporting caregivers and allowing for more opportunities for respite ensures that care recipients can maintain a desirable quality of life at home and their caregivers can remain healthy and avoid becoming hospitalized themselves.

I will be presenting on these and other issues at the Canadian Home Care Association Summit on October 24, 2011.

Look for our full report on home and community care for seniors in 2012!

Shilpi Majumder, Policy Lead, Health Council of Canada

Key Words: Home and Community Care, Primary Health Care

Patient Engagement Grows From Trust

Arlene Hache is the Executive Director of the Centre for Northern Families in Yellowknife, Northwest Territories. The Centre offers a broad range of services that support multi-stressed and marginalized families.  She is well known across the North as an advocate for social change and is a founding partner in the development of therapeutic programs and in-home family support services designed to support families recovering from trauma related to colonization and ongoing violence.  Arlene was awarded the Order of Canada for her work in the North in 2009.

As a habitual “no show” patient, I listened to doctors, nurses and health planners in community meetings try to grapple with the challenges I and others pose in terms of lost time and money when we fail to keep medical appointments.  They appeared to be frustrated and puzzled.  I was surprised, not realizing that my personal decisions had such systemic repercussions when they were simply based on how I felt that particular day.  All of us in the meetings were committed to improving the health system and its outreach to marginalized populations.  In response to the discussion, I reflected on the underpinnings of my own behaviour and recalled the numerous conversations I had had with women over the years about their experiences interacting with the health care system. 

For me, it really boiled down to the residual dregs of a long-time pattern of self-hate that revealed itself through sporadic attention to my health.  Other women, particularly those from small, northern communities who stayed at the emergency shelter exhibited similar responses.  Other factors that created barriers for First Nations and Inuit women included low-literacy levels, English as a second language, cultural differences and a lack of trust or comfort with mainstream service providers.  It was these needs that gave impetus to the establishment of a medical outreach clinic at the family resource centre in Yellowknife through a partnership with the local college, a medical clinic and the regional health authority.  The clinic was held one day a week and offered on a drop-in basis.  It was open to the community, but was situated in the same building as the emergency shelter for women who were homeless.  It was also used as the pilot site to introduce the doctor and nurse practitioner team in the North. 

The outcomes were interesting and the rewards were instantaneous.  The doctor and nurse practitioners fit into the chaotic nature of the family resource centre like a glove.  On the other hand, substitutes not so much.  We learned it takes a particular kind of personality to work successfully in a community-based setting.  People from the general public mingled with women from the emergency shelter in the kitchen as they drank coffee and ate bannock.  At first, both groups appeared to be tentative with each other, but as time passed a real familiarity and comfort level developed.  We learned community-based services create an opportunity to build inter-cultural understanding and acceptance.  The 24 to 30 women who stay in the shelter attended the clinic on a consistent basis.  One elder who didn’t speak English and had been limping for several years from an unattended injury was finally diagnosed and got hip surgery.  Women with mental health and addictions received immediate support with appropriate referrals so incarceration rates were reduced.  We learned that locating services where people are, in an environment that they trust, removes barriers.  It has been five years since the clinic opened.  It has been a tremendous experience.  About 45 people still come to the clinic each day.

Key Words: Access to Care in the North, Patient Engagement, Primary Health Care

It’s About Time

Eric Grief, M.D. is a family physician in Brampton and Thornhill, Ontario. He has written a book called Get Diagnosed Fast. His book can be accessed at www.publishamerica.com.

This bulletin by the Health Council of Canada highlights for us the factors contributing to whether or not patients feel ‘engaged’ in their medical care. What the survey results make apparent is how vital the time factor is in motivating Canadians to spend more energy safeguarding their health.

Time is brain when it comes to a brain attack (stroke) treatment and time is muscle in the algorithm for the treatment of a heart attack. So what does time represent in terms of the medical visit that millions of Canadians participate in annually? It turns out that time means engagement. People prefer that their medical doctor spends enough time with them—listening to their health concerns, organizing their symptoms and answering health-related questions and explaining treatment options. This time investment pays off dividends in the yield of ‘patient engagement.’

Unfortunately, medical doctors’ time is at a premium. This means that to ensure adequate time with every patient, some patients have to wait or else access medical care in a circuitous route: emergency departments, urgent access medical clinics, or clinic shopping that may involve out-of-pocket expenses.

Medical doctors and patients alike prefer to have health problems diagnosed and treated quickly. A fast and timely diagnosis leads to fewer backlogs, less suffering, and often results in improved patient adherence to treatment plans. Canadians can help their medical doctors at each visit by preparing in advance -  by rehearsing their concerns, negotiating their agenda their doctor, and asking questions. If they are not satisfied with the care, then Canadians need to follow up with the same medical doctor and explain their concerns forthrightly. Often, this latter strategy sends the message that people are not just a health complaint but rather they are humans with emotions who happen to have a health concern.

Medical colleges are aware that time is a factor in patient care. Ordering expensive tests does not replace one-on-one communication with patients... nor is it likely to replace doctors any time soon. Solving the time crunch requires continued vigilance from Canadians to communicate efficiently when visiting their doctor and from medical colleges to negotiate adequate payment schedules to reflect the time requirements that exist to deliver ‘timely’ care.

Patients engaged in their medical care ... it’s about time.

Key Words: Primary Health Care, Patient Engagement

Patients want to be part of the solution

Archie Allison is a retired health care manager who lives in South Surrey/White Rock, BC. He and his wife Sheila are active volunteers with the Patient Voices Network, a province-wide initiative led by ImpactBC in collaboration with Patients as Partners, Ministry of Health in British Columbia.

I am pleased and inspired to see that you have included a section on patient-provider relationships in this document. As a Patient Partner for the Patient Voices Network (PVN) I have had, in the course of just one year, numerous opportunities to “have a voice” at the individual level, the community level and the system level.  In the process I have shared my experiences as a patient in a collaborative and welcoming atmosphere where providers and patients have grown and learned together. 

One of the most satisfying opportunities was being a volunteer facilitator for a PVN pilot program called “Talking with Your Doctor”. It’s an interactive workshop that provides a framework for the responsibilities listed in the “What can patients do?” section of the document. These workshops are consistently received by patients with open arms. They are eager to learn self-management skills and empower themselves when it comes to their own care.

Under “What can physicians do?” I see you are reporting that 75% of physicians state that increasing patient expectations are placing more demands on their time.  What physicians are seeing as increasing patient expectations may actually be communication issues.  When there is clear communication by both physicians and patients the relationship is not only more satisfying, it is very likely less time consuming. 

My own experience with my doctor has impacted my belief in this process.  Once I recognized my specific responsibilities as an active self manager, my relationship with my doctor evolved into a truly satisfying partnership.  By ensuring I clearly communicate the purpose of my visit, the symptoms that concern me and any specific questions I have, my appointments are well within the allotted 10 – 15 minutes, despite the number of chronic conditions I have.

Patients want to be part of the solution. I believe that supporting patients to learn self-management skills and to become active partners in our own health care is key to system transformation and sustainability.

To read the full report, visit www.healthcouncilcanada.ca/patient.

Key Words: Primary Health Care, Patient Engagement

Guest blogger Gail Starr on Patient Engagement

Gail Starr of Richmond, BC, is an advocate for injured workers. He is a member of the Patient Voices Network, a province-wide initiative led by ImpactBC in collaboration with Patients as Partners, Ministry of Health in British Columbia.

I’ve always thought of myself as an “engaged” patient, although I may not have used the term. My family doctor and I have been collaborating on my health care since I started visiting her in 1994.  I can even recall sending her a thank you note for helping me look after my health.

Decision-making and ongoing cooperation are areas where my doctor and I would score very highly. We listen to each other, weigh options and likely results, and agree on most things. She has supported me quietly but firmly in making some lifestyle changes I agreed I needed to make. When our opinions differ, there is mutual respect.

But reading this report has helped me raise the bar on myself. I saw some measures of engagement where my doctor and I don’t necessarily score at the top of the scale. I’m preparing this week for an annual check-up, and I now have new ideas for getting more out of that.

Upon reflection, I realize that I almost always have enough of her time. She is especially generous with it when it comes to “big” issues. It occurred to me, however, that I do not know how to get in touch with her – or a substitute for her – if I need medical advice outside office hours. I’ve never tried phoning for anything other than an appointment, and they are always available reasonably soon. But “after hours” assistance – or telephone advice during office hours?  I don’t know what I would do.  I should find out.

I also realized that I have been unduly passive in the face of long delays in seeing some specialists. It is hard to know who can be approached to find a solution, but I have resolved to pursue the matter when consultation is delayed unreasonably.

But all in all, I’m proud to say that this report makes my relationship with my doctor look good. . . with healthy room for improvement.

Read the full report, “How Engaged are Canadians in their Primary Care?” at www.healthcouncilcanada.ca/patient.

Key Words: Primary Health Care, Patient Engagement

How Engaged are Canadians in their Primary Care?

Do you have enough time during visits with your regular doctor?
Can you always ask questions about your recommended treatment?
Do you feel involved in decision-making about your care?

If you answered yes to these questions, you are among half of Canadians who can be considered engaged in their health care. These Canadians often take an active role in maintaining their health and are often more satisfied with their care.

But what about the remaining half of Canadians who don’t feel as involved in their care? We wanted to find out what enables Canadians to be more engaged in their care and what the barriers are.

In the upcoming Canadian Health Care Matters Series Bulletin 5: How Engaged are Canadians in their Primary Care? we will assess the enablers and outcomes of patient engagement

Using international survey data from both the patient and physician perspectives, the bulletin will review current findings from Canada and other countries on the patient-provider relationship.

Read the full report on September 22, 2011 at www.healthcouncilcanada.ca, and check back to this blog for guest entries from the patient and physician perspectives.

Sukirtha Tharmalingam, Senior Policy Analyst, Health Council of Canada

Key Words: Primary Health Care, Patient Engagement

Think big, start small, act now: Tackling indicator chaos

The health quality councils of Saskatchewan, Alberta and British Columbia, in partnership with the Canadian Patient Safety Institute recently released their proceedings report from the national summit held in May to discuss health indicator reporting in Canada. We participated in the summit, along with other national organizations including the Canadian Institute for Health Information and Statistics Canada, Accreditation Canada, provincial health quality councils, provincial and territorial ministries of health and academic leaders in health indicator development and reporting.

The report summarizes the outcomes from the meeting, which were to bring together stakeholders involved in health indicator reporting from across Canada to work towards a national alignment of health indicator reporting priorities.  The report acknowledges the vast expertise in health indicator reporting in Canada and the capacity that exists to measure health system performance.  However, in the words of one of the organizers, Gary Teare, the way forward is “… to step back and try to understand how to connect the expertise and use it to the best advantage across the country”.

For more information, read the full report.

Susan Brien, Policy Lead, Health Council of Canada

Shooting the video, “Culture is Good Medicine”

The day I flew to Halifax to shoot our video on Aboriginal maternal and child health, Hurricane Irene was blasting up the eastern seaboard. Was this project going to be cancelled by Mother Nature? Happily, my flight suffered nothing worse than heavy rain and winds.

After landing, Halifax cameraman/editor, Duncan Moss and I split a soggy five-hour drive to Cape Breton Island. The next morning, bright and sunny, we interviewed Charlotte Jesty, Coordinator of the Unama'ki Maternal & Child Health Program in the town of Eskasoni. Charlotte expressed great pride in their initiative across the island - a program which combines western medicine and practices and the Mi’kmaq culture.

Afterward, along with her colleagues at the Eskasoni Community Health Centre, we shared some truly Canadian culture – pizza! Next, we met the stars of our video, Charlotte Christmas and her fifteen-month old daughter, Elizabeth. Charlotte gave us perspective on how the program helps moms like her be better parents and keep the Mi’kmaq language alive for future generations.

What remained was to shoot “B-reel” - general footage of Eskasoni. But it wasn’t until we returned to our hotel that our hosts gave us the idea for our opening shot – a beautiful Cape Breton sunrise. So, the next morning at 5 a.m., Duncan and I set up for a time-lapse sequence of the day’s beginning. Once we got the shot, it was back to Halifax where we put it all together in the editing suite.

After weeks of rewrites and organization, that final part of the creative process had a special sweetness. I hope you enjoy it as much as we enjoyed producing it.

You can watch the video on our youtube channel.

Terry Glecoff, Media Specialist, Health Council of Canada

Our cameraman and editor, Duncan Moss, hard at work on the video 

Duncan shooting Charlotte Christmas and her daughter Elizabeth

Health Innovation Challenge launched today

We’re putting the next generation of leaders in health to the test with our third annual Health Innovation Challenge. The Challenge launches today, and we’re asking students to identify innovative policies or practices in Canadian health care and let us know why the innovations are working and how they could benefit the whole country.

Competing students will prepare a written submission of up to 2,500 words answering one of these questions:

Health Policy

How are innovations in public policy having a positive impact on health care in Canada or abroad? Describe a ground-breaking public policy initiative that is changing practices, outcomes or perceptions of health care.

OR:

Health Practice

How are new practices having a positive impact on the delivery of health care in Canada or abroad? Describe leading edge research, technology or processes that are changing practices or outcomes of health care.

Winners will get $1,000 and a chance to apply for a paid internship at the Health Council of Canada office in Toronto.

For all the details and to find out how to enter, check out the contest Facebook page at www.facebook.com/healthinnovation.

Key Words: Health Council of Canada, Innovative Practices