CUPE Health Care

The hospital would have to get approval under Ontario's Public Hospitals Act to operate those beds at the retirement home

it is the first time a hospital in the region - or maybe even the province - tries this

to open up some extra beds in an existing space in the community while Windsor waits for its new 256-bed long-term care facility to be built

The hospital would rent the wing from the retirement home as a tenant.

Ontario has the fewest hospital beds per capita of any jurisdiction almost in the world

According to the Organization for Economic Development and Co-operation, Ontario has two hospital beds for every 1,000 residents. Only Mexico has fewer. Canada-wide, there are three hospital beds per 1,000 residents, an amount also considered relatively low.

152 residents

A compact, self-contained model village on a four-acre site on the outskirts of town, half of it is open space: wide boulevards, cosy side-streets, squares, sheltered courtyards, well-tended gardens with ponds, reeds and a profusion of wild flowers. The rest is neat, two-storey, brick-built houses, as well as a cafe, restaurant, theatre, minimarket and hairdressing salon.

low, brick-built complex, completed in early 2010

suffering from severe or extreme dementia

250-odd full- and part-time staff

six or seven to a house, plus one or two carers, in 23 different homes. Residents have their own spacious bedroom, but share the kitchen, lounge and dining room.

25 clubs, from folksong to baking, literature to bingo, painting to cycling

encourages residents to keep up the day-to-day tasks they have always done: gardening, shopping, peeling potatoes, shelling the peas, doing the washing, folding the laundry, going to the hairdresser, popping to the cafe

seven different "lifestyle categories"

One is gooise, or Dutch upper class

a house in ambachtelijke style, for people who were once in trades and crafts: farmers, plumbers, carpenters

Huiselijke is for homemakers: neat, spotlessly clean, walls hung with wooden display cabinets for dozens of brass and porcelain ornaments

No doors – apart from the main entrance, with its hotel-like reception area – are locked in Hogewey; there are no cars or buses to worry about (just the occasional, sometimes rather erratically-ridden, bicycle) and residents are free to wander where they choose and visit whom they please. There's always someone to lead them home if needed.

Other houses are designated christelijke, for the more religious residents; culturele, for those who enjoy art, music, theatre (and, says Van Zuthem, "getting up late in the morning"); and indische, for residents from the former colony of Indonesia (rattan furniture, Indonesian stick puppets on the walls, heating two degrees higher in winter, and authentic cuisine).

urban, for residents who once led a somewhat livelier lifestyle

By the time Hogewey was finished, it had cost ¤19.3m (£15.1m). The Dutch state funded ¤17.8m, and the rest came from sponsors and local fundraising.

anyone can come and eat in the restaurant, local artists hold displays of their work in the gallery, schools use the theatre, businesses hire assorted rooms for client presentations

Nor is the cost per resident of this radically different approach to dementia care much higher than most regular care homes in Britain: ¤5,000 a month, paid directly to Hogewey by the Dutch public health insurance scheme

Some residents also pay a means-tested sum to their insurer. There is a very long waiting list.

You don't see people lying in their beds here. They're up and about, doing things. They're fitter. And they take less medication.

we've shown that even if it is cheaper to build the kind of care home neither you or I would ever want to live in, the kind of place where we've looked after people with dementia for the past 30 years or more, we perhaps shouldn't be doing that any more."

Britain is following suit, reactivating a hospital food program the former government discontinued in 2006

Janice Gillan, the head of the Hospital Caterers Association in the U.K., who told CBC Radio, "Food is the simplest form of medicine."

The Sun, is campaigning for minimum dietary standards in hospitals

Ontario probably leads efforts for better hospital food, thanks to the provincial government making grants available to hospitals to purchase local food through its Broader Public Sector Investment Fund

Canadian Coalition for Green Health Care

Before 2005, nearly all the patient meals at St. Joseph's were pre-made and outsourced. Now, the hospital prepares about 75 per cent of them from scratch.

The move to home-style meals has not only seen patient satisfaction increase to 87 per cent but it's also had "a huge positive impact on morale," Leslie Carson, the manager of food and nutrition services

It has been estimated that about 30 per cent of hospital food ends up in the garbage.

Carson says that at St. Joseph's plate waste is about half that amount.

they avoid packaged meals

grain-fed beef they get from a local supplier

20 per cent of the food it serves is grown locally, contributing at least $140,000 per year to the local economy

$7.60 per patient per day, not including the cost of labour

The province does not stipulate an amount for patients in acute hospital care but the average is about $8 a day.

Retherm was the trend 10 to 15 years ago and is being put back into service

Over at St. Joseph's they also had to figure out how to make the changes to fresh and nutritious without a proper kitchen.

Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care

The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.

A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).

In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).

Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).

Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.

Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.

Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.

Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).

A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).

If sustainability means bending the cost curve for health care, we need more than what Flaherty’s Done Deal offers.  I’m not talking more money. The $26 billion over five years could buy important reforms if it’s harnessed to that purpose; like our governments agreed to do in 2004.

Wait times for cataract, knee and hip and cardiac surgery and screening for cancers have fallen dramatically across the country. That means that in every part of Canada more citizens are getting more care more quickly.

The Accord has shown that focus and commonality of political will, with a long-term financial guarantee, can bring about positive and meaningful change.

Canada’s most valued social program needs a plan.  A plan that tackles growing disparities in health outcomes and growing gaps in access to care.  A plan that brings our best minds together, working in concert, to bend the cost curve by focusing on improving health and improving care.  It’s possible, but it requires more than the blunt tool of cost control. It requires a shared strategy and focus on improvement. 

Widely perceived as a 50-50 bargain, the federal share of provincial and territorial health care expenditures peaked at 55 per cent of what was spent on doctors and hospitals in 1977-78

Federal cash only covered 25 per cent of what the provinces and territories spent on all health care that year.

Genuine cost sharing was most generous in the 1960s, when federal transfers for health care covered 33 per cent of provincial and territorial total health care expenditures.

By 2001-2, when negotiations for the 10-year Health Accord started, federal cash contributions covered 12 per cent of all provincial and territorial spending.  It had fallen even lower during the Troubled Times of the late 1990s

It may seem generous to put an accumulated $26 billion more into provincial and territorial coffers over the next five years.

But the deal pales in comparison with the over $220 billion dedicated to tax cuts since 2006, or the 20-year, $490 billion commitment to refurbishing military hardware.

Dr. Fernand Taras, medical director of Rockland MD and the majority shareholder

When informed the law does not allow doctors taking part in the public system to bill patients for nursing care, Taras grew increasingly agitated, shouting at the reporter over the phone, saying: "I will sue your guts."

Quebec also changed the law governing RAMQ to permit it to launch investigations on its own initiative - rather than act on complaints by patients - following a Gazette exposé on private health care in 2005.

About one in four home care clients in Ontario reported that their pain is not well-controlled

One in six long-term care residents in Ontario was physically restrained at least once in the previous three-month period.

more than double the rates found in other countries, such as the U.S. and Switzerland

About one in five long-term care residents in 2009-10 was being prescribed drugs that should be avoided in the elderly

About one in four newly admitted long-term care residents in Ontario was being prescribed a class of sedatives known as benzodiazepines.

One in seven newly admitted long-term care residents was being prescribed antipsychotic drugs without a clear reason for using them.

“assess/restore” bed in a long-term care facility

short-term rehabilitation for three months or less

advertised as a long-term care facility capable of taking care of dementia patients

some seniors will pay as much as $6,000 a month for care.

Tranquility Care Homes

She has not yet done so, and officials have refused to say whether the Conservatives plan to lift the cap after the spring election. They have said only that they plan to conduct public consultations on the issue before making that decision.

two weeks later, owner Karen Cazemier asked for a 43-per-cent increase in fees. The new monthly bill: $5,000.

the family received an eviction notice, and on March 6, Cazemier called an ambulance and sent Denyer to hospital.

each resident is subject to a three-month probationary period and that the facility issued an eviction notice be-cause of the negative impact on the other residents and because Denyer was "slapping" caregivers, creating a potentially dangerous work environment.

Bill Moore-Kilgannon, executive director of Public Interest of Alberta

"If the government doesn't do anything to stop a for-profit owner from sending a senior to an acute-care hospital, then they're allowing this type of for-profit seniors' care to cherry pick only the healthiest seniors."

Most Canadian hospitals have long since given up the basics, such as distilling soup stock from simmered bones, in favour of convenient powdered mixes. Some have gutted kitchens altogether, lured by the 30-per-cent labour cost savings that comes with installing what the industry terms “kitchen-less” systems. These consist mainly of “re-thermalization” units used to reheat food that is prepared offsite in massive kitchens.

Ms. Maharaj’s mission is to prove that scratch cooking is a feasible panacea in this publicly funded, cash-strapped system. She’ll try to do it by shifting the hospital’s procurement – when it’s cheaper – to produce certified by the sustainability inspection group Local Food Plus.

a $191,000 grant from the provincial government and the Greenbelt Fund

40 U.S. hospitals run by the firm Kaiser Permanente have transformed themselves into community food hubs by hosting farmers’ markets

focus on the culture of secrecy found in homes that refuse to acknowledge problems exist

Submissions are accepted through its website at www.longtermcaretaskforce.ca until March 19.

Canada-wide problems with the financial and physical abuse of the elderly was the focus of a federal government announcement Thursday morning when Justice Minister Rob Nicholson proposed changes to the Criminal Code that would require judges to consider the age of the victim during sentencing.

But Judith Wahl, a lawyer with the Advocacy Centre for the Elderly said judges can already to take into account the age of the victim during sentencing.

The proposed legislation, she said, does little to actually prevent the harm facing seniors — sometimes from their own families. In many cases, the elderly would benefit more from affordable housing or home care to save them relatives who “influence” them to hand over money.

Prevention is key, agreed Doris Grinspun, chief executive officer of the Registered Nurses Association of Ontario

“Our elders need security and dignity,” said Sharleen Stewart of the Service Employees International Union. “With a growing political focus on seniors, the time has probably come for a national seniors’ strategy.”

The literature in this area identifies many potential sources of waste and provides a broad range of estimates of the magnitude of excess spending.

The Table shows estimates of the total cost of waste in each of these 6 categories both for Medicare and Medicaid and for all payers.

Failures of Care Delivery: the waste that comes with poor execution or lack of widespread adoption of known best care processes

this category represented between $102 billion and $154 billion in wasteful spending

Failures of Care Coordination: the waste that comes when patients fall through the slats in fragmented care.

represented between $25 billion and $45 billion in wasteful spending

Overtreatment: the waste that comes from subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them

represented between $158 billion and $226 billion in wasteful spending

Administrative Complexity

represented between $107 billion and $389 billion in wasteful spending

Pricing Failures: the waste that comes as prices migrate far from those expected in well-functioning markets, that is, the actual costs of production plus a fair profit.

US prices for diagnostic procedures such as MRI and CT scans are several times more than identical procedures in other countries.

represented between $84 billion and $178 billion in wasteful spending

Fraud and Abuse

represented between $82 billion and $272 billion in wasteful spending

Addressing the wedge designated “overtreatment,” for example, would require identifying specific clinical procedures, tests, medications, and other services that do not benefit patients and using a range of levers in policy, payment, training, and management to reduce their use in appropriate cases. The National Priorities Partnership program at the National Quality Forum has produced precisely such a list in cooperation with and with the endorsement of relevant medical specialty societies.

As a of the change, the other provinces — especially Ontario, British Columbia and Quebec — will all receive less than they otherwise would have. Ontario will be losing out on $382 million annually, British Columbia will be down $351 million and Quebec will see $210 million less each year.

A separate calculation by researchers at the Library of Parliament shows that on a per capita basis, the change in health funding penalizes Newfoundland and Labrador the most.