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Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 6, 2011 - 0 views

www.parl.gc.ca/...49076-e.htm

accord home care senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Pamela Fralick, President and Chief Executive Officer, Canadian Healthcare Association
  • I will therefore be speaking of home care as just one pillar of continuing care, which is interconnected with long-term care, palliative care and respite care.
  • The short-term acute community mental health home care services for individuals with mental health diagnoses are not currently included in the mandate of most home care programs. What ended up happening is that most jurisdictions flowed the funding to ministries or other government departments that provided services through established mental health organizations. There were few provinces — as a matter of fact, Saskatchewan being one of the unique ones — that actually flowed the services through home care.
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  • 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.
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      get cite from document
  • 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.
  • Irene Jansen on 23 Jan 12
     
    Home Care
Irene Jansen

The effect of for-profit laboratories on the accountability, integration, and cost of C... - 1 views

www.openmedicine.ca/...489

labs privatization ally excellent

shared by Irene Jansen on 18 Dec 12 - No Cached
  • increased for-profit delivery has led to decreased transparency
  • Using for-profit laboratories increases the cost of diagnostic testing and hinders the integration of health care services
  • In 2012, Canadian governments will pay private corporations over a billion dollars (a conservative extrapolation from recent spending in Ontario, Manitoba, Alberta, British Columbia, and Saskatchewan)1 for medical laboratory services, making them among the most privatized of Canada’s essential medical services.
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  • Three multinational companies—LifeLabs, Gamma-Dynacare and CML HealthCare—will receive over 80% of this money.
  • since private sector corporations are substantially protected by law from the public disclosure of “confidential business information,” increased for-profit delivery has had the effect of decreasing transparency
  • The experience in Alberta and Saskatchewan provides some indication of the potential harm integration poses for private providers. Over the 15 years since all laboratory services were integrated under the control of the regional governments, the role of for-profit laboratories in Alberta has been significantly diminished, and in Saskatchewan for-profit laboratory provision has effectively ended.
  • the argument for using public sector institutions, primarily hospitals and public health laboratories, for all laboratory services is straightforward
  • “there is massive reserve capacity in the hospital laboratories … a fully staffed evening shift could absorb the private laboratories’ workload without difficulty.”
  • Excess capacity in either the public or private sector is paid for with public funds and, aside from the redundancy necessary to accommodate fluctuations in demand, is a waste.
  • the Canadian health care system could save a minimum of $250 million per year by moving all publicly funded medical laboratory work into an integrated public non-profit medical laboratory system
  • added benefits of facilitating the integration of medical records, staff, and administration, and of improving public accountability
Govind Rao

St. Joe's integrated health-care model guides new home care report - Latest Hamilton ne... - 0 views

www.cbc.ca/...new-home-care-report-1.2994206

from heather home care Ontario

shared by Govind Rao on 16 Mar 15 - No Cached
  • Integrated Comprehensive Care Program pairs patients with a coordinator throughout care process
  • Mar 14, 2015
  • A pilot project of integrated health care tested in Hamilton has lent some wisdom to a new report aimed at improving home and community care in Ontario. The Integrated Comprehensive Care Program (ICC) at St. Joseph’s Health System is testing a model of “integrated case management” among health-care providers. Started in the spring of 2012, it pairs patients with a care coordinator — usually a registered nurse — from pre-operation treatments to post-surgical home care.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • 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.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • 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
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • 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.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • 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
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • 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.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • 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.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • 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.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Economic and Social Integration of Immigrant Live-in Caregivers in Canada » I... - 0 views

www.irpp.org/...atanackovic-bourgeault-no46

from heather migrant worker home care

shared by Govind Rao on 12 May 14 - No Cached
  • Jelena Atanackovic and Ivy Lynn Bourgeault Diversity, Immigration and Integration April 16, 2014
  • Unlike most other temporary foreign workers in Canada, participants in the Live-In Caregiver Program (LCP) are eligible to apply for permanent residence after completing 24 months of paid employment within a period of four years. The LCP was introduced in 1992 to address a lack of live-in workers to care for dependent people. It is estimated that a total of 17,500 former caregivers, their spouses and dependants will be admitted as permanent residents in 2014.
  • Few studies have addressed the economic and social integration of LCP workers after the program or explored how different types of caregiving — for children, disabled people or older adults — affect integration. This study helps fill these gaps through extensive qualitative research, including interviews and focus groups with 58 live-in caregivers.
Govind Rao

Critics urge mental-health reform; Federal government should be working with provinces ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150525|221198129

from heather mental health

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Mon May 25 2015
  • The federal government should work with the provinces to integrate mental-health services into the health system, the opposition NDP and Liberals say. NDP health critic Murray Rankin said his party would implement the broad strokes of recommendations from the Mental Health Commission of Canada, which include a call to make psychotherapy and clinical counselling more accessible. Hedy Fry, health critic for the Liberal Party, said mental-health services should be part of a more integrated approach to health care. Both said their parties would work more closely with the provinces on health-care matters if they form the next government after the election this fall.
  • Their comments came after a Globe and Mail article detailed the difficulties many Canadians face in accessing psychotherapy to treat depression and anxiety. Long waiting lists for publicly funded psychotherapy mean the treatment is often out of reach for low-income Canadians who cannot afford to pay for private care and are less likely to be covered by workplace benefits. Instead, many people rely on visits to family doctors and prescription drugs, which experts say are not always the most effective treatment. Mental illness in Canada costs nearly $50billion a year in health-care dollars and lost productivity, according to the Mental Health Commission of Canada.
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  • Mr. Rankin said that Ottawa should be working with the provinces, territories and municipalities to ensure they can provide an appropriate combination of services, treatment and support for those dealing with mental illness. He pointed to the national mental-health strategy developed by the Mental Health Commission of Canada in 2012 as a roadmap for improving services.
  • We would obviously want to look at each of those recommendations [in the strategy], but the general thrust of those recommendations, we would implement, absolutely," Mr. Rankin said. Among other points, the strategy calls for increased access to qualified psychotherapists and counsellors and the removal of financial barriers for children, youth and their families.
  • Mr. Rankin also called for a revival of the Health Council of Canada and a new federal health accord to foster communication between the federal government and the provinces on health. Both expired last year. Dr. Fry said the Liberals, if elected, would work closely with the provinces to develop a more integrated approach to health-care services, including mental health.
  • She said the last accord, which expired in 2014, had begun to look beyond the physician and the hospital and toward health care that could be provided by multidisciplinary teams. "We want to integrate mental health, in a fulsome way, into our health-care system," Dr. Fry said. "And that would mean a lot of the things that the Mental Health Commission talked about." However, she said the Liberals would not commit to specific actions before consulting with the provinces
  • We have to talk to the provinces about it," she said. "That's what we can commit to doing." Dr. Fry said a partnership between the federal government and the provinces on health care is necessary but declined to specify if a Liberal government would establish another health accord or bring in a different system. The length of the next partnership could also be up for discussion, she said.
  • Research suggests that psychotherapy, which is provided by a licensed therapist, is an effective treatment for many people struggling with anxiety and depression, the two most common psychiatric diagnoses. Therapy by private psychologists or social workers is not currently covered by any of the provinces. A spokesman for Health Minister Rona Ambrose said the provinces and territories are responsible for health-care delivery, including psychotherapy. The Conservative government created the Mental Health Commission of Canada and recently renewed its mandate for another 10-year period, he said.
  • A written statement from Ms. Ambrose, provided to The Globe and Mail, said the Canada Health Act does not preclude provinces and territories from extending public coverage to other services or providers such as psychologists. "Provinces and territories may choose to extend public coverage for such services," she said. With reports from Erin Anderssen in Ottawa This is part of a series about improving research, diagnosis and treatment
Heather Farrow

"Who Cares?" - CUPE launches campaign for public integration of Community Care Services... - 0 views

nb.cupe.ca/...-community-care-services-in-nb

cupe nb integration

shared by Heather Farrow on 13 Sep 16 - No Cached
  • Fredericton – This Monday, CUPE officially launches a campaign named “Who Cares?” to get government and the public to talk about community care services (CCS). CUPE is advocating that services such as group homes, special care homes, transition houses and home care should be integrated under public administration.
  • Heather Farrow on 13 Sep 16
     
    sept 13, 2016
Irene Jansen

MHCC Seniors Guidelines - 0 views

www.mentalhealthcommission.ca/...MHCC_Seniors_Guidelines.aspx

dementia seniors mental health commission

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    New guidelines for seniors' mental health have been released by the Mental Health Commission of Canada. It includes: key factors to consider in planning a comprehensive integrated mental health system for seniors; an integrated model for mental health services in late life; and, facilitators of a comprehensive mental health service system.
Irene Jansen

Internationally Educated Health Professionals: Workforce Integration and Retention :: L... - 0 views

www.longwoods.com/21795

international training hhr

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Abstract It is essential that internationally educated healthcare professionals (IEHPs) residing in Canada re-enter and remain in their profession. To make the most of this important supply of healthcare professionals, it is vital to understand who IEHPs are, the challenges they face and how to facilitate their entry and integration into the workforce. In this article, after a summary of what is known of IEHPs who migrate to Canada, common problems of entry and integration into the workforce are discussed. Profession-specific challenges are considered, including how roles in certain professions vary globally and the importance of cultural and communication competencies. Resources to assist physicians and nurses are described and compared with those available for other professions. Finally, future possibilities and strategies for workforce integration are considered. Although the focus in this paper is on one province, the issues and strategies discussed are relevant to other provincial and international jurisdictions that are struggling with shortages and trying to capitalize on potential sources of workforce supply
  • Irene Jansen on 23 Jan 12
     
    Healthcare papers 10(2) 2010:8-20
Irene Jansen

Global Calgary | With greying population, better integrated health care will be needed:... - 0 views

www.globaltvcalgary.com/...story.html

home care seniors ltc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • While cost is an issue, the more critical concern is how to provide the best possible care to those who often have complex medical needs, said Kathleen Morris, CIHI's director of health system analysis and emerging issues.
  • we're not worried that the system isn't sustainable," said Morris, noting that the greying of the population appears to be having less effect on costs than once predicted
  • more integrated care, an increased focus on prevention and adoption of new technology to improve efficiency
  • ...7 more annotations...
  • Two-thirds of Canadians 65 and up are taking at least five prescription medications; almost one in four are taking 10 or more.
  • technology should play a much bigger role in the future
  • prevention must take a higher profile in the care of those 65-plus, three-quarters of whom have a chronic health condition
  • Roughly half of Canadian seniors have high blood pressure.
  • Dr. Paul Katz of Baycrest
  • we can keep people at home by the use of really smart care management, interdisciplinary teams, all with a focus on basic geriatric principles of care
  • "The biggest barrier is the status quo," he said, noting that health-care institutions tend to operate as separate entities as opposed to an integrated whole."We need to break apart those silos ... and spread accountability across the system. So when a patient is transferred from a hospital to a long-term care facility for rehabilitation, for example, the hospital should maintain responsibility. They should be partners with the nursing home in treating that particular individual."Right now, when the patients leave the door, the responsibility stops."
Govind Rao

Partners in Education and Integration of IENs Conference 2015: Recap | NHSRU - 0 views

nhsru.com/-of-iens-conference-2015-recap

from heather nursing migrant worker international

shared by Govind Rao on 15 May 15 - No Cached
  • Dana Ross from the NHSRU presented at the Partners in Education and Integration of IENs Conference 2015, which took place in Regina from April 30-May 1.
  • Other stakeholders involved in the Internationally Educated Nurses (IEN) project – Partnering with Employers: Increasing IEN Employment in Healthcare Organizations – also attended (Hamilton Health Sciences, CARE for Nurses). We have provided a summary that highlights relevant presentations. Integration of IENs into the Workplace – Matching Demand and Supply (NHSRU, McMaster University Site) Ross introduced participants to the NHSRU, McMaster University Site project, Partnering with Employers: Increasing IEN Employment in Healthcare Organizations and led discussions with conference attendees on the employment situation of nurses and IENs in their regions.
Govind Rao

Share of health spending on doctors increases - 0 views

www.cmaj.ca/...E506

from heather doctors wages chc

shared by Govind Rao on 22 Dec 15 - No Cached
  • CMAJ December 8, 2015 vol. 187 no. 18 First published November 9, 2015, doi: 10.1503/cmaj.109-5191
  • Carolyn Brown
  • After years of erosion, doctors’ share of health spending has rebounded to levels last seen in the 1980s, according to the Canadian Institute for Health Information’s (CIHI’s) annual release of national health expenditure data. But it comes from a pie that is slowly shrinking, as health spending has not kept pace with inflation and population growth.
  • ...12 more annotations...
  • Figures compiled in CIHI’s database over 40 years show the share spent on physicians hit an all-time high in 1988, then slowly declined until 2007, when it turned around, growing at about 2.2% annually. It now accounts for 15.5%, comparable to levels seen in the late 1980s. Hospital spending has decreased from 45% of total health spending in the mid-1970s to just under 30% today, whereas drug spending has been increasing since the mid-1980s to account for just under 16% of spending.
  • “The guild has done a great job of protecting our income,” Dr. David Naylor said, referring to medical associations’ success in negotiations with governments. “But wouldn’t you expect [the share of spending on physicians] to drop a little?” Naylor, past president of the University of Toronto and chair of the Advisory Panel on Healthcare Innovation, spoke at a panel discussion on the CIHI findings, held Oct. 29 in Ottawa.
  • He said the “constancy of focus on doctors, drugs and hospitals … speaks to the stasis in the system. If anything, it’s in a state of arrested development.” While overall health spending has gone up in dollar terms, amounting to $6105 per capita in 2015, it has declined as a proportion of gross domestic product (GDP). After the 2008–2009 recession, health spending fell from 11.6% of to an estimated 10.9% of GDP today. When inflation and population growth are taken into account, health spending also shows a decline.
  • The first half of this movie seems similar to what happened in the 1990s,” said Don Drummond, an economist at Queen’s University. He said that in the 1990s, government austerity led to a decline in health spending, but a return to a good economy resulted in health spending growing “much faster than economic growth.”
  • In regard to the similar spending decline after 2011, Drummond asked “did we create efficiencies or just cut off the money and create pressure?” Drummond and Naylor clearly think that efficiencies are lacking. The solution, said Naylor, is integrating services, including home care and virtual care. “There’s not a single province that has taken steps in that direction.”
  • CMA President Cindy Forbes agreed. “We need integrated, appropriate and high-quality care.” She gave the example of a patient in an acute care hospital discharged to community care and later moving to palliative care. “The patient goes through three different systems. They all have their own budgets and caregivers. These silos have to be broken down so it’s one system.”
  • She stressed the need for a national seniors’ strategy to address a population that is aging and living longer, often with complex, multiple diseases. Integrated services could address the patients needing an alternative level of care who currently occupy 20% of beds in acute care hospitals, she said. “They are not ‘bed blockers,’” she said. “They are waiting for long-term or home care.”
  • Naylor also thinks changing the way physicians are paid is part of the solution. “The fee schedule is full of perverse incentives. It doesn’t create ‘integrative quarterbacks.’ There should be rewards for good prescribing and shorter hospital stays.”
  • Wide variations in the price tag for health care among provinces and territories also stood out in the data. Costs in Canada’s provinces range from $5665 per person per year in Quebec to $7036 in Newfoundland and Labrador. (In the territories, costs are much higher.) Seven provinces devote more than 40% of their budget to health, of which two devote more than 45%.
  • Demographics and geography account for some of the variation, according to Brent Diverty, CIHI’s vice-president of programs, especially costs to transport critical cases from remote areas. However, panellists expressed concern about inequalities in quality of care and access.
  • “People who are covered for a drug in one province are not covered in another,” pointed out Forbes. “Especially cancer drugs, which are expensive.”
  • Naylor added, “There’s a huge challenge for the [federal/provincial/territorial ministers] to understand this variation. We need to unbundle why these disparities occur. How do we get to a common higher ground as Canadians?”
healthcare88

Freeze Sudbury hospital laundry contract until investigation clears up questions about ... - 0 views

cupe.ca/uestions-about-integrity-murky

cupe ochu ontario hospital cuts privatization

shared by healthcare88 on 25 Oct 16 - No Cached
  • Oct 21, 2016
  • With increasing scrutiny on the outcome of shared hospital services, questions are being raised about the “integrity of the process” used in awarding the hospital laundry contract to an out-of-Sudbury provider
Irene Jansen

Neena Chappell and Marcus J. Hollander. 2011. How we can sustain our health-care system... - 0 views

www.timescolonist.com/...story.html

home care substitution bc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • So what's actually causing the increases in our health spending? Evidence shows that the cost drivers are high technology, increased service utilization across all ages, and wage increases.
  • With good policy, it is possible to both provide better care, and reduce costs. This can be done, for example, by developing better, integrated systems of care delivery for older adults and people with disabilities.
  • home-care costs less than residential care, and is often more appropriate to the needs of the patient
  • ...4 more annotations...
  • actual cost savings can only be obtained in integrated systems of care that enable trade-offs between lower-cost homecare services and more costly long-term care facilities
  • Over a 10-year period from the mid-1980s to the mid-1990s, British Columbia had an integrated system that allowed it to restrain the growth of longterm care beds and invest new money into home care, which resulted, after 10 years, in estimated annual cost avoidance of about $150 million.
  • it is often non-professional supportive care that allows people to continue to function independently
  • A B.C. study found that people who had been evaluated by nurse assessors as needing homemaking services due to their frailty, and whose home care was discontinued, cost the system considerably more, three years later, than people in similar communities with similar conditions who had been able to maintain a modest level of home-support services over the same period of time.
Irene Jansen

Government will not merge health and social care budgets for the present, minister says... - 0 views

www.bmj.com/...bmj.e527

ltc home care NHS england individualized funding

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The government is not planning to merge health and social care
  • The minister was questioned by MPs on 17 January about integration, funding, and system reform in the final hearing of the committee’s inquiry into social care.
  • he said the government was doing many things to improve integration, such as setting new incentives for organisations to work differently, and a range of “nudges, pressures, and obligations” in the system. “The nearest thing to a game changer is personal budgets,” he said.
  • ...3 more annotations...
  • MPs repeatedly challenged the minister to accept there was a funding crisis in social care, warning that this could undermine integration and possible reforms such as those recommended by the Dilnot Commission on Funding of Care and Support, published last year.
  • some experts estimated that 900 000 people in the UK were left without basic care.
  • The health committee is due to report its findings on social care before the government publishes a white paper on care and support in the spring.
Irene Jansen

Social Affairs, Issue 5 - Evidence - October 27, 2011 - 0 views

www.parl.gc.ca/...05evb-e.htm

doctors education primary health care innovation accord hhr senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dr. Paul Armstrong, Founding and Former President, Canadian Academy of Health Sciences
  • As an example of these accomplishments, I would cite the work of CIHR funded researcher Dr. Cyril Frank and his team at the Alberta Bone and Joint Health Institute, who developed a new and more cost-effective model of care for hip and knee replacement. This model has markedly improved outcomes while decreasing hospital stays and wait times for surgery. For governments, the cost savings from a nationwide implementation of this model of care is estimated at approximately $228 million per year.
  • CIHR, in partnership with the provinces, universities, disease charities and the private sector, will be investing in a 10-year initiative to transform community-based primary health care.
  • ...10 more annotations...
  • It will be the largest scale initiative ever undertaken in Canada. Within five years, it will involve 30 per cent of Canadians from coast to coast, testing new innovative models of care, monitoring success and engaging a national and international network of senior policy-makers to investigate the conditions that will be necessary to scale up successful models of care. We will no longer be a country of pilot projects.
  • Dr. Armstrong: What we propose in our assessment is to redesign the way the health professions work with each other. As opposed to solo practitioners, we believe they should be integrated, and we believe this requires a substantial cultural change because the historical divisions around scopes of practice have led to a silo mentality, and the future is clearly an integration one.
  • Assuming we have an accord in 2014 to succeed this one, and assuming similar funding methods are used, what are the main proposals or incentives you think should be put to the provinces?
  • Dr. Armstrong: I believe we need to establish national standards and make our system accountable. We need to measure those standards. We need to get return on our investment that is more meaningful than we have in the past, and we need to emphasize innovative transformative change, then publish the results on an annual basis.
  • one of the gaps you are referring to is the lack of a robust, country wide technology assessment system
  • We take it for granted that we practice evidence-based medicine, but in fact we do that only in part.
  • We talk about 5 million Canadians not having access to a family doctor, but they should have access to an integrated health care team where the first point of care would not necessarily be a physician.
  • Public health interventions aimed at improving quality of lifestyle, food security and tax reforms with respect to sales tax on foods will be a way forward.
  • Not all physicians should be trained the same way and, indeed, for many the training is too long.
  • Dr. Tamblyn: I think you need to focus on the outcomes you are wanting to achieve in accordance with basic principles that we have been known for internationally, which is equitable access, appropriate care and so on, but you need to focus on preventing disease, reducing disparities and improving outcomes, and then you need to put something in an innovation fund to actually make that happen.
Govind Rao

Workplace Integration of New Nurses - Nursing the Future (WINN-NTF) Conference Nov 30 t... - 0 views

www.winn-ntf.com

nursing fromdelicious from heather conference

shared by Govind Rao on 07 Nov 13 - No Cached
  • Workplace Integration for New Nurses (WINN) Nursing The Future (NTF) proudly presents…
  • KEYNOTE SPEAKER Marlene Kramer, PhD, RN, FAAN   Challenges Encountered by New Graduates Integrating into the Contemporary Practice Setting Evening Address Tuesday, April 29, 2014 Facilitating A Successful Transition for New Nurses: The Role of Residency Programs Welcome Address Wednesday, April 30, 2014
  • Govind Rao on 07 Nov 13
     
    OCHU went to the 2010 conference in Ontario - Helen Fetterly and Diane Morin
  • Govind Rao on 07 Nov 13
     
    OCHU went to the 2010 conference in Ontario - Helen Fetterly and Diane Morin
Govind Rao

Ambulance services should be integrated into Canada's Health Act, group says - Calgary ... - 0 views

www.cbc.ca/...ealth-act-group-says-1.3187115

from heather ems user fees union

shared by Govind Rao on 19 Aug 15 - No Cached
  • Fees much higher for people who use emergency services by air and land out-of-province
  • Aug 11, 2015
  • Alberta's Amy Savill faces a bill for up to $30,000 after her water broke while she was on holiday in Ontario and she was flown by air ambulance to a hospital in Sudbury
  • ...1 more annotation...
  • The president of the Paramedic Association of Canada says no one should have to pay a large fee for an ambulance ride. "Ultimately, we'd like to see paramedic or ambulance services — whether that be land, air or community — be integrated and be part of the Canada Health Act and therefore it would fall under the same common principles that the rest of the health-care system does — that it's universal and that it's equitable," Chris Hood said.
Govind Rao

Home-care system failing patients; Expert panel is urging 'cultural shift' to focus on ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150313|216308825

from heather Ontario home care coalition

shared by Govind Rao on 13 Mar 15 - No Cached
  • Toronto Star Fri Mar 13 2015
  • Ontario's home and community care system is failing patients and their families and needs "urgent attention," says an expert panel tasked by the province to take a hard look at services and suggest fixes. "Everyone - clients and families, providers and funders - is frustrated with a system that fails to meet the needs of clients and families," says the strongly worded report released Thursday. It makes 16 recommendations aimed at making the system more accountable, transparent and co-ordinated. They are also focused on creating a "cultural shift," so that the system becomes centred around the needs of clients and families rather than those of service providers.
  • The 51-page report acknowledges the growing pressures on the more than three million unpaid caregivers in Ontario and calls for more respite services. The recommendations will require a cash infusion, but the report doesn't specify how much. The province currently spends about $5 billion on home and community care. "I want this report to have given the nudge to a robust family-centred model of integrated and co-ordinated care for families at home, and I think we have recommendations here that can begin to make that happen," said Gail Donner, former dean of nursing at the University of Toronto and chair of the expert panel. The report says clients and families are confused about the availability of publicly covered services, including support from visiting nurses and personal support workers, rehabilitation, transportation, home help and meals. "The assessment process for determining eligibility is not transparent," it says in reference to how care co-ordinators from community care access centres (CCACs) determine what publicly funded services patients will be able to receive.
  • ...2 more annotations...
  • The expert panel steered clear of making recommendations on structural problems, but acknowledged that the current structure is not working. That was a reference to the province's 14 CCACs and 15 local health integration networks (LHINs). CCACs co-ordinate home and community care for 700,000 clients, and LHINs plan and integrate health and community services. CCACs have been criticized for cutting client care when they are running deficits and for providing varying levels of service across the province. NDP health critic France Gelinas said the report validates concerns she has long been raising in question period. Conservative deputy health critic Bill Walker said he hopes the government adopts the recommendations as soon as possible. Health Minister Eric Hoskins said the recommendations will serve as an important guide, "as we improve and transform the home and community care sector."
  • Natalie Mehra, executive director of the Ontario Health Coalition, said she is concerned that a recommendation calling for LHINs to select a lead agency to design and co-ordinate delivery of services could lead to more privatization of health care. Earlier this week, the coalition released a scathing report on the state of home care in the province. Toronto resident Tracey MacMaster said changes are desperately needed. She believes that insufficient home care was one of the reasons her elderly mother suffered a stroke last August. Her mother lived alone in Burlington and was not eating properly and was not able to properly care for herself, said MacMaster, explaining that she had to make a big fuss with the CCAC and wait three months just to get her mother one hour of care a week.
Govind Rao

Ontario plans health-care overhaul; Changes to include deep reforms for home care, incl... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151124|234361282

from heather Ontario home care

shared by Govind Rao on 24 Nov 15 - No Cached
  • The Globe and Mail Tue Nov 24 2015
  • The Ontario government is preparing to overhaul health care in the province, including scrapping its troubled system for delivering home care and reforming primary care with the aim of improving patient access. The proposed changes, mapped out in a paper to be made public in the coming weeks, will be the focus of consultations in the new year and are expected to touch on all aspects of the health system.
  • A centrepiece of the proposals will be the expansion of the role played by the province's Local Health Integration Networks. At the same time, the province would eliminate Ontario's 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes. The agencies have long been a lightning rod for criticism, and were the focus of a Globe and Mail investigation this year that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.
  • ...8 more annotations...
  • As well, a report this fall from Ontario Auditor-General Bonnie Lysyk found that as little as 61 cents out of every dollar spent by the agencies goes to face-to-face client services, and discovered gaps in the level of care offered across the province. A second report on home care will be included in the Auditor-General's annual report in early December.
  • Suggested changes to the way primary care is delivered by family doctors and other health-care providers are also expected to gain wide attention, especially from doctors, who are in a battle with government over fees. Ontario Health Minister Eric Hoskins has been hinting for some time that change was in the works, but the existence of a policy paper and its contents have been kept under wraps.
  • Individuals familiar with different aspects of the document, who spoke to The Globe on the condition that they not be identified, describe it as "transformational" - a term that has become a favourite of the Health Minister. Earlier this month, Dr. Hoskins delivered a speech at a hospital conference in Toronto in which he repeatedly spoke of "system transformation" and the need for stronger "local governance."
  • The minister responded to questions from The Globe in a statement Monday night, saying that the ministry is "putting together a document which we hope will serve as a starting point for discussions and consultation about how we can better integrate various parts of the system and improve the patient experience." "We plan to share that discussion document in the coming weeks and will be engaging with our partners, including care providers and the public, to solicit feedback on those ideas to achieve deeper integration," the statement said.
  • The plans for change come at a critical time for Ontario's Liberal government as it looks to cut costs and tame the provincial deficit. To do that, keeping health-care spending in check is imperative, but the minister has also pledged to make improvements such as ensuring more people have access to primary care, and are not reliant on walk-in clinics and emergency rooms for after-hours nonurgent care. Any efforts to change how primary care is paid for or organized are likely to meet resistance from doctors, who are already at odds with the province after it imposed a contract and two rounds of fee cuts this year.
  • An expert panel report on primary-care reform - released quietly this fall and widely criticized by doctors - recommends dividing the province into "patient care groups," similar to school boards, with each group responsible for ensuring every resident in the area has access to primary care. As a prelude to the coming reform, at least one merger plan among two hospitals and a CCAC was paused this fall after the ministry advised the boards involved of the coming changes.
  • John Davies, chair of the board of William Osler Health System in Brampton, Ont., said merger talks with the Central West CCAC and Headwaters Health Care Centre in Orangeville, Ont., were suspended after deputy Health Minister Bob Bell wrote to them a few weeks ago advising them to suspend talks because of the coming reforms. Those familiar with the proposed reforms say the beefed-up local health networks will be given responsibility for overseeing home care, with front-line workers and case managers retaining their jobs.
  • "For the client, there will be no change," one source said. Some aspects of home care involving patients who have been hospitalized will continue to move over to a new model called "bundled care," which has been piloted by St. Joseph's Health System in Hamilton and was recently expanded to six other sites, one source said. The province will also look at tailoring care delivery to the needs of local communities, with different models possible for urban and rural settings, another source said.
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