Group items tagged

In 2007-2008, 5% of hospitalizations (N = 74,504) and 14% of hospital days (N = 1.7 million) involved ALC patients. The provincial range for ALC hospitalizations was 2-7% of all hospitalizations (Figure 1).

LC patients were also more than twice as likely to have a comorbid condition as measured by the Charlson Comorbidity Index (Sundararajan et al. 2004). Dementia, as a main or comorbid diagnosis, accounted for almost one quarter of ALC hospitalizations and more than one third of ALC days.

Patients with dementia as a main diagnosis had a median ALC length of stay of 23 days compared with 10 days for ALC patients overall.

Total 26 4

Overall, the predominant discharge destination (43%) was to a long-term care facility (Figure 3).

ALC portion 10 -

Acute portion 11 4

More than one quarter of ALC patients were discharged home. Seventeen (17%) percent of these patients were readmitted to hospital within 30 days.

This compares to 12% for non-ALC patients discharged home.

Of the 12% who died during their ALC hospitalization, 42% were receiving palliative care and 45% were awaiting admission to another facility.

This issue of ALC is a sizeable challenge for hospitals and health system managers in Canada, with over 1.7 million hospital days used for ALC outside of Manitoba and Quebec in 2007-2008.

ALC patients were older and had diagnostic, comorbidity and length-of-stay profiles that indicate complex follow-up care requirements.

The reasons for provincial and facility variations in the number of ALC patients and days are not well understood.

However, ALC variation may also arise from differences in documentation and data collection.

Patient Pathway: Transfers from Continuing Care to Acute Care. found that new long-term care admissions accounted for most of the ALC waits for long-term care beds

The report points out that the health system shouldn’t find out that people need nursing-home care or more home supports when they show up in emergency rooms. Hospitals aren’t equipped for frail elderly patients’ complex needs

Walker’s report recommends “three immediate, short-term, high impact strategies.”First, hospitals with severe ALC problems should receive funding for beds specifically designated for people who can be treated and discharged within three days, to help keep people moving through emergency rooms.Second, work harder on “Home First” programs aimed at keeping ALC patients out of nursing homes at almost all costs; instead, find and fund whatever community supports they need.Third, launch an “intensive case management program” to keep ALC patients from becoming “long-stay” ALC patients, whose prospects for getting out of hospital are dim.

More work needs to be done on the transitions of care, said Paquette, between the hospital and community care services.

Working together to search out every opportunity to get patients home is working, he said.

At Tuesday's meeting, the HSN board officially approved a seniors' strategy for the hospital that will make it more senior-friendly -- based largely on recommendations of a province-wide report by Dr. Samir K. Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto.

The United Kingdom and Australia consider an 85% acute care bed occupancy rate to be the safe upper limit, according to the OECD. But Campbell, who says the OECD’s figures on Canadian occupancy rates are probably accurate, is not interested in debating appropriate overall rates.

It may come as a surprise that despite these statistics, Ontario Hospital Association president Pat Campbell is not advocating for more hospital beds.

Between 1998 and 2011, the number of all types of hospital beds in Ontario remained “virtually constant at approximately 31,000” while the population increased by 16%, according to a 2011 Ontario Hospital Association document.

Rose says, for example, that occupancy rates in surgical critical care units, characterized by rapid turnover and short stays, should be about 75% to be efficient.

This kind of cooperation could also work when hospital crowding becomes excessive, for example when flu season hits, says Mike Tierney, vice-president for clinical programs at The Ottawa Hospital and one of the editors of Healthy Debate. What is needed is “an ability to look at hospital occupancy

Still, Schull does not advocate for more hospital beds. “It would be a mistake to add beds to a dysfunctional system,” he says.

Occupancy rates matter if you accept the premise that high rates lead to poor access for patients who need to be admitted from emergency departments, notes Michael Schull, an emergency room doctor at Sunnybrook who has published on wait times in emergency and overcrowding risks.

and bed availability across a region in real time, rather than each hospital trying their best to manage on their own

The sobering reality is that Ontario hospitals are tight for capacity largely because of the number of beds occupied by patients, most of them elderly, waiting for admission to another facility (such as rehabilitation or long-term care) or for support to return home.

Administrators at Health Sciences North in Ontario have discovered the benefit of very active cooperation between the 459 bed Ramsey Lake Health Centre (formerly the Sudbury Regional Hospital) and the local Community Care Access Centre (CCAC).

Working together, the result has been a reduction of ALC patients at the health centre from 133 to 78 in the period between September and December 2012, says David McNeil, vice president of clinical services and chief of nursing.

The challenge for the CCAC was to expand its capacity for community-based care, and some funding was received from the province for new programs including behavioural support and mobility programs. For its part, the hospital recruited a new geriatrician, gradually closed beds at the former Memorial Hospital site that had been used for ALC patients, and redirected money towards chronic disease management.

As well, community groups have been engaged “to help them understand that the hospital is no longer the centre of the universe,” McNeil says

While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.

we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time

Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?

one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients

the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care

consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.

focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality

of the Wait Time Alliance

Dr. Simpson

the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.

Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.

The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.

the lack of attention given to timely access to care beyond the initial five priority areas

all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks

we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times

how the wait times agenda could be supported by a new health accord

governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care

look at the total wait time experience

The measurements we use now do not include the time it takes to see a family physician

a patient charter with access commitments

Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access

In Ontario, for example, ALC patients occupy one in six hospital beds

Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.

The progress that has been made varies by province and by region within provinces.

Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences

Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.

Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.

Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.

A similar problem exists following discharge from hospital.

Poorly integrated and coordinated care leads to readmission to hospital

This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.

Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.

Critical reforms needed to achieve health system integration include governance, information enablers and incentives.

we need an engaged federal government investing in the development and implementation of a national health system integration agenda

complete absence of any mention of Canada as a place where innovative health system reform was happening

Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual

the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac

no one is quite sure where those five areas came from

There was no scientific base or evidence to support any of the benchmarks that were put in place.

I think there is much less than meets the eye when we talk about what appropriate benchmarks are.

The one issue that was added was hip fractures in the process, not just hip and knee replacement.

in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour

When we started, wait-lists were used by most physicians as evidence that they were best of breed

That continues, not in all areas, but in many areas, to be a key issue.

The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.

There were almost no efforts in the country at the time to use basic queuing theory

We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.

the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based

the issue of appropriateness

Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed

the accord did a very good job with what we do, but a much poorer job around how we do it

the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.

We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.

It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.

I am not saying to turn off the tap.

the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?

Canada currently spends about the same amount as OECD countries

Many of our physicians are saying these five are not the most important anymore.

they are not our top five priority areas anymore and frankly never were

this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.

if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.

people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives

There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.

Ontario is leading the way here with their home first program

There is a need for some nursing home beds, but I think our attention needs to switch to the community resources

they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.

I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.

One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program

some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things

I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.

the PATH program. It is meant to be palliative and therapeutic harmonization

has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care

Where you see patient safety issues come to bear is often in transition points

When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.

If you require a lot of home care that is where the gap is

in terms of emergency room wait times, Quebec is certainly among the worst

Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.

One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.

We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.

The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.

the customer is always right, the person who is getting the health care

It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.

How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.

There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.

There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.

Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.

“Although the impact of population aging on health costs has remained relatively stable over time, health care planners and providers are rightfully looking at ways to meet the needs of a growing senior population,” says John Wright, CIHI’s President and CEO.

opportunities for the health system to meet these changing needs, including improved integration across the health care continuum, an increased focus on prevention and more efficient adoption and use of new technologies

seniors spend more time in emergency departments than their younger counterparts before being admitted to hospital (3.7 hours compared with 2.7 hours in 2009–2010)

Seniors account for 85% of all ALC patients—approximately 85,000 cases a year. CIHI data shows that nearly half of all senior ALC patients (47%) were waiting to be moved to a long-term care facility.

In 2009, almost two out of three (63%) Canadians age 65 and older took 5 or more prescription drugs from different drug classes, with close to one-quarter (23%) taking 10 or more—up from 59% and 20%, respectively, in 2002.

in 2009, 1 out of 10 Canadian seniors was taking a drug from the Beers list, an internationally recognized list of prescription drugs identified as potentially inappropriate for use by seniors

76% of seniors reported at least 1 of 11 major chronic conditions in 2008

1 out of every 11 emergency department visits by seniors is for a chronic condition that can potentially be managed in the community

In 2008–2009, nearly half (44%) of Canada’s seniors had not had a dental check-up in the previous year.

Preventing falls is another important strategy to keep seniors healthy.

The vast majority (93%) of Canadian seniors live at home

More than 60 support and administrative staff positions -- 21 of which are currently vacant -- will be impacted by the cutbacks, she said, noting doctors, who are not employees of the hospital, will not be affected.

OSMH is also examining ways to make money, including in its parking lots.

There appears to be significant overlap between LTC 'convalescent care' beds and hospital 'assess and restore' beds.  

35,000 LTC beds must be redeveloped over the “next few years” according to the OLTCA panel.  That’s about half the LTC bed stock. 

Up to 64 ALC patients have stayed at SAH at the same time. The 50 patients will be transferred over a 10-day period. "We don't want to rush it," she said. Hospital staff who work with the patients will help with the move. Thirty were in an area of the hospital typically not used. "At least 14" beds will become free with their departure, said Bertrand. "Today is another example of creating more opportunities for long-term care in Sault Ste. Marie," said MPP David Orazietti. There are now about 850 long-term care beds in the city.

The rollout of the interim beds took several years to develop, said Orazietti. North East Local Health Integration Network issued a request for proposal for a company to operate the beds in the fall of 2013, said Autumnwood president Joe DiPietro. His company was selected in the winter of 2014. Autumnwood ope ra tes three retirement residences and an apartment building in Sudbury, North Bay and Timmins. The privately-held company spent $1.8 million to renovate the former Davey Home. Improvements included new flooring, carpeting, fixtures, furniture and lighting, said DiPietro. Renovations will continue over the next two months for the remainder of the facility. That's expected to cost about $400,000. Total bed capacity is about 96.

Whether the province will fund more interim long-term care beds at Cedarwood depends on health care priorities identified in the community, said Orazietti. "We need to ensure as a government we're putting the resources in the right places so that we can balance those needs and priorities," he said. Autumnwood is employing up to 55 full-and part-time staff at Cedarwood Lodge. Positions include personal support workers, registered practical nurses, registered nurses and administration. The company, established in 1998, makes care for seniors its priority, said DiPietro.

"Absolutely 100%," he told The Sault Star. "That's the reason why we're in the business. We're not in the business for any other reason. We could have come here and literally spent half of what we actually spent in this facility and still opened the doors. It would have passed, but we didn't want to do that. We spent more money than we needed to spend to ensure that the residents had a dignified place to lay their head down at night." Dr. Al McLean is Cedarwood's medical director.

The warning, issued in the chief coroner’s 2009 report on geriatric and long-term care, was the first of many red flags raised about the program.

During much of that time, Prince of Wales was unlicensed, meaning it was not controlled by the Ontario government and was not required to have trained medical staff — or the appropriate equipment and facilities — to look after elderly patients needing round-the-clock care.

I trusted the hospital when they told us it would be the same care as a nursing home.”

A coroner’s report into her death determined that given Coates’s fragile condition the hospital should not have moved her to Prince of Wales in the first place. That’s because the home did not have the facilities, expertise or services to provide nursing-home level care, the report concluded.

“I want caregivers to be careful about assuming that the health-care system has their best interests at heart.”

Kitts, who is an anesthesiologist, said methods he practised a few decades ago, which required an anesthesiologist to be right beside the patient, are “primitive” compared with current technology, which measures carbon dioxide and oxygen levels. It would be possible, Kitts pointed out, for one anesthesiologist to supervise four or five operating rooms.

Meanwhile, most people can go into a drugstore and take their own blood pressure using a mechanized monitor. In a hospital, a nurse is required. Perhaps a less-skilled worker could do the job, leaving nurses free for more specialized tasks, said Kitts.

Kitts added that there also has to be an alternate level of care for patients who don’t need to be in an acute-care hospital but aren’t well enough to be at home.

Late in May, The Ottawa Hospital’s board of governors will be exploring ways to keep populations of patients with multiple health risks out of the hospital, said Kitts.

That will start by identifying these pockets of patients

thanks to predictable and escalating funding over the first seven years of the plan

however, there are, unfortunately, pockets of inattention and/or mediocrity as well

Six areas, in fact, were identified by CHA

funding matters; health human resources; pharmacare; wellness, identified as health promotion and illness and disease prevention; continuing care; and leadership at the political, governance and executive levels

The focus of this 10-year plan has been on access. CHA would posit that it is at this juncture, the focus must be on quality and accountability.

safety, effectiveness, efficiency, appropriateness

Canada does an excellent job in providing world-class acute care services, and we should; hospitals and physicians have been the core of our systems for decades. Now is the time to ensure sufficient resources are allocated to other elements of the continuum, including wellness and continuing care.

Home care is one readily available yet underused avenue for delivering health promotion and illness prevention initiatives and programs.

four critically important themes: dignity and respect, support for caregivers, funding and health human resources, and quality of care

Nadine Henningsen, Executive Director, Canadian Home Care Association

Today, an estimated 1.8 million Canadians receive publicly funded home care services annually, at an estimated cost of $5.8 billion. This actually only equates to about 4.3 per cent of our total public health care funding.

There are a number of initiatives within the home care sector that need to be addressed. Establishing a set of harmonized principles across Canada, accelerating the adoption of technology, optimizing health human resources, and integrated service delivery models all merit comment.

great good has come from the 10-year plan

Unfortunately, there were two unintended negative consequences

One was a reduction in chronic care services for the elderly and

a shift in the burden of costs for drugs and medical supplies to individual and families. This was due to early discharge and the fact that often a number of provinces do not cover the drugs and supplies under their publicly funded program.

Stakeholders across Canada generally agreed that the end-of-life expectations within the plan were largely met

How do we go from having a terrific acute care system to having maybe a slightly smaller acute care system but obviously look toward a chronic care system?

Across Canada, an estimated 30 to 50 per cent of ALC patients could and should benefit from home care services and be discharged from the hospital.

Second, adopt a Canadian caregiver strategy.

Third, support accountability and evidence-informed decision making.

The return on investment for every dollar for home care is exponentially enhanced by the in-kind contribution of family caregivers.

Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association

June 2004

a status report on hospice, palliative and end-of-life care in Canada

Dying for Care

inconsistent access to hospice palliative care services generally and also to respite care services; access to non-prescribed therapies, as well as prescription drug coverage

terminated by the federal government in March of 2008

the Canadian Strategy on Palliative and End-of-Life Care

Canadian Hospice Palliative Care Association and the Canadian Home Care Association embarked on what we called the Gold Standards Project

In 2008, the Quality End-of-Life Care Coalition released a progress report

progress was made in 2008, from the 2004 accord

palliative pharmaceutical plan

Canadians should have the right to choose the settings of their choice. We need to look for a more seamless transition between settings.

In 2010, the Quality End-of-Life Care Coalition of Canada released its 10-year plan.

Seventy per cent of Canadians at this point in time do not have access to hospice palliative care

For short-term, acute home care services, there was a marked increase in the volume of services and the individuals served. There was also another benefit, namely, improved integration between home care and the acute care sector.

last summer, The Economist released a document that looked at palliative services across 40 countries

The second area in the blueprint for action is the support for family caregivers.

The increasing need for home-based care requires us to step up and strive for a comprehensive, coordinated and integrated approach to hospice palliative care and health care.

Canadian Caregiver Coalition

in Manitoba they have made great strides

In New Brunswick they have done some great things in support of family caregivers. Ontario is looking at it now.

we keep on treating, keep on treating, and we need to balance our systems between a curative system and a system that will actually give comfort to someone moving toward the end of their life

Both the Canadian Institute for Health Information and the Canadian Health Services Research Foundation have produced reports this year saying it is chronic disease management that needs our attention

When we look at the renewal of health care, we have to accept that the days of institutional care being the focus of our health care system have passed, and that there is now a third leg of the stool. That is community and home care.

Over 70 per cent of caregivers in Canada are women. They willingly take on this burden because they are good people; it is what they want to do. The patient wants to be in that setting, and it is better for them.

The Romanow report in 2002 suggested that $89.3 million be committed annually to palliative home care.

that never happened

What happened was a federal strategy on palliative and end-of-life care was announced in 2004, ran for five years and was terminated. At best it was never funded for more than $1.7 million.

Because our publicly funded focus has been on hospitals and one provider — physicians, for the most part — we have not considered how to bring the other pieces into the equation.

Just as one example, in the recent recession where there was special infrastructure funding available to stimulate the economy, the health system was not allowed to avail itself of that.

As part of the 10-year plan, first ministers agreed to provide first dollar coverage for certain home-care services, based on assessed need, by 2006. The specific services included short-term acute home care, short-term community mental health care and end-of-life care. It appears that health ministers were to report to first ministers on the implementation of that by 2006, but they never did.

One of the challenges we find with the integration of mental health services is

A lot of eligibility rules are built on physical assessment.

Very often a mental health diagnosis is overlooked, or when it is identified the home care providers do not have the skills and expertise to be able to manage it, hence it moves then over to the community mental health program.

in Saskatchewan it is a little more integrated

Senator Martin

I think ideally we would love to have the national strategies and programs, but just like with anything in Canada we are limited by the sheer geography, the rural-urban vast differences in need, and the specialized areas which have, in and of themselves, such intricate systems as well. The national picture is the ideal vision, but not always the most practical.

In the last federal budget we got a small amount of money that we have not started working with yet, it is just going to Treasury Board, it is $3 million. It is to actually look at how we integrate hospice palliative care into the health care system across all these domains.

The next 10-year plan is about integration, integration, integration.

the Canadian Patient Safety Institute, the Health Council of Canada, the Canadian Health Leadership Network, the health sciences centres, the Association of Canadian Academic Healthcare Organizations, the Canadian College of Health Leaders, the Canadian Medical Association, the Canadian Nurses Association, the Canadian Public Health Association, the Canadian Agency for Drugs and Technologies in Health and Accreditation Canada

We are all meeting on a regular basis to try to come up with our take on what the system needs to do next.

most people want to be cared for at home

Family Caregiver Tax Credit

compassionate care benefit that goes with Employment Insurance

Have you done any costing or savings? Obviously, more home care means more savings to the system. Have you done anything on that?

In the last federal election, every political party had something for caregivers.

tax credits

the people we are talking about do not have the ability to take advantage of tax credits

We have a pan-Canadian health/human resource strategy in this country, and there is a federal-provincial-territorial committee that oversees this. However, it is insufficient

Until we can better collaborate on a pan-Canadian level on our human resources to efficiently look at the right mix and scope and make sure that we contain costs plus give the best possible provider services and health outcomes right across the country, we will have problems.

We have not as a country invested in hospital infrastructure, since we are talking about acute care settings, since the late 1960s. Admittedly, we are moving away from acute care centres into community and home care, but we still need our hospitals.

One of the challenges is with the early discharge of patients from the hospital. They are more complex. The care is more complex. We need to train our home support workers and our nurses to a higher level. There are many initiatives happening now to try to get some national training standards, particularly in the area of home support workers.

We have one hospital association left in this country in Ontario, OHA. Their CEO will constantly talk about how the best thing hospitals can do for themselves is keep people out of hospitals through prevention promotion or getting them appropriately to the next place they should be. Jack Kitts, who runs the Ottawa Hospital, and any of the CEOs who run hospitals understand one hundred per cent that the best thing they can do for Canadians and for their institutions is keep people out of them. That is a lot of the language.

We have an in-depth brief that details a lot of what is happening in Australia

I would suggest that it is a potentially slippery slope to compare to international models, because often the context is very different.

The layoffs are part of the fallout from cuts announced last month by the Horizon Health Network in attempts to balance its $2.1-billion budget.

Officials with the Horizon Health Network have said the creation of transitional-care units in provincial hospitals will help improve services for alternative-level-of-care patients.Those patients are currently scattered throughout various acute care units in the province's hospitals.But now most of these patients will be admitted to specialized transitional units.

They need care and attention paid to their socialization needs, to their recreation, walking, mobility needs. So it's a very different pace and requires a very different skill set.

Horizon has roughly 300 alternative-level-of-care patients in its hospitals across the region - roughly 25 per cent of acute care beds.

At a public meeting on Monday, held by the Save Our Hospital Action Committee which aims to safeguard the services at the Miramichi Regional Hospital, Dr. Gerard Losier called on the provincial government to create more nursing home beds in the province.

In January, plans to build new nursing homes in Neguac and Miramichi were put on hold by the Social Development Department pending a review.Social Development Sue Stultz said in October that provincial officials are putting the finishing touches on the review which she hoped to make a public announcement about the nursing homes before the legislature reconvenes Nov. 23.Stultz has confirmed that none of the projects have been cancelled.

While government has said the area isn't losing beds as a result of the changes, Sugden said the beds being designated as ALC beds take away from acute care.

Reducing hours at community health centres and having select centres close for five non-consecutive days in the coming months are initiatives Horizon has also undertaken.They also trimmed $1 million from the renovation budget and made cuts to education and minor equipment to save $300,000.

Some of Vitalité Health Network other cost-cutting measures:* Implementation of re-sterilization of some instruments in the surgical suites;* Improved use of on-call physician fees;* Improved use of the budgets allocated to sitters;* Optimization of resources and standardization of procedures in the laboratories;* Plan to improve employee attendance and reduce overtime;* Increased efficiency of therapeutic space utilization;* Reduction in renovation budgets;* A10 per cent reduction in budgets for employee training and small equipment purchases;* Reduction in travel expenses through video and audio conferencing; and* Promotion of self-funded leave of absence.