According to Library of Parliament estimates from 2011-2012, Alberta is the only province to benefit from the change to equal-per-capita funding.

As well, the 6-per-cent increase was a national average and not all provinces would receive the same rate.

"The federal government's commitment to increase their transfer payment by 6 per cent this coming year has actually be been broken and rather than getting 6 per cent Ontario will be getting only 3.4 per cent," Matthews said, referring to the health increase.

Sousa said Tuesday he was "infuriated" to learn from federal Finance Minister Jim Flaherty that Ottawa's funding to Ontario for 2014-15 would be $19.158 billion - down $641 million, or 3.24 per cent, from this year's $19.799-billion allotment

he national safety improvement programme, launched in 2008, included a focus on infection prevention, targeted screening of vulnerable elderly patients, and extra checks on administration of high risk drugs.2Although the study was not a randomised controlled trial and so proved no causal relation, the researchers argued that the reductions found in numbers of preventable adverse events in elderly and surgical patients fitted well with progress made in the use of checklists for these groups as part of the national patient safety programme. Though the figures are encouraging, concerns remain that nearly 1000 patients still die every year.

Saher said the province's hand hygiene strategy is working, but compliance only grew marginally from 50% in 2011 to 56% most recently. Other provinces such as Ontario and B.C. can claim over 70%, he said.

Emergency room data was pulled for Alberta and Ontario – in this case, between 2011 and 2012, almost 53,000 people left the department even though they weren’t supposed to yet. That’s about one in every 100 patients.

One in three people who leave the hospital or emergency room come from the lowest-income neighbourhoods, the report says.

In 2012, age-related needs were identified as the single most common problem requiring help from caregivers (28%) (Chart 1). This was followed by cancer (11%), cardio-vascular disease (9%), mental illness (7%), and Alzheimer’s disease and dementia (6%).

The majority of caregivers reported providing transportation to their primary care receiver, making it the most frequent type of care provided in the last 12 months (73%)

In addition, about half of caregivers (51%) reported that they performed tasks inside the care recipients’ home in the last 12 months, such as preparing meals, cleaning, and laundry. Another 45% reported providing assistance with house maintenance or outdoor work.

The most common types of care were not always the ones most likely to be performed on a regular basis (i.e., at least once a week). For instance, despite the fact that personal care and providing medical assistance were the least common forms of care, when they were performed, these tasks were most likely to be done more regularly.

Emotional support often accompanied other help to the care receiver. Nearly nine in ten caregivers (88%) reported spending time with the person, talking with and listening to them, cheering them up or providing some other form of emotional support. Virtually all caregivers (96%) ensured that the ill or disabled family member or friend was okay, either by visiting or calling.

Overall, caregivers spent a median of 3 hours a week caring for an ill or disabled family member or friend. This climbed to a median of 10 hours per week for caregivers assisting a child and 14 hours for those providing care to an ill spouse (Chart 3).

Most often, caregivers spent under 10 hours a week on caregiving duties. In particular, one-quarter of caregivers (26%) reported spending one hour or less per week caring for a family member or friend. Another 32% reported spending an average of 2 to 4 hours per week and 16% spent 5 to 9 hours per week on caregiving activities.  

For some, caregiving was a large part of their life - equivalent to a full time job. Approximately one in ten caregivers were spending 30 or more hours a week providing some form of assistance to their ill family member or friend.  These caregivers were most likely caring for an ill spouse (31%) or child (29%).5

The actual time spent performing tasks is often combined with time needed to travel to provide care. Approximately three-quarters (73%) of caregivers indicated that they did not live in the same household or building as their care receiver, meaning they often had to travel to reach the care recipients’ home. Just over half (52%), however, reported having to travel less than 30 minutes by car.  Roughly 12% of caregivers provided help to a family member who lived at least one hour away by car.

Certain health conditions required more hours of care. This was the case for developmental disabilities or disorders, where 51% of these caregivers were spending at least 10 hours a week providing help

Caring for an ill or disabled family member or friend can span months or years. For the vast majority of caregivers (89%), their caregiving activities had been going on at least one year or longer, with half reporting they had been caring for a loved one for four years or more.

Four provinces had rates above the national average of 28%, including Ontario (29%), Nova Scotia (31%), Manitoba (33%) and Saskatchewan (34%) (Textbox Chart 1). The higher levels of caregiving in Ontario, Nova Scotia and Manitoba were largely related to caring for a loved one suffering from a chronic health condition or disability, whereas in Saskatchewan, the higher level of caregiving was attributed to aging needs. 

Historically, caregivers have been disproportionally women (Cranswick and Dosman 2008). This was also true in 2012, when an estimated 54% of caregivers were women.

Although the median number of caregiving hours was similar between men and women (3 and 4 hours per week, respectively), women were more likely than their male counterparts to spend 20 or more hours per week on caregiving tasks (17% versus 11%). Meanwhile, men were more likely than women to spend less than one hour per week providing care (29% versus 23%) (Chart 5).

For instance, they were twice as likely as their male counterparts to provide personal care to the primary care receiver, including bathing and dressing (29% versus 13%).

Caregivers have multiple responsibilities beyond caring for their chronically ill, disabled or aging family member or friend. In 2012, 28% of caregivers could be considered “sandwiched” between caregiving and childrearing, having at least one child under 18 years living at home

The aging of the population, higher life expectancies and the shift in emphasis from institutionalized care to home care may suggest that more chronically ill, disabled and frail people are relying on help from family and friends than in the past. Using the GSS, it is possible to examine the changes in the number of caregivers aged 45 years and older, recognizing that methodological differences between survey cycles warrant caution when interpreting any results.

Bearing in mind these caveats, results from the GSS show that between 2007 and 2012, the number of caregivers aged 45 and over increased by 760,000 to 4.5 million caregivers, representing a 20% increase in the number of caregivers over the five years.

Having less time with children was an often cited outcome of providing care to a chronically ill, disabled, or aging family member or friend. About half (49%) of caregivers with children under 18 indicated that their caregiving responsibilities caused them to reduce the amount of time spent with their children.6

Overall, the vast majority of caregivers (95%) indicated that they were effectively coping with their caregiving responsibilities, with only 5% reporting that they were not coping well.7 However, the feeling of being unable to cope grew with a greater number of hours of care. By the time caregivers were spending 20 or more hours per week on caregiving tasks, one in ten (10%) were not coping well.  

In addition, while most were able to effectively manage their caregiving responsibilities, 28% found providing care somewhat or very stressful and 19% of caregivers indicated that their physical and emotional health suffered in the last 12 months as a result of their caregiving responsibilities.

The health consequences of caregiving were even more pronounced when caregivers were asked specific questions on their health symptoms. Over half (55%) of caregivers felt worried or anxious as a result of their caregiving responsibilities, while about half (51%) felt tired during the past 12 months (Chart 8). Other common symptoms associated with providing care included feeling short-tempered or irritable (36%), feeling overwhelmed (35%) and having a disturbed sleep (34%).8

The financial impacts related to caring for a loved one can be significant. Lost days at work may reduce household income, while out-of-pocket expenses, such as purchasing specialized aids or devices, transportation costs, and hiring professional help to assist with care, can be borne from caring for a loved one. In many cases, financial support, from either informal or formal sources, can ease the financial burden associated with caregiving responsibilities. Overall, about one in five caregivers (19%) were receiving some form of financial support. 

He added, “The government is very helpfully moving away from what they have given all of us to work with, which were 28 standards, which we have translated into 16 outcomes.

Some of the suggested criteria, which are intended to capture the diversity of care and of service providers, include cleanliness; protection from abuse and discrimination; adequate pain relief; the provision of food and drink; whether complaints are listened to; and the effective organisation of ongoing care.

“These are really shocking indictments of the system when you realise just how many older people in particular simply don’t have those really fundamental needs met in a whole range of care settings.”

“They [the government] will consult next month on essentially a new set of standards [which] will be about the fundamentals of care—the really basic things. Are people hydrated? Are they fed? Are they supported to hydrate themselves? Are their basic care needs being addressed?

The new standards reflect the regulator’s beefed up approach to inspection, which it announced in April this year,1 in the wake of stinging criticism of its role in the well publicised care failings at Winterbourne View, Mid Staffordshire NHS Foundation Trust, and Cannock Chase Hospital.

Still, the aging of Canada’s population has a surprisingly modest overall impact on health care budgets, contributing a mere 0.9% to total spending growth.

Overall, Canada spends $5948 annually on health care for each citizen, up 2.2% from 2011.

In terms of the split between health care paid for through taxes, or directly out of consumer pockets, public funds account for about 70% of the money spent on health care in Canada. In turn, hospitals and physician payments account for most of that money. Payments for drugs and nonphysician services account for the bulk of direct consumer spending.

Though the growth of private sector outlays (4.6%) in 2012 is expected to outpace that of the public sector (2.9%), the public–private ratio has been stable for some time.

The report concluded, “What the Canterbury experience demonstrates is that it is possible to provide better care for patients, reduce demand on the hospital, and flatten or reduce elements of the demand curve across health and social care by improved integration—particularly around the interface between the hospital, primary care and community services.”

On the contracting side, the report said that the abolition of the purchaser-provider split in the health system was important as it gave boards the autonomy to decide how to fund their hospitals.

It said this would require a greater emphasis on general wards with specialists visiting patients rather than the other way round.

The authors - drawn from across the NHS and social-care spectrum - also called for an end to the two-tier weekday and weekend service in many facilities.

They even said it would be preferable to work at 80% capacity across the seven days if extra resources were not available in the short-term.

Health Secretary Jeremy Hunt said the report was "bold and refreshing". "I agree completely that we must make services more patient-centred both inside and outside hospital."

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

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

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

Total 26 4

Acute portion 11 4

ALC portion 10 -

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

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

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

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

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

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

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

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

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

in British Columbia who contracted H1N1 in the spring and summer of 2009. People who had received a seasonal flu shot the previous autumn were more likely to contract the new pandemic strain.

Still, the finding is reminiscent of something that was observed in people in Canada during the 2009 H1N1 pandemic.

The authors cautioned against drawing a line between what happened to the pigs in the study and what might happen with people.

Her findings, which were initially dismissed by many in the global influenza research community, were later replicated in studies done in other provinces as well, leading some to dub the phenomenon “the Canadian problem.”

“I think . . . what they’re showing is a biological mechanism that warrants further evaluation in terms of its relevance to the use of seasonal vaccines in humans and what that may mean for the next pandemic threat,” Skowronski said.

It’s a frustrating target for flu vaccine designers. There are 17 known hemagglutinins, which give flu viruses the H in their name. (Most don’t currently infect people.) The hemagglutinins on H1 viruses look different than those on H3 viruses, and antibodies to one don’t protect against another.

Even within a subtype — H1, for instance — there are different strains, and a vaccine against one might offer lots, some or no protection against another. And all these hemagglutinins are constantly changing, which is why flu vaccines have to be updated almost every year.

Instead of being protected, the H1N2-vaccinated pigs developed more severe disease than exposed pigs that hadn’t been pre-vaccinated. When the researchers tested the blood of the vaccinated pigs, they found high levels of antibodies that attached to the stalk of the H1N1 hemagglutinin, but not to the head of the protein.

Skowronski and others suggested the work demonstrates the complexity of influenza immunology — the science of how the viruses interact with immune systems. “The problem is everybody wants influenza to be simple and be like other vaccine-preventable diseases. And it’s not,” Skowronski said.

Infectious diseases expert Dr. Michael Osterholm said with influenza, there is always a complicated interplay between the virus and the person the virus infects, one that is influenced by what viruses and vaccines the person’s immune system has previously encountered.

“It really drives home the need to be very cautious about what are we actually accomplishing.”

Diane Doran, the scientific director of the University of Toronto's Nursing Health Services Research Unit, notes that patients often deal with a rotating cast of nurses and personal-care workers, each with their own style of delivering care.

Advancing technologies and an aging population are fueling the push toward home care. Plus, overcrowded hospitals are under immense pressure to free up beds, which can contribute to the types of communication breakdowns like Burkitt experienced, says Davis.

MacLeod says the organization has vowed to prioritize home-care safety issues over the next five years ? a sign of the times. "There has been a very significant shift from acute care to home care," he says. "The public is demanding this shift."

Doran says that their study of home care across Canada found that often that type of risk assessment wasn't done, but even when it was, it wasn't acted upon because of confusion over whose responsibility it was.

The use of electronic charts would also go a long way to making sure that details about a patient's care don't get lost between the multiple caregivers and transfers.

The speech, her first as Health Minister, was warmly received to the point where CMA president Anna Reid

She also expressed concern that Ms. Ambrose remained mum on the 2014 health accord. Ottawa has offered to increase transfer payments to the provinces by 6 per cent annually until 2017 and then 3 per cent subsequently, but otherwise has refused to negotiate.

Ms. Ambrose, for her part, said federal funding has reached unprecedented levels – $30.3-billion this year and growing. “Now that the funding is there, we need to have a conversation on what can be done to make the system more sustainable,” she said.

She said promoting health innovation is “worthy of federal leadership

The minister said she has already reached out to many of her counterparts, but discussions will begin in earnest at the federal-provincial-territorial meeting of health ministers in October.

She will also “reach out” to the working group on innovation that was created by the Council of the Federation.

She said another priority will be work with her provincial and territorial counterparts to improve health care for seniors,

Women, as well as Canadians aged 34 to 54, and those already caring for an elderly person, are among those least confident that hospitals and long-term care facilities can handle the demands of a population that is living longer

he Ipsos Reid poll of 1,000 Canadians was released to coincide with Monday's opening of the CMA's annual meeting

Overall, the 2011 census counted nearly five million people aged 65 and older in Canada.By 2031, 22.8 per cent of the population will be 65 or older, jumping to one quarter - 25.5 per cent - by 2061.

Three-quarters, or 75 per cent, of those surveyed gave an "A" or "B" grade

overall

Going into the premiers' conference, Ontario Premier Kathleen Wynne said health care would be on the agenda but the focus would be on how to keep the system sustainable with the fiscal pressures of an aging population.

Under this approach, hospitals begin to admit more patients and discharge them more quickly.More patients are treated for the same number of beds.

New models of funding healthcare that use shared incentives to motivate communication and safe transitions between providers are needed for today's complex patients.

Only a few types of patients are funded with the new 'Quality-Based Procedures' policy, with little cash to spare for buying additional volumes of care.

Traditional hospital-focused patient funding does a good job of buying more surgeries, but it doesn't do much to address the challenge of coordinating care across healthcare providers.

Elsewhere, countries that have used per-patient funding for years, like the U.S. and England, are now wondering if it's time to move on

Instead of pouring money, time and effort into upgrading our 8-track funding models to cassettes, we can learn from what others have done and skip a generation in payment reform.

By introducing per-patient funding approaches that also integrate payments across hospitals, physicians and community care providers, Ontario can begin to tackle the triple challenge of access, cost and quality rather than passing the buck from one healthcare sector to the other.