Canadian Home Care Priorities for Seniors: What Can We Learn From Australia? Your questions answered

In May, our international webinar, Canadian Home Care Priorities for Seniors: What Can We Learn From Australia?, sparked many more questions than we were able to answer in one hour, so we asked our panelists to address your questions directly.

Here, one of our panelists, Pamela Fralick, President and CEO of the Canadian Healthcare Association, answers your question about underserved and vulnerable populations. If you want to see all the answers from all three panelists, or the presentations from the webinar, click here.

Q: Can you identify any specific strategies in working with the Aboriginal population and aging strategies in relation to this?

A: At the federal level, Health Canada launched the First Nations and Inuit Home and Community Care (FNIHCC) program in 1999. The program provides various health-related home care, including case management and nursing care. In addition, the Assisted Living program, administered by Aboriginal Affairs and Northern Development provides support services to elderly or disabled First Nations persons living on reserves. Services provided include homemaker, foster care and institutional care services.

Throughout Canada, provinces and territories vary in the extent to which they provide home care services to Aboriginal People. Challenges lie in providing adequate home care to these populations and ameliorating the differences between the provincial home care program and the on-reserve federally-funded programs. The differences can make it difficult to offer consistent care delivery.

From 2008 to 2010, the Victorian Order of Nurses undertook a National Aboriginal Health Initiative through which several culturally relevant resources were developed.

Canadian Home Care Priorities for Seniors: What Can We Learn From Australia? Your questions answered

In May, our international webinar, Canadian Home Care Priorities for Seniors: What Can We Learn From Australia?, sparked many more questions than we were able to answer in one hour, so we asked our panelists to address your questions directly.

Here, one of our panelists, Nadine Henningsen, Executive Director of the Canadian Home Care Association, answers your question about provincial versus federal responsibility. If you want to see all the answers from all three panelists, or the presentations from the webinar, click here.

Q: There used to be a federal Minister of State responsible for caregiving.  Would you say that caregiving is now considered a 'provincial' issue (aside from CPP changes and the Aboriginal population)?

A: Both the federal and provincial governments in collaboration with NGOs and other stakeholders across Canada are actively working on initiatives to support caregivers.  

These actions may be a part of a distinct strategy to support all caregivers (as seen in Manitoba’s Caregiver Act) or targeted to caregivers providing support for the frail elderly and included in policy to support continuing care and healthy aging.   Specifically, the jurisdictions are moving forward on key elements of the Canadian Caregiver Strategy (proposed by the Canadian Caregiver Coalition), such as:

1. Safeguard the health and wellbeing of family caregivers through identification of caregiver needs and provision of flexible respite options. Note: This is a provincial issue and activity.
2. Minimize excessive financial burden placed on family caregivers by providing direct payment, where caregivers receive allowances, compensation or reimbursement for expenses and / or tax credits, pension credits, and dropouts from pension. Note: This is a federal activity with the Compassionate Care Benefit and Caregiver Tax Credit.  Provinces have advanced this with unique programs.
3. Enable access to user-friendly information, education, resources and counseling. Note: This is a provincial focus, with Federal Government research grants to support access to information (e.g., Caregiver Policy Lens & Caregiver Toolkit).
4. Create flexible workplace environments that respect caregiving obligations including labour policy, workplace policies, labour standards and Employment Insurance policies such as the Compassionate Care Benefit. Note: There’s limited activity in this area. 
5. Invest in research on family caregiving as a foundation for evidence-informed decision making. 
6. Note: Federal government – through HRSDC – 2009 Call for Proposals (listing of approved projects here. Provincial activity varies by jurisdiction. 

Canadian Home Care Priorities for Seniors: What Can We Learn From Australia? Your questions answered

In May, our international webinar, Canadian Home Care Priorities for Seniors: What Can We Learn From Australia?, sparked many more questions than we were able to answer in one hour, so we asked our panelists to address your questions directly.

Here, one of our panelists, Jeff Fiebig, Manager of Program Development with the ACH Group in Adelaide, answers your question about home care packages in Australia.

If you want to see all the answers from all three panelists, or the presentations from the webinar, click here.

Q. Can you elaborate on the Australian home care packages - are these based on funding/services/functionality?

A: Current access to all “higher level” services is loosely based on individual functionality, a rationed system of places (114 places per 1000 of population aged 70 plus)along with capitation grants for some services (low level HACC services, socialisation etc). Here is the best description of the current system.
Under the Living Longer, Living Better Reforms there is proposed:

• Common entry levels between Residential and Community Care
• Common means testing and fees
• A universal approach to quality, standards, and more.

Health impact assessment as a policy tool

Recently the CMAJ wrote about the importance of health impact assessments as a policy tool. In June, The Canadian Medical Association told the Senate Finance Committee that evidence-based health impact assessments should be applied to all cabinet decision making.

What is a health impact assessment? It is a structured way to evaluate the potential impact of policies or programs on the population’s health. It means seeing health as not only the responsibility of the ministry of health, but of all government departments at all levels Health impact assessments can provide an integrated policy response to complex problems that might involve solutions from a variety of departments.

For example, our report, Stepping it up: moving the focus from health care in Canada to a healthier Canada, discusses income as a key determinant of health. Canadians with the lowest incomes are more likely to suffer from chronic conditions like diabetes, arthritis  and heart disease, live with a disability, be hospitalized for a variety of health problems, have many mental health issues and to die earlier.  So how can governments approach this complex issue using health impact assessments? A healthy population has to be viewed as the responsibility of governments and society as a whole, not just that of the ministries of health. Governments need to work collaboratively, among ministries, to identify solutions beyond just the acute care system that take a look at policies affecting the health of these populations, and develop appropriate solutions.

As the article says, Quebec already uses health impact assessments. We hosted a webinar last year and one of our presenters was Lyne Jobin, Director of Public Health Planning, Evaluation and Development, Ministère de la Santé et des Services Sociaux. She discussed the implementation of this strategy, and challenges that arose in the process (see her presentation slides here).

The evidence we need

At a knowledge translation (kt) conference two years ago in Gatineau, Quebec, the KT research community seemed to agree that value judgments, tacit knowledge and peer opinion will always exert a certain level of influence on health care decision-makers. However, the game-changer was really the power of evidence to inform decisions, making them more transparent, objective and defensible. One can make the leap to say that evidence is more than fundamental to sound decision-making; it is a necessary consideration in the pursuit of something I value even more: wisdom.

Enter the launch of a new online tool called the Evidence-Informed Healthcare Renewal (EIHR) Portal on a McMaster University site to which policy and decision-makers have been turning for a while. The difference is that this portal is the only one of its kind dedicated exclusively to health care renewal in Canada and is the accomplishment of a number of national health care organizations and entities (including the Health Council). As a Health Council representative on the portal steering committee, I can attest that this portal has already met with enthusiasm and support from researchers and many governments. 

I hope you’ll delve into some of the different formats like videos that present rich evidence on innovative practices throughout the country.

From my experience, journalists are well-served by consolidated health system evidence on the Evidence Network, health care professionals are increasingly served through the Canadian Virtual Health Library, and now researchers, policy and decision-makers can turn to the EIHR portal as a comprehensive hub that draws from multiple contributors.

If your area is healthcare renewal, I also invite you to the Health Council’s site because every aspect of our evidence-based reporting is implicitly linked to renewal. We underline all our work with a focus on innovative practices that have the power to transform the system.

“Will it work here?” is the next question you’ll have to answer for yourself. 

Christine Pierroz, Director of Communications, Health Council of Canada

Set national goals to achieve progress in health care

Originally published as a letter to the editor in the Regina Leader Post.

The absence of a robust and available set of comparable health indicators makes it difficult to hold the health system accountable for improving population health. As this recent Regina Leader-Post article noted, without valid comparisons, how do we measure success? Perhaps we can replace the discussion on national standard with a need to have national vision, performance targets for health care and health outcomes and the leadership to achieve them.

By way of example, the federal and provincial governments did not set out clear parameters for change in the 2003 Health Accord or the 2004 10-Year Plan. Most commitments were vague and set with low expectations; and were in place more to put provinces and territories on an equal footing instead of pushing them towards excellence in health care.

If we are to see improvements in health delivery across Canada, our governments need to set clear policy goals with both measurable health outcomes and supporting health indicators so the public can hold health system leaders accountable for performance. We can harness the existing data collection and measurement capacity of CIHI and Statistics Canada, as well as that of provincial health quality councils and related agencies to get this information. Agencies such as ours can then report more effectively to Canadians who in turn can hold their governments and the system to account.

Once we have a shared vision across Canada supported by comprehensive goals complete with concrete targets, that’s when we will see real progress take place. For further information, visit our website at healthcouncilcanada.ca and download our report on measuring and reporting on health system performance.

John G. Abbott, CEO, Health Council of Canada