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Irene Jansen

Patient advocates help bridge the gap - 0 views

www.leaderpost.com/...story.html

advocate privatization navigator quebec

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Patient advocacy has always existed, but experts say that the phenomenon has become more pronounced than ever
  • the issue has caught the attention of the Canadian Medical Association Journal. In a two-part series published last week, the CMAJ concluded that "patient navigators (are) becoming the norm in Canada."
  • Historically, hospital social workers have fulfilled the role. But friends and relatives of patients have often stepped in to help. During the 2004 C. difficile hospital epidemic in Montreal, some family members whose loved ones fell ill from the diarrhea-causing bacterium told The Gazette that they hired private cleaners to scrub patient rooms.
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  • Today, patient advocacy has even evolved into a commercial industry of its own, with the so-called professional patient navigator - at least in the United States. But there are also signs of it emerging in Canada, too.
  • The U.S. advocates will accompany patients to their medical appointments with a prepared list of questions for the doctor. Afterward, they will follow up with the patients to make sure they're taking their prescriptions. They educate patients about treatment options that they might not have been aware of, especially after a cancer diagnosis. They also co-ordinate care among the various specialists a patient might see. Fees range from $75 to $400 an hour.
  • There are about 2,000 patient advocates in the U.S. - a tiny percentage of the population, but the number is climbing every year.
  • Llewellyn said her company is interested in expanding into the Canadian market.
  • In Montreal, a couple of private companies that specialize in services to the elderly - like finding placement in a seniors' residence - are also beginning to advertise limited patient advocacy.
  • Some observers argue that the need for patient advocacy is even stronger in Quebec because two-tier medicine is more entrenched here than elsewhere in the country.
  • Quebec has responded to what many have called the cancer crisis by creating the new position of the infirmiere pivot - a nurse who acts as a navigator for cancer patients. There are about 270 infirmieres pivot in Quebec, and other provinces have set up similar positions.In addition to the infirmiere pivot, CLSC clinics assign social workers and nurse liaisons to advocate on behalf of patients. Then there are hospital social workers like Johanna Salvanos, who assists the elderly in the geriatrics department at the Jewish General.
Govind Rao

Why are patients isolated due to antibiotic-resistant "superbugs" even if they're not s... - 0 views

healthydebate.ca/...-resistant-superbugs-isolation

from heather hai hospital

shared by Govind Rao on 10 Sep 15 - No Cached
  • by Paul Taylor (Show all posts by Paul Taylor) September 8, 2015
  • The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskPaul@Sunnybrook.ca Question: My mother has been hospitalized several times for heart problems.  Most recently, she was put into a room without any other patients and we had to wear disposable gowns and gloves to visit her.  The doctor said my mother was “colonized” by antibiotic-resistant bacteria. The bacteria didn’t actually make her sick, but the doctor said the germs might spread to other patients. It seemed to be a lot of fuss over nothing – not to mention a waste of money for all those disposable garments.  Did the hospital overreact?
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

The rise of the private patient advocate - Healthy Debate - 0 views

healthydebate.ca/...patient-advocate

from heather privatization advocate

shared by Govind Rao on 16 Apr 15 - No Cached
  • by Ryan O'Reilly, Mike Tierney, Andrew Remfry & Jeremy Petch
  • April 16, 2015
  • Maureen struggled with her condition for a number of years, until a friend of her daughter recommended she speak with Laurie Jenkins, a patient advocate from Healthcare Navigators Inc. After hearing Maureen’s story, Jenkins believed that she could help, and convinced Maureen to get a new MRI. Once that was completed, Jenkins spoke with Maureen’s family doctor about referring her to a surgeon who had expertise in similar cases.
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  • Jenkins proceeded to not only arrange an appointment with the surgeon, but accompanied Maureen to the hospital and provided the surgeon with a detailed medical history of her previous encounters with the specialists. Once the details of her case were laid out, the surgeon quickly diagnosed her complaint and recommended back surgery.
  • Unfortunately, the issues Maureen faced in accessing the appropriate care and treatment are not uncommon. For many patients, simply navigating the health care system can often feel like wandering through a maze. Especially for seniors, staying on top of appointments, medications and lab tests can quickly become overwhelming. “It’s easy to get lost… it’s not that [patients] don’t have faith in their providers, they just have questions and there’s no one to ask,” explains Jenkins.
Irene Jansen

Center for Medicare Advocacy - 0 views

www.medicareadvocacy.org

organization advocate us us medicare

shared by Irene Jansen on 23 Jan 12 - Cached
  • Irene Jansen on 23 Jan 12
     
    JUDITH STEIN Executive Director in NYT December 2011: Your editorial about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage. I have been an advocate for Medicare beneficiaries for almost 35 years. I've seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program. I don't recommend a private plan to my mother. That should be a good test for anyone championing premium support. Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system. Call it what you will, "premium support" is the latest jingle for privatizing Medicare. It's not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what's needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
Govind Rao

Part-time maternity ward proposed for town; Rather than closing the $1.4-million unit i... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150501|219569967

from heather hospital cuts Ontario

shared by Govind Rao on 01 May 15 - No Cached
  • The Globe and Mail Fri May 1 2015
  • The navigation centre would be funded with "existing resources," while the hospital would save money by no longer paying obstetrical nurses to wait on standby in the maternity ward when it is empty. "I think it has tremendous potential," said Martin Girash, chair of the local LHIN's board. Although he could not speak on behalf of the full board, he plans to vote in favour of the panel's recommendations at a public meeting on May 5, after which community members will have 30 days to submit written comments before a final decision is made. Angelina Chan, Leamington's only obstetrician-gynecologist, also voiced reservations about the panel's proposal. The navigation centre, she said, sounds like a duplication of the kind of integrated care Ontario's family health teams already provide. And the "turn-on-the-lights" approach at the ward could be perilous, depending on how it is implemented, she added. "Is there still an [obstetrical] nurse in the building to do that initial triage and assessment or, when the [woman] arrives, are we calling in anybody that's obstetrically trained to handle the situation?" Dr. Chan said. "If it's the latter situation, I don't think that's safe."
Govind Rao

Sudbury hospital teams up with health centres to help aboriginal patients - Sudbury - C... - 0 views

www.cbc.ca/...-aboriginal-patients-1.3195229

from heather Ontario aboriginal

shared by Govind Rao on 20 Aug 15 - No Cached
  • New health care helpers part of shift to deliver more services in the community and outside of institutions
  • Aug 18, 2015
  • More aboriginal patients in the northeast are getting help to figure out the healthcare system. This spring, Health Sciences North created a formal process to refer patients to patient navigators at three aboriginal health centres. The positions have been in existence for the last few years, but because there was no formal process, many patients weren't receiving help. Aboriginal patient navigators help patients access better care by helping with things such as appointments and paperwork.
Heather Farrow

Canadian Health Care in 2035: Four Scenarios on the Future of Health Care Funding - 1 views

www.conferenceboard.ca/...abstract.aspx

conference funding privatization

shared by Heather Farrow on 10 May 16 - No Cached
  • The Conference Board of Canada, June 21, 2016 at 02:00 PM EDT Live Webinar by Satyamoorthy Kabilan
  • Webinar Highlights Join Satyamoorthy Kabilan, Director of The Conference Board of Canada's National Security and Public Safety, and strategic foresight teams for this 60-minute webinar, in which you will learn about: Seven key health system drivers that will affect future health care funding models Five strategic elements decision-makers must consider regardless of how our world evolves How strategic foresight can be used to improve our chances of successfully navigating a range of possible health care funding futures The session will be introduced by Thy Dinh, the Conference Board's Director of Health Economics.
Irene Jansen

Nurse helps patients navigate care - Owen Sound Sun Times - Ontario, CA - 0 views

www.owensoundsuntimes.com/ArticleDisplay.aspx

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Banks, a registered nurse, heads up a new program for lung cancer patients that gives them emotional support but also helps them through the maze of tests, medical appointments, diagnoses and the start of treatment. She works out of the Owen Sound hospital and sometimes receives a faxed referral from a doctor’s office before the newly diagnosed patient even leaves the building.
  • Banks, a registered nurse, heads up a new program for lung cancer patients that gives them emotional support but also helps them through the maze of tests, medical appointments, diagnoses and the start of treatment. She works out of the Owen Sound hospital
  • The program is funded through Cancer Care Ontario
Govind Rao

Government of Canada Funds Research on Teams to Strengthen Healthcare - Press Release -... - 0 views

www.digitaljournal.com/1746160

shared by Govind Rao on 19 Feb 14 - No Cached
  • Government of Canada Funds Research on Teams to Strengthen Healthcare HAMILTON, ONTARIO--(Marketwired - Feb. 19, 2014) - Health Canada Today, Parliamentary Secretary Eve Adams on behalf of the Honourable Rona Ambrose, Minister of Health, announced $6.5 million in funding to McMaster University for a project to study the use of team-based care as a way to achieve better health outcomes for patients and make the system more cost effective.
  • The project: "Teams Advancing Patient Experience: Strengthening Quality," (TAPESTRY), will examine how changing the way a primary healthcare team operates and interacts with its patients can improve the quality and efficiency of primary healthcare services. By integrating resources such as community volunteers, eHealth technologies and system navigation, the project will support patient-centred care and stronger connections to community services. The TAPESTRY project is expected to provide valuable information regarding ways to increase access to primary healthcare services. The initiative aims to generate evidence and develop tools to assist provincial and territorial governments in addressing ongoing primary healthcare challenges.
  • Quick Facts The Government of Canada is one of the largest investors in healthcare research with more than $1 billion invested annually. The Government of Canada has increased health transfers to the provinces and territories to unprecedented levels. This funding will continue to grow, reaching $40 billion by the end of the decade. The need for innovation, both in terms of medical technologies and healthcare delivery systems, is a significant public policy challenge that the Government of Canada is committed to addressing.
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  • Quotes "Innovation is critical to improving the efficiency of the healthcare system but also to helping Canadians maintain good health. This project is looking at innovative ways that health professionals can work together to provide care to Canadians." Eve Adams, Parliamentary Secretary to the Minister of Health "We're finding ways to combine the personal touch of community volunteerism and the latest technologies to improve primary health care. The TAPESTRY project will connect citizens with their health care team to encourage early identification of potential health problems. This is important for Canadians and for the efficiency of our health care system." Dr. David Price, Professor and Chair, Department of Family Medicine, McMaster University
Govind Rao

Government of Canada Funds Research on Teams to Strengthen Healthcare - EIN News - 0 views

www.einnews.com/...teams-to-strengthen-healthcare

from heather research staffing government

shared by Govind Rao on 25 Feb 14 - No Cached
  • HAMILTON, ONTARIO -- (Marketwired) -- 02/19/14 -- Health Canada
  • Today, Parliamentary Secretary Eve Adams on behalf of the Honourable Rona Ambrose, Minister of Health, announced $6.5 million in funding to McMaster University for a project to study the use of team-based care as a way to achieve better health outcomes for patients and make the system more cost effective. The project: "Teams Advancing Patient Experience: Strengthening Quality," (TAPESTRY), will examine how changing the way a primary healthcare team operates and interacts with its patients can improve the quality and efficiency of primary healthcare services. By integrating resources such as community volunteers, eHealth technologies and system navigation, the project will support patient-centred care and stronger connections to community services.
Govind Rao

Improvements suggested to the health system that failed Greg Price - Healthy Debate - 0 views

healthydebate.ca/...hqca-greg-price

from heather Alberta case study privatization

shared by Govind Rao on 13 Mar 14 - No Cached
  • by Karen Born, Andreas Laupacis & Sachin Pendharkar
  • March 13, 2014
  • Greg Price died at the age of 31. His death may have been preventable had he been diagnosed and treated earlier for testicular cancer. He was left alone to navigate the health system and follow up on referrals, while experiencing major delays and the absence of communication and information.
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  • His journey through the health system, and untimely death, were the focus of a December 2013 Health Quality Council of Alberta (HQCA) study.  
Govind Rao

The right's latest Obamacare lie: Scapegoating America's seniors - Salon.com - 0 views

www.origin.salon.com/..._scapegoating_americas_seniors

from heather ltc costs

shared by Govind Rao on 14 Nov 13 - No Cached
  • Thursday, Nov 7, 2013
  • The right’s latest Obamacare lie: Scapegoating America’s seniors Obamacare foes blame the elderly for rising healthcare rates. Don't believe them Martha Albertson Fineman and Stu Marvel
  • We have had plenty of time to consider the possible implications of the inevitable aging of the baby boomers and respond with appropriate policies before a crisis emerged. Investment in the health of every person would have been a good place to begin.  As research data from our northern neighbors handily proves, the notion that the elderly are inevitable money pits for health dollars is simply not true. Last year the Canadian Institute for Health Information [CIHI] examined thirty-five years of health care costs with a particular focus on aging populations. Like other industrialized countries
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  • Contrary to the conventional belief that an aging population will overrun hospitals and accelerate growth in health spending, the CIHI reported that elderly-related care actually accounted for a minimal 0.8 percent annual increase in annual costs. An official behind the study, Jean-Marie Berthelot, remarked on how surprisingly marginal the impact of seniors actually is: “Over the past decade, the proportion of health dollars spent on seniors…has remained relatively stable at 44%. This tells us that spending on seniors is not growing faster than spending for the population at large.”
Govind Rao

6 reasons privatization often ends in disaster - Salon.com - 0 views

www.salon.com/...often_ends_in_disaster_partner

from heather privatization

shared by Govind Rao on 14 Nov 13 - No Cached
  • Thursday, Oct 24, 2013
  • 6 reasons privatization often ends in disaster Inequality is much more pervasive in the private sector. Just look at the median salary for US workers Paul Buchheit, AlterNet
  • 1. The Profit Motive Moves Most of the Money to the Top
  • ...5 more annotations...
  • 2. Privatization Serves People with Money, the Public Sector Serves Everyone
  • 3. Privatization Turns Essential Human Needs into Products
  • 4. Public Systems Promote a Strong Middle Class
  • 5. The Private Sector Has Incentive To Fail, or No Incentive At All
  • 6. With Public Systems, We Don’t Have to Listen To “Individual Initiative” Rantings
Doug Allan

A frightening time to be old | Toronto Star - 0 views

www.thestar.com/...rightening_time_to_be_old.html

LTC ALC

shared by Doug Allan on 10 Jun 14 - No Cached
  • On a weekly basis, once her condition was deemed “non-medical” and therefore no longer the hospital’s issue, I was pressured to put her into some alternative. Luckily I was able to take a compassionate care leave from work to investigate her options and research her rights (a kind CCAC worker suggesteed I call ACE).
  • Despite completing the applications for nursing home care, she still has a wait of potentially one year or more until a spot opens for her at one of the nursing homes we selected. Yes, there are others available sooner, but one look at Ministry reviews of some of those, and you wouldn’t put your goldfish in one. Lists of infractions are the deterrent.
  • He was in hospital for roughly three weeks, at which point, we were told by the discharge planner that Dad was “ready to come home”.
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  • Since March 19, 2014, when my 87-year-old father was admitted to hospital, we have been put through hell trying to arrange appropriate care for him.
  • As this was not feasible, given the fact that he could not safely navigate the stairs, we were told that we would have to put Dad into a retirement home in the “Wait at Home” program. We were instructed to find such a facility immediately and let them know, and to sign a consent for placement. At no time were we told that there were any other options available. We were told that the Wait at Home Program was for a period of up to 45 days, and that during that time, Dad would be assessed by CCAC for determination as to whether he was in crisis. CCAC agreed to put in place nursing care and personal support workers during Dad’s stay in the retirement home, up to a maximum of 21 hours per week, which under Dad’s circumstances was ludicrous.
  • We arranged for Dad to be admitted to a retirement home which cost $115/day, a fee we could not afford. The retirement home director sent a representative to the hospital to determine Dad’s needs and subsequently said they were “comfortable with the level of care required.” Within the two days there, Dad fell and hit his head. Dad told us this – the staff did not; however, they confirmed it when we asked about it. The personal support workers were “not allowed to feed Dad.”
  • Approximately 6 days into the program, Dad was returned to hospital from the retirement home with a urinary tract infection. The hospital emergency staff simply x-rayed, reinserted a catheter and sent Dad back to the retirement home at 3:00 a.m. by ambulance. Three days later, the retirement home again called an ambulance because Dad was not eating, and his oxygen levels were low. He was admitted to a Toronto hospital and was diagnosed with pneumonia.
  • The staff at the Toronto hospital advised that Dad had “so many acute issues” (pneumonia, Parkinsonism, Dementia) that a retirement home was neither equipped nor staffed to properly care for him. It was determined that not only could Dad not walk, but he could not even stand up without being assisted by two staff. My complaint is that at no time did the discharge planners / social workers during Dad’s first hospital stay advise us of any manageable options, we were railroaded by discharge staff to place Dad in a facility which was in no way equipped or staffed to care for him, and that was impossible for Dad to afford, and we were advised that placement into a long term care facility directly from hospital was impossible. We were not told about interim beds until after we had committed to place Dad in a retirement home.
Govind Rao

Ontario vows 'self-directed' home care; Pilot project would give patients or their care... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|ntgm|20150514|220448040

from heather cupe Ontario hospital home care privatization cuts

shared by Govind Rao on 14 May 15 - No Cached
  • The Globe and Mail Thu May 14 2015
  • n a bid to respond to a blistering report on home care in Ontario, the provincial government is promising a series of minor fixes to the system, including a Canadian-first pilot project that would give patients or their caregivers money to spend on the home health services of their choosing. Details were scant on the government's plans for experimenting with "self-directed care," an approach that Health Minister Eric Hoskins said is already working well for some parents of autistic children who have been given the flexibility to spend public funds on the programs they believe are best for their children. Dr. Hoskins said that although it was too early to say where the pilot programs would be located, who would qualify or how much they would cost, he was excited about eventually offering more choice to patients as they heal or age at home.
  • "We will provide them with the funds to effectively purchase their own home care under terms where they will have even greater control," he told reporters Wednesday at The Second Mile Club, a seniors' day program in Toronto. "We'll start, obviously, at a smaller scale to allow us the opportunity to make sure we get it right." The minister also announced some other changes to the home-care system, including $5-million for funding 80,000 more hours of at-home nursing care by raising the cap to 150 visits per month from the current limit of 120; developing a "statement of values" for the system; and making it clear which services are available to patients in their homes, no matter where in the province they live. He rehashed some old promises, too, including the extension of 5-per-cent annual increases in funding for home and community care and the phasing in of a $4-an-hour raise for home-care personal support workers, which The Globe and Mail reported has been delayed this year because of problems with the rollout last year.
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  • Experimenting with self-directed care was one of 16 recommendations for improving home care made in March by a group of experts led by Gail Donner, the former dean of the Faculty of Nursing at the University of Toronto. "It's a positive first step, a really good beginning," Dr. Donner said Wednesday of the minister's 10-point plan. "I'm glad he mentioned this is the first phase because we have still lots of work to do in the transformation." Dr. Donner's report criticized Ontario's publicly funded home care sector as disjointed, opaque and onerous to navigate, making it "a system that fails to meet the needs of clients and families." But the report also acknowledged the breadth and depth of the challenge faced by the 14 local Community Care Access Centres (CCAC) that co-ordinate home care in a province that is moving aggressively to keep patients out of expensive hospital and nursing home beds. Although the Liberals have doubled funding for home and community care since taking office in 2003, the number of patients receiving services through the CCACs has also doubled in that time, with a sharp increase in the number of complex-needs, long-term patients seeking care, the report said.
  • Auditor-General Bonnie Lysyk is currently investigating the CCACs, but she told The Globe and Mail Wednesday that her findings will be released in the fall, not this spring as was widely expected. Her audit will be released in two parts - the first will respond directly to a request from opposition members of a legislative committee and the second will be part of her annual report in December. Some groups, including the Registered Nurses' Association of Ontario, have called for the CCACs to be scrapped altogether, but both Dr. Donner and Dr. Hoskins said Wednesday that basic fixes must precede larger reform. "We believe we need to get ... some consistency, transparency and accountability into the system," Dr. Donner said. "Then, do we need to deal with the structure? Yes, we do. Our view was that's not where you start." The provincewide organizations that represents the CCACs welcomed the minister's announcement, as did the health-care arm of the Service Employees International Union , the labour group that advocated for the raise for personal support workers. But Michael Hurley, the president of the Ontario Council of Hospital Unions, which is part of CUPE, slammed the plan as falling woefully short of the needs in the sector.
  • "We can't pretend to people that it's possible to downsize the acute-care sector and that they can rely on the community sector without a substantial investment and this doesn't deliver that," he said. "We haven't been given a system - we've been given another announcement of an another experiment."
Govind Rao

Health minister taking home care in wrong direction with do-it-yourself, "self-directed... - 0 views

cupe.ca/lf-self-directed-care-approach

from heather Ontario home care privatization cupe

shared by Govind Rao on 14 May 15 - No Cached
  • May 14, 2015
  • Far from being the “fix” to Ontario’s disjointed and under-resourced home care system, today’s announcement by the health minister for “self-directed” home care is “taking us further in the wrong direction,” says the Canadian Union of Public Employees (CUPE) Ontario.
  • Rather than building a home care system based on the principles of universal access to care, “the Ontario Liberals are downloading the responsibility of home care provision to sick, vulnerable patients and their families, through a do-it-yourself approach that they are flogging as individual control and choice over care,” says CUPE Ontario health care committee chair Kelly O’Sullivan. Under the “self-directed” care model, health minister Eric Hoskins announced this morning, families would be given a pot of money and they would be left to their devices to source and navigate a myriad of services in the community.
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  • The 80,000 new care hours announced today are a “drop in the bucket. This falls far short of what’s actually needed to increase patient care. If it weren’t so sad that patients pushed out of hospital sicker than ever need every little bit of additional home care provided, the increase in care hours would be laughable,” says Hurley.
Govind Rao

MUHC irons out glitches on first full day at Glen site - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|mtgz|20150428|219341247

from heather p3 hospital Quebec quality

shared by Govind Rao on 28 Apr 15 - No Cached
  • Montreal Gazette Tue Apr 28 2015
  • n its first full day of operations, doctors at the MUHC superhospital examined patients with a wide range of ailments, the emergency room was 27 per cent occupied and staff continued to become acquainted with the sprawling facilities. Some patients said they were impressed with the Glen site of the McGill University Health Centre, while one disabled man expressed frustration on Monday about a lack of access to the superhospital. Meanwhile, a union representative complained that the access passes to restricted areas for certain employees weren't working.
  • Parts of the Glen site were still a construction zone one day after the historic move of 154 patients - including 15 babies - from the Royal Victoria Hospital on Mount Royal. The move went much more smoothly than organizers expected, but with the superhospital now open, there are a number of glitches that will need to be addressed in the coming days. Pierre Vaillancourt, who is disabled and in a wheelchair, went to see his doctor for an appointment, but soon grew upset when his companion, Diane Perron, couldn't find a chair to sit on in the waiting room. At one point, Perron needed to go to the bathroom, but the door was locked.
  • ...4 more annotations...
  • After the appointment, the two waited forlornly in the lobby for more than an hour for an adaptedtransport vehicle. Perron, who is not disabled, sat in a wheelchair because there were no seats in the lobby. As she wheeled Vaillancourt to a waiting taxi van, his wheelchair got stuck in several decorative grooves in the pavement outside the entrance to the new Royal Vic. "That's terrible," Perron said of the pavement for those who must use wheelchairs. "It's a beautiful building, but they are not yet ready to receive patients," Vaillancourt said. However, another patient, 76-year-old Shirley Ann Wood of LaSalle, praised the ultra-modern facilities of the superhospital, especially its "fast" elevators. Wood had just seen her cardiologist for a checkup and was sitting on a wooden bench outside waiting for her daughter to pick her up.
  • Wood said she was initially skeptical about the superhospital - having gone for years to the Royal Vic on Pine Ave., first for her mother, then herself - but was won over. "Everything is clearly marked and it's easy to get around," Wood said. "It's really nice." But Daniel Andrade, a representative of the MUHC Employees Union affiliated with the CSN, noted that some people found it difficult navigating the many corridors of the superhospital. "It would be nice to have more people standing around directing people to where they need to go," Andrade said.
  • He identified a number of what he called "hiccups," such as the phone system not working properly, some employees not having phones or computers, printers that were not yet attached and the access cards malfunctioning. Ironically, Andrade added, his card gave him access to every restricted department at the Glen site, and that's not supposed to be the case. Those problems should be ironed out, but Andrade expressed concern that the superhospital won't have enough support staffto function smoothly. Two years ago, the Quebec government imposed $50 million in cuts to the MUHC's operating budget. The $1.3-billion superhospital was built as a public-private partnership to avoid cost overruns. However, design-build contractor SNC-Lavalin is demanding an extra $172 million for what it argues were unforeseen expenses.
  • SNC-Lavalin delayed handing over the keys to the superhospital by five weeks, which caused delays for the MUHC in "activating" equipment. On Monday, construction workers walked past the new entrance even as patients filed out. As of 4 p.m. Monday, the number of in-patients at the superhospital stood at 125, down from the 154 transferred on Sunday. The volume of outpatient visits was 25 per cent of the normal rate but is expected to rise gradually this week. On Sunday night, the superhospital performed its first operation, an appendectomy, followed by a Cesarean section on Monday. Dr. Ewa Sidorowicz, the MUHC's associate director general of medical affairs, has said that the hospital network will concentrate first on emergency operations and then ramp up the volume of elective surgeries. aderfel@montrealgazette.com twitter.com/Aaron_Derfel
Govind Rao

When does a bath become a necessity? - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150422|218933908

from heather ltc safety medicare

shared by Govind Rao on 22 Apr 15 - No Cached
  • The Globe and Mail Wed Apr 22 2015
  • How many times a week should a nursing home patient get a bath? If one bath weekly, the standard, is deemed insufficient, should patients be able to pay for more? That debate, which has been raging in Quebec in recent days, perfectly captures two of the principal challenges faced by Canada's system and its aging cohort of baby boomers: What exactly are patients entitled to under medicare?
  • Should patients/clients be able to (or obliged to) pay out-ofpocket to bolster the care that the publicly funded system offers? Generally speaking, public health insurance plans (medicare for short) cover "medically necessary care," and that is defined as physician and hospital services. However, all provinces and territories provide some additional public coverage of prescription drugs, home care and long-term care. The philosophy, though never explicitly stated, is that medicare should cover the basics, and the "extras" should be paid for with supplementary private health insurance or out of pocket. About 30 per cent of healthcare services in Canada are paid for privately, 70 per cent with tax dollars. The problem is that it is rarely clear where the lines are drawn and why.
  • ...4 more annotations...
  • Bathing is a good example: At what point does caring for the personal hygiene of a patient move from necessity to luxury? Should patients have choice in these matters, or do you have to give up your voice and succumb to the whimsy (and cost controls) of the system? In Quebec, Health Minister Gaetan Barrette said that "black market baths" (those provided by staff of publicly funded longterm homes in their off-hours) were unacceptable, but he defended the one-bath-a-week standard. He added that families unhappy with that level of care could bathe loved ones themselves or hire outside help. Seemingly trivial issues like bathing are essential elements in the care of frail seniors. But how do we regulate these matters?
  • And how do we offer quality care and choice, while keeping costs affordable, and maintaining equitable access to care? There are roughly 400,000 residents of long-term care facilities, and they live in a mix of privately and publicly owned homes. Eligibility criteria and costs vary between jurisdictions: What you pay can depend on your age, income, medical condition, province of residence, and your ability to navigate Byzantine rules. National data are hard to come by, so let's take Ontario as an example. There are 77,101 long-stay beds.
  • Getting a spot depends on level of frailty and availability. There were, at last count, 23,436 people waiting for a long-stay bed in the province and the median wait is an excruciating 108 days. For eligible patients, the province pays $137 a day per resident (just over $50,000 a year) - of which $91 goes to nursing and personal care, $11 for therapy and recreational programs, and $8 for food. (It's no wonder that the No. 1 complaint of institutionalized residents is the quality of food.) That costs the province $4-billion a year. In addition, residents and their families are expected to pay their "room and board," but the province sets daily maximums, ranging from $36.85 (for temporary respite) to $80.18 (private long stay). That means residents pay up to $30,000 out of pocket annually, but there are subsidies available for low-income residents. Virtually no one in Canada has long-term care insurance.
  • On average, patients spend about five years in institutional care, but that number is falling as people go to long-term care later and sicker. Instead, they require home care, which is also costly, and can be a great strain on family caregivers. No one wants to live in longterm care or a nursing home - or so goes the commonly held belief. What people fear is warehousing and loss of dignity, as exemplified by the notion that they won't even get bathed. The reality is that, despite some highly publicized abuses, long-term care homes do not deserve the horrible reputation they are saddled with: Most do a decent job of caring for their charges, given the challenges they face and the resources they have. But the broader problem with long-term care, as with much public policy related to seniors, is that there is no plan. If we're going to deliver necessary, appropriate care for the aging population of baby boomers, we have to start with a cold, hard calculus of the cost of meeting (or not meeting) those needs. If we want quality care, we're going to have to pay for it, individually and collectively. Getting the right mix of private and public spending is key to ensure no one is left out in the cold.
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