Webinar: Canadian Home Care Priorities for Seniors: What Can We Learn From Australia?

On Wednesday, May 9, 2012 at 10:30AM (EDT) John G. Abbott, CEO of the Health Council of Canada will host a panel of guests including:

• Jeff Fiebig, Manager, Program Development of the ACH Group in Adelaide, Australia
• Pamela Fralick, President and Chief Executive Officer of the Canadian Healthcare Association
• Nadine Henningsen, Executive Director of the Canadian Home Care Association.

Join us and add your voice to the conversation with your questions on this important topic. The webinar will expand on many of the issues presented in our recent report, Seniors in need, Caregivers in distress: What are the home care priorities for seniors in Canada?

Date: Wednesday, May 9, 2012

 

Time: 10:30 AM EDT (GMT – 4:00)

 

To register for the online event, click here, then click on “register”. On the registration form, enter your information, and then click "Submit." You will receive a confirmation email message with instructions on how to join the event once your registration is approved.

 

Family - the invisible backbone of the health care system

Nadine Henningsen is the Executive Director of the Canadian Home Care Association.

Home is the place that in so many ways defines who we are; it is, in the words of the Pulitzer prize winning journalist John Ed Pearce “...a place you grow up wanting to leave, and grow old wanting to get back to.“ How true this is, especially when we think about aging and how we want to live out our lives – independently and with dignity; surrounded by our loved ones in the comfort of our home. Thanks to the great strides made in the development and growth of home care programs across Canada, this vision is very much a reality.

The aging process inevitably brings both physical and mental challenges as one must often deal with a number of chronic diseases as well as complex emotional situations such as the death of a spouse or loved one. Although publicly funded home care programs are essential to providing vital clinical and social supports to seniors, an integral part of aging at home is the involvement of family caregivers. Family caregivers – a spouse, children, siblings and even friends and neighbours - are the invisible backbone of the health care system. Without family caregivers, receiving care in the home would not be a viable option.

Congratulations to Health Council of Canada for their recognition and sound recommendations for both home care and family caregivers. We look forward to working with the Council and governments across Canada to advance home care as a vital component of an integrated health care system that is responsive to all Canadians.

Centre Stage: Where Seniors and Caregivers Belong

Shirlee Sharkey is president and chief executive officer of Saint Elizabeth, a leading national health care organization. Saint Elizabeth delivers five million health care visits annually and employs almost six thousand people providing nursing, rehabilitation, personal support, research and consulting services.

Home care is in the spotlight as economics, aging and consumerism push care closer to home. A timely new report from the Health Council of Canada showcases a range of examples, from across Canada and internationally, of promising approaches in home care.  I agree we need to broaden the reach of these positive advances, shifting from pockets of innovation to more mainstream implementation.  At the same time, we must use the opportunities for care in the home to help the entire system leap forward by optimizing the strengths of individuals, families and communities. 

A quick win might be to simply increase funding, expecting more of the same to provide better results. And it will – to some degree. Existing home care services encompass everything from highly complex care, such as home dialysis and chemotherapy, to chronic disease management, to personal and home support. More funding will enable these services to reach more people.  However, this approach will keep us responding to people and their needs reactively, often after a life-changing event takes place, rather than proactively filling the gaps in an individual’s health journey. Other countries conduct needs assessments with seniors in their homes and communities after the age of 75 in order to get ahead of the care curve.

For optimal investment we need to shift the lens from providers to seniors and their families, bringing health care to where they are.  The greatest value of care in the home will come from supporting people where and how they need us, throughout their lives. 

To achieve this vision we need to deeply understand the health and life circumstances of individual seniors and their caregivers.  Only then can we offer choices that best suit their needs, preferences and environment.  Seniors and family caregivers will take centre stage, while we step back to provide the props and backdrops.

Home Care – we need more action, fewer excuses

Susan Eng is Vice President for Advocacy at CARP, the national, non-partisan, non-profit organization committed to advocating for social change that will bring financial security, equitable access to health care, and freedom from discrimination for all Canadians as we age.

The health care system serves us best when it helps us live our lives how and where we want even when we have medical challenges. People want to stay at home as long as possible and need comprehensive community-based care to keep them out of institutions. A bonus in these times of austerity is that the system stands to save billions.

Politicians tout Aging at Home so much that most of us think that it’s in place already. This Health Council report reminds us that it most assuredly is not. There is a patchwork of services – varying degrees of access and standards – across the country. Even when home care is available, there is a cap on services. So family caregivers are left to pick up the slack or people have to move into institutional care.

Last month’s Ontario budget moved forward on Aging at Home with increased funding for community-based care while holding other budgets down. But more is needed. CARP has long called on governments to facilitate a seamless continuum of care starting from an acute episode or diagnosis and continuing to end of life.

Post acute home care was declared the next essential service in the 2004 Health Accords, and billions were put on the table for it; that this is so far from being realized almost a decade later is a national shame.

Living out one’s days in the safety and comfort of one’s own home should be taken for granted. With all the research and technology available to us today, there are no more excuses.

"Home is where the heart is."

Dr. John Hirdes was commissioned to provide data analyses of Canadian and international RAI-HC data for our report. Dr. Hirdes is a Professor in the School of Public Health and Health Systems at the University of Waterloo and a senior Canadian Fellow and Board Member of interRAI, an international consortium of researchers from 29 countries.

It’s a saying that often comes to mind for travelers who have become weary of their time away. The familiar sights and sounds of home, the comfortable bed, and the companionship of family and friends  - all take on greater importance with prolonged absence. For older Canadians, returning home from hospital or staying at home rather than entering long term care is an almost universal preference.

More than ever, home care is an essential service. It acts as a hub connecting primary care, acute care, and long term care settings. Home care professionals provide a broad array of services that help older Canadians live as independently as possible despite health challenges resulting from aging and its associated illnesses.  For Canada’s health care system to be sustainable, home care needs to succeed.

 

The Health Council of Canada’s new report entitled, Seniors in Need, Caregivers in Distress, sheds new light on the experience of home care clients and their caregivers. For the first time, we have a coast-to-coast view of home care. While we often think about advances in health care as being driven by new technology, the emergence of high quality evidence is one of the most important innovations in home care that Canadians generally don’t know about. The implementation of a standardized health assessment across the country provides insights into home care that were unimaginable less than two decades ago. Eight Canadian provinces have adopted a common home care assessment system developed by interRAI (www.interRAI.org) to evaluate the strengths, preferences and needs of home care clients. When compiled at the regional and provincial levels, this information can provide vital insights to variations in the patterns of care in response to needs. The Health Council of Canada report is the first national study to use data from the first five provinces that have adopted this system.

 

What emerges is a picture of heroism by family members and friends whose commitment to care often determines whether older Canadians can stay at home. Many caregivers work the equivalent of a full-time job to help seniors with serious physical and mental health concerns. In fact, about three quarters of the care that frail older Canadians get at home comes from their family members.

 

The paid services offered by home care agencies throughout the country are vital supports to seniors and their family members, but the level of care being provided is simply too low to meet their needs. According to the Canadian Institute of Health Information’s (CIHI) 2007 report, home care expenditures grew rapidly in the 1990s, but then flat-lined between 1998 and 2004. Canadian caregivers need more help to support their family members at home. Putting more priority on funding for home is the right thing to do because it helps Canadians achieve what they want, but it is also a sound investment. Home care costs a fraction of what we spend on nursing homes. A day in hospital costs more than two weeks of home care for older Canadians.

 

Health care decision-makers have difficult choices to make at the best of times. When we face economic constraints, the choices become tougher and have greater impact. Canadian caregivers already do most of the heavy lifting in home care. The best way to save money in the expensive parts of the health care system is to respond to the calls for help from caregivers and home care clients in the greatest need

Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada?

On April 16^th, the Health Council of Canada will be releasing our report, Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada?

The use of home care services has notably increased in the last decade. This report takes a deeper look at the seniors who are receiving home care, the family caregivers who are lending support, and the overall challenges of home care in Canada.

Most seniors live at home and want to stay there as long as possible.  In this report, we provide a snapshot of seniors receiving home care in five regions across Canada (the Yukon, Ontario, Nova Scotia, the Northern Health Authority in British Columbia, and the Winnipeg Regional Health Authority in Manitoba).

Along with our analyses of home care data, we feature caregiver stories that take a poignant look at the struggles seniors and their caregivers face, as their health care needs increase.

We profile a number of Canadian innovative practices, as well as some international examples of how home care can be integrated within the wider health care system. The recent Senate committee review of the 2004 health accords, Time for Transformative Change, also stressed the importance of integration, calling for governments to develop and implement a continuing care strategy for Canada.

This month, leaders in Canadian home care will be blogging from their unique perspectives in the system. Look for Nadine Henningsen, Executive Director of the Canadian Home Care Association; John Hirdes, interRAI expert and consultant for our report; Shirlee Sharkey, CEO of Saint Elizabeth; and Susan Eng, Vice President for Advocacy at CARP.

We’ll also hear from Kevin Mercer, CEO of the Waterloo Wellington CCAC,  who’ll blog about some system issues surrounding home care, and Paul Holyoke, a home care researcher who will blog about the experiences of home care providers, clients, and caregivers and their perspective on meaningful approaches to care.

On May 9^th, we look forward to bringing you a webinar called, Canadian Home Care Priorities For Seniors: What Can We Learn From Australia? The webinar will feature Jeff Fiebig, an expert on Australia’s National Aged Care System, who’ll discuss how Australia was able to integrate care for seniors. Pamela Fralick of the Canadian Healthcare Association and Nadine Henningsen of the Canadian Home Care Association will provide commentary on what we can learn from Australia’s experience.

Aging well matters to all of us. In developing this report, we also drew from our own experiences with family members facing similar challenges and the many personal stories we heard. We hope you’ll find much to talk about and share in your conversations about the future of seniors’ care in Canada.  We hope this report will generate discussion and conversation about your own experiences and the future of senior care in Canada. 

Shilpi Majumder

Policy Lead
Health Council of Canada

Shifting Focus to Performance Improvement

Last week, health care leaders met in Ottawa for the annual wait time conference known as Taming of the Queue.  Now in its ninth year, this event has been an important forum for sharing what works in wait time management. Canada’s strategy to reduce long waits for surgical, radiation and diagnostic services has yielded results. It’s time to apply this same formula – set targets, measure results, report progress – to the performance of our health care system as a whole. Wait times are only one aspect of quality in health care. We also need to ensure that the care we’re waiting for is safe and effective. And the care must be tailored to each patient’s needs and preferences.

As the Health Council of Canada has reported, provinces and territories have made progress toward meeting the national wait time benchmarks that came out of the First Ministers’ 2004 Ten Year Plan. Working with hospital managers and clinicians, governments have taken practical steps to manage wait times. They continue to report publicly on their progress.

Despite our efforts and investments, wait times in Canada for some services are still longer than in other OECD countries. For example, in a survey of sicker adults conducted last year, 50% of Canadian patients reported that they waited four or more weeks for an appointment with a specialist. Canada ranked 10^th out of 11 countries surveyed. Moreover, about 14% of hospital beds in Canada are occupied by patients who are waiting to be discharged to another facility, such as long-term care, or are waiting for home care.  

Long waits for care in the community are symptoms of wider system issues. To address these waits, we need to improve the performance of our health care systems overall. We can start by setting measurable goals and targets. In the case of hospital wait times, the pan-Canadian benchmarks were a catalyst for change. Patient satisfaction, coordination of care, or waits for home support services are just a few examples of indicators that are being tracked today, at least in some regions.

Where targets are set, clinicians and managers can come together to develop an action plan that meets local needs. Measurable targets also enable us to monitor performance continuously, providing crucial feedback to know where health care services are improving outcomes for patients, and where they are not.

Clearly, monitoring performance system-wide requires a data infrastructure that reaches and connects every point of care, including physicians’ offices, long-term care facilities and home care providers. Interoperable health records are essential to providing streamlined care and to making each patient’s information available where and when it is needed.

Many patients today have chronic conditions. They need a wide range of services and they use them over many years. A high-performing system requires that each sector, from acute care to primary health care to continuing care, be safe and effective in its own right. We also need seamless linkages among them. Far from being wishful thinking, this type of care is already a reality for some Canadian patients. Examples of effective patient-centred care were showcased at the Canadian Health Services Research Foundation’s CEO Forum held in February.

Some observers warn that surgical wait times may rise again once we shift our attention to system performance. I don’t believe this will happen. Hospitals have implemented a suite of information technologies for managing wait times. These tools are becoming ingrained in the way hospitals do business and are here to stay. There is also more transparency with all provinces now publishing their wait times online.

Canada has been unique in its narrow focus on wait times for selected health care procedures. It’s time to shift our attention to the bigger picture and articulate a vision for the health care system we want. To do this, we need to tap into a vital source of knowledge on what constitutes good health care:  patients. At our national symposium on patient engagement, we heard how health care managers are engaging patients in the design of the health care system. In the process, they see the unique perspective that patients bring. As one participant put it, “patients have the 360 view.”

The Health Council works with patients, providers, governments and stakeholders at all levels to promote innovative practices. Through this work, we see pockets of excellent patient engagement and health care performance across the country. We know what works.  Now, spread what works and hold providers, managers and governments accountable to implement effective practices.

John G. Abbott, CEO, Health Council of Canada

Health Council of Canada encouraged by Senate Committee's health accord report

We welcome the recent report issued by the Senate Committee on Social Affairs, Science and Technology. The committee reviewed the remaining work that is needed to meet the goals of the 10-Year Plan to Strengthen Health Care. The resulting document, Time for Transformative Change, released last week, is a comprehensive report with 46 recommendations outlining how to continue to ensure progress is made in reforming Canada's health care system.

The report emphasized the need for government action including federal leadership in guiding and promoting reform across jurisdictions. It also recommended the use of federal funding to support the necessary changes in how health services are delivered by the provinces and territories.

The Health Council is pleased to see that many of its recommendations made it into the final report such as the need for measurable goals, timetables and public reporting employed by governments to improve our health care system.  As the Health Council’s Progress Report 2011 noted, where jurisdictions have comprehensive strategies for reform that include clear targets and measurable goals, better progress was achieved. Wait times is just such an example.

“Accountability supported by strong public reporting is essential to achieve transformative change in health care,” says Dr. Jack Kitts, Chair of the Health Council of Canada. “By establishing solid governance structures, measurable goals and clear targets as suggested by the Senators, we can gauge our successes, highlight areas in need of attention and charge those responsible to make the improvements.”

The senate report echoes many of the observations and recommendations contained in the Health Council’s recent work, including primary health care reform and the importance of patient engagement. The report also stresses the need to focus on health promotion and chronic disease prevention, which is a crucial shift to thinking about the factors that materially affect our health rather than just the acute care system.

In the coming months, the Health Council will continue to report on many key areas from the 10-Year Plan to Strengthen Health Care. Reports on home care and chronic disease self-management will be released in April and May respectively, followed by our annual Progress Report 2012 in June.

“We look forward to providing our perspective in the areas the Senate has indicated as important in achieving the progress envisioned in the 10-Year plan. We will do this by continuing to highlight innovative practices from across the country,” said John G. Abbott, CEO of the Health Council of Canada. “Focusing on innovative practices allows the Health Council to share what is working and encourage the adoption of practices that have been demonstrated to strengthen Canada’s health care system.”