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Canada would benefit from a coordinated approach to price determination.

We recognize that the future of health care is digital and this strategic investment will make us a better health and wellness partner to patients and providers," said Loblaw spokesperson Tammy Smitham. "QHR brings complementary talent and technology to our organization, providing opportunities to establish new business partnerships and drive improved care co-ordination for Canadians." Smitham said that Loblaw has no short-term plans to change the way its pharmacy business operates - but that the company is hopeful the acquisition will in the long term make its patient care more efficient, and allow it to work with more health care providers beyond the pharmacy niche. In recent years, retailers including Shoppers have added medical services, notably dispensing flu shots and prescription renewal services, as governments have sought to regulate the professional allowances pharmacies receive from drugmakers. RBC Dominion Securities analyst Irene Nattel said in a note that the QHR acquisition will have negligible impact on Loblaw's results but should fit alongside the company's existing pharmacy and health care operations.

QHR's shares climbed 22 per cent to close at $3.10 on the TSX Venture Exchange Monday. Loblaw shares were up one per cent, closing at $71.81 in Toronto. Loblaw has looked to its Shoppers division to deliver new avenues for earnings growth, as competition for sales volume in its grocery business has expanded beyond traditional competitors like Metro Inc. and Sobey's to include big-box retailers Costco Wholesale Corp. and Walmart Canada.

The Shoppers acquisition in 2014 gave Loblaw access to smaller sized stores in high-density urban neighbourhoods. Following the introduction of increased food and grocery offerings at its drugstores, revenue growth at Shoppers Drug Mart outpaced other parts of the company's business in the second quarter.

It appears that increased use of data may be the only thing we can be certain of in the future of health care. And so its ice storm-proof data room – “the heart of the whole hospital,”

Improved security in the hospital was also a prime consideration. That was of particular concern in the maternity ward.

new Mackenzie Vaughan Hospital, set to open in 2019-20.

along the lines of how an automotive plant gets built.

You put the assembly line and all the technology and the robotics in first, and then you put the shell around that assembly line because that’s the more expensive, complex piece,” he says.

He envisages hospitals eventually becoming “the hub of co-ordinating care,” but a place where patients come as a last resort.

For example, Philips is undergoing a pilot study with Trillium Health and Cancer Care Ontario with cancer patients coming out of hospital where they can remotely monitor white blood-cell count, a key indicator of how they are doing, and whether they have to come back to the hospital.

The measures make age-old tasks more efficient. They might also dredge up worries about a patient's every move being tracked and whether it's entirely safe to have machines mix and process toxic drugs. To the skeptics, Collins responds: "It's safer to have an alarm telling me if (a patient) got out of bed and fell, than not knowing," and "Robots are robots, but they still need monitoring."

That's why employees will be on hand to double-check robot-filled prescriptions and to ensure equipment is working correctly, while still delivering a human touch. If you're fretting about how many employees were cut loose to make way for technology, the hospital has an answer for that, too. Rather than using technological efficiencies to axe jobs, the hospital has hired 700 more employees to staff the hospital's 656 rooms - 80 per cent of which are single-patient spaces.

Unlike the old Humber River Hospital, the private rooms allow the hospital to nix restricted visiting hours and to place chairs that convert into beds in every room for use by family members - who "are encouraged to stay over." For out-of-town family or those who face extenuating circumstances, there is even an "amenity" suite on each floor, with a bed and bathroom for overnight stays.

Implementing the policy and building the hospital into a futuristic facility "hasn't been all smooth," says Collins. There were tussles about getting electronic features to "speak to each other" and naysayers to prove wrong, including a former deputy health minister, whom Collins refused to name, who insisted renovations could be made to the old hospital instead of building a new one. That deputy minister has since had a change of heart, claims Collins, but it's hardly a surprise to her. After 15 years planning the new facility, she says without hesitation: "This could well be a model."

Bedside terminals act as a computer, phone, record display, menu and radio. Built-in cameras let patients communicate with family members or nurses.

To read the full report, please click here

The Standing Senate Committee has asked Canadians to answer the question: Excluding increased funding, what are the three most important areas of government responsibility (either federal or provincial) that need to be improved to ensure adequate and timely access to needed mental health services?

Three Priorities for Action

1) Act outside of the traditional health care sector: Ensure access to housing, supportive housing, income, and employment.

2) Include mental health in health care reform initiatives.

Expand coverage under the Canada Health Act

include home care under the Act and to ensure public funding for the costs of medications prescribed outside of institutions

reinforce the work already underway by First Ministers to expand home care to people with mental illness

include people with concurrent disorders and addictions in any national home care program

3) Develop a National Action Plan on Mental Health.

Until quite recently, you could say that pharmaceutical drugs were far more regulated than medical devices.  That's changing, albeit slowly.  Last June, the Auditor General issued a report on the job Health Canada is doing regulating medical devices.  Among the main conclusions:  more than 45 percent of the time Health Canada does not meet its service standards for timely review of medical device submissions

As well, Health Canada has not established what levels of activity are needed to protect the health and safety of Canadians. 

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

To make aging at home a reality for all Canadians, we must redesign the delivery of home care to make it more accessible, accountable and affordable.

As government funding continues to decline, unpaid caregivers — typically a spouse or child — are having to fill the gap or pay out of pocket to hire care privately. In 2007, approximately 3.1 million Canadians, largely women between the ages of 45–64 years old (44%) (StatsCan 2012), were estimated to act as an informal caregiver to their loved ones, providing over 1.5 billion hours of care annually.

These caregivers provide 10 times the number of care hours by formal services, which is not only taxing on their personal well-being and their relationship with their recipient, but also on Canada’s economy — the cost to businesses from absenteeism and turnover related to unpaid care was estimated to be $1.28 billion in 2007.

The Caring Economy is made up of for-profit marketplaces that serve the needs of others. Like the Sharing Economy, it is a marketplace that empowers neighbours to care for neighbours— removing the need for corporations to intervene. Through the latest mobile technology, businesses in the caring economy connect the supply of care to the demand for care.

In the Caring Economy, there are two key end users: the demand side that needs to hire care and are willing to pay and the supply side that has time and is looking to help. Demand side users can build their own personalized team of care providers, communicate directly within the platform, and pay on demand via mobile payments — a seamless, convenient and transparent process. This is made possible through a peer-to-peer marketplace that uses mobile technology to efficiently manage the relationships between paid care-workers to primary caregivers and their loved ones — on demand. Simply put, it is Uber for home care.

At its core, this model redesigns how care is delivered to make ‘aging in place’ a reality. The model’s objective is threefold — to help seniors age with dignity, to unburden their family caregivers, and to turn compassionate people and Personal Support Workers (PSWs) into ‘micro-entrepreneurs’ — providing them with an opportunity to earn a 20–30% higher wage- a win, win, win.

The Uplift® smartphone platform delivers on-demand home care services — at the touch of a button. As a company, we are laser focused on harnessing the latest mobile technology and analytical problem solving to deliver a superior user experience that fulfills the aging population’s demand for higher quality care. We are setting the new standard.Our app is an affordable solution to expensive agency fees. We offer 30–50% lower fees than private agencies. We are also an innovative substitute to long-term care.As an organization, we are devoted to making a positive impact in the world. Moreover, we are a pioneer of the ‘caring economy’ — where neighbours can care for neighbours and caregivers are empowered.

The campaign is the beginning of a multiyear process to push for better tools to protect these workers. That will include more awareness among families of patients, who need to inform doctors and nurses if the patient has certain triggers or warning signs of a violent outburst. It could also involve tools such as personal alarms workers can wear to call for help when a situation arises. More generally, it also means informing workers of their rights, and encouraging workplaces to do better risk assessments and even flag patients who may become violent. For people working in home care, who do not have security nearby, risk assessment is even more important.

Last year, 639 health-care workers in Ontario were injured in a violent incident, badly enough that they were unable to work their next shift. That statistic does not account for incidents where workers are pushed, hit, or scratched, for example, and do not report them or take time away from work. "They're seeing [these incidents] as part of the job," Ms. Van hulle said. According to a decade-old Statistics Canada study, 33.8 per cent of nurses surveyed in hospitals and long-term care facilities reported being physically assaulted by a patient in the past 12 months. Nearly half reported emotional abuse on the job. More recent national statistics are hard to come by, but industry associations and unions say the problem is growing.

This is due to a couple of factors. First, there has been a move to deinstitutionalize people with mental health issues. While it is seen as positive to put fewer people with mental-health issues into institutions, protections for workers dealing with these patients have not kept pace with the changes. Another major issue is Canada's aging population, and rising cases of dementia. Although not everyone with dementia is violent, people who are cognitively impaired can easily become frightened and lash out, Ms. Van hulle explained. The campaign uses technology that identifies health-care facilities in Ontario - and through "geofencing," can serve ads to mobile devices inside those facilities.

"When someone is in a hospital and they see a message targeting people in a hospital, the context makes it relevant," said David Katz, executive vice-president of EQ Works, the digital media buying company for the campaign. This kind of technology is attractive to advertisers because the more relevant an ad is, the less likely a person is to ignore it - known as "banner blindness" for digital ads.

The trouble is that locationbased ads can seem creepy. Because this is dealing with a serious issue - and not selling something - it is less likely to trigger that reaction, said Robert Wise, partner at Scratch Marketing, PSH&SA's ad agency. The campaign will not involve storing information about people it targets. "We're targeting generically, people who are visiting facilities," Mr. Wise said.

At Chartwell, a chain of 27 homes, chief operating officer Karen Sullivan said the pharmacy that services the chain, MediSystem, pays for "many additional valued-added services" such as employee education, nurse leadership sessions and conferences for leaders of homes. MediSystem also pays for Wi-Fi systems and therapeutic care equipment at the homes, Sullivan said in an email. The Star asked pharmacies what they are told the money is used for. Among the responses from pharmacies were "staff education," "resident programs" and payments toward Wi-Fi systems. Classic Care, a pharmacy, said the money it pays covers monthly rent of an area in the nursing home, staff education, technology and "donations and sponsorships" for conferences and other training. Other pharmacies, such as Rexall, say their fees have paid for diabetes education, for example. The largest pharmacies serving long-term-care homes in Ontario include Medical Pharmacies Group, MediSystem (owned by Loblaw), Classic Care (Centric Health) and Rexall. The fees are not new. Pharmacies have willingly offered money or agreed to demands for years. But there's a growing outrage among some who say homes are more interested in "inducements" than "clinical excellence" that pharmacies can provide seniors. Last year, after the Ontario government cut each dispensing fee by $1.26 (it is now $5.57 per prescription in nursing homes), sources said some pharmacies wanted to stop paying the fees. The problem was, the sources said, that the homes refused to give up the extra cash flow and other drug companies were willing to pay, so nothing changed.

It's usually the larger companies that can afford to pay. One insider said smaller pharmacies now ask the homes, "Do you want the money or do you want good service? Because we can't afford to give both." Sources said the Ontario Ministry of Health and Long-Term Care knows the money changes hands but does nothing to stop it. Instead, pharmacies are "held hostage" by the homes, the source said. One home that no longer charges the fees is John Noble Home in Brantford, a municipally operated 156-bed facility. The Star obtained a 2010 request for proposals (RFP) that noted "only proposals with a minimum rebate of $20,000 annually will be considered for the project." A spokesperson for the city said the RFP "references a previously approved practice employed by several long-term care homes." A recent RFP did not ask for a rebate, though some offered to pay. The city spokesperson, Maria Visocchi, said it chose a pharmacy that "demonstrated qualifications and experience, project understanding, approach and methodology, medication system processes and quality control." This pharmacy did not offer a rebate. Not all pharmacists pay. Teresa Pitre runs Hogan Pharmacy Partners in Cambridge and serves long-term-care homes that don't ask for money. Instead, she signed contracts with several homes in the People Care chain to provide a "highly personalized approach." Pitre sends a registered pharmaceutical technician into each home daily to relieve nurses of much of their work regarding medication, confusion over communications and extensive paperwork. Her company also puts a bookshelf-sized dispensing machine in each home, which holds medication (pain relievers, antibiotics or insulin) that residents need on short notice but, in the traditional system, often can't get for hours. "I really wanted our pharmacy to be a partner with homes instead of servicing them and just meeting the requirements," she said. Meadus says the added cost of bed fees means pharmacies have no reason to reduce their rates, either by lowering dispensing fees or not charging the $2 co-payment.

A recent Star story revealed that pharmacies serving nursing homes typically charge dispensing fees for drugs once a week, rather than once a month as they typically do in a community pharmacy. Long-term-care pharmacies told the Star they charge the weekly fee because the medication for frail residents can change weekly. That was a claim hotly disputed by some family members the Star spoke to, including Margaret Calver, who has spent years documenting the costs of dispensing fees at Markhaven Nursing Home, where her husband is a resident. "This needs oversight and that's the problem," she said. "Nobody is doing the checks and balances." Moira Welsh can be reached at mwelsh@thestar.ca.

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

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

Six areas, in fact, were identified by CHA

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

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

safety, effectiveness, efficiency, appropriateness

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

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

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

Nadine Henningsen, Executive Director, Canadian Home Care Association

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

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

great good has come from the 10-year plan

Unfortunately, there were two unintended negative consequences

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

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

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

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

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

Second, adopt a Canadian caregiver strategy.

Third, support accountability and evidence-informed decision making.

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

Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association

June 2004

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

Dying for Care

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

terminated by the federal government in March of 2008

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

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

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

progress was made in 2008, from the 2004 accord

palliative pharmaceutical plan

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

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

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

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

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

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

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

Canadian Caregiver Coalition

in Manitoba they have made great strides

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

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

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

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

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

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

that never happened

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

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

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

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

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

A lot of eligibility rules are built on physical assessment.

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

in Saskatchewan it is a little more integrated

Senator Martin

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

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

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

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

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

most people want to be cared for at home

Family Caregiver Tax Credit

compassionate care benefit that goes with Employment Insurance

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

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

tax credits

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

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

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

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

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

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

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

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

“In a more integrated system of care delivery, it is possible to both save money and increase the quality of care at the same time.”

Eleven commentaries were written by leading health policy experts across Canada to respond to the lead paper by Chappell and Hollander, who also wrote a response to the commentaries.

One system including community services such as meals on wheels, non-professional supportive services, professional home care services, supportive housing, long-term care facilities and specialized geriatric assessment and treatment units in hospitals would also have one overall budget. Professional case managers would coordinate care and assess needs, develop customized care plans, and authorize access to any of the services in the integrated system. They would also coordinate care with other parts of the health system, such as hospitals

budgets for long-term supportive care that allow people to remain in their homes have been frozen or reduced

While some seniors do need some professional care, say the authors, often their needs can be addressed primarily by non-professional supportive care such as feeding, bathing, and maintaining a clean living environment.