Continuing Care: The Common Challenge Ahead

John G. Abbott, CEO

Health Council of Canada

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Health Council of Canada

Our Strategic Priorities Informing Communicating Collaborating Having Impact

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Continuing Care for Seniors and Others

A continuum of care requires integration across health care sectors and services

We recognize that this continuum can include the pillars of home care, respite care, long-term care, and palliative care

Our focus: An aging population with multiple and complex needs

An integrated system of continuing care can determine the appropriate place and level of care required, particularly for seniors

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Integration Across the Health Care Continuum for Seniors

Source: Hollander, M.J. and M.J. Prince, Organizing healthcare delivery systems for persons with ongoing careneeds and their families: A best practices framework. Healthcare Quarterly, 2008. 11(1): p. 42-52.

Hollander and Princes’ framework depicts an integrated system of care across various sectors and at multiple levels, linked through case management.

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Focus on Home Care for Seniors

The 2004 Ten Year Plan focused on home care for short-term post-acute, mental health, and palliative care

Health Council Report (April 2012): To inform Canadians of the challenges in home care for seniors and family caregivers, using RAI-HC data analyses

We profile innovative practices that integrate home care across the continuum of care

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Seniors need support to ageat home

Most seniors (93%) live at home and want to remain at home (CIHI, 2011), but will need support from home care and family caregivers to remain at home

Many seniors waiting in hospitals for long-term care facility placement, can return home if appropriate supports are put in place

Home care can delay entrance into LTC, lead to cost savings in hospitals and a better quality of life for seniors

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Home care services for seniors vary across Canada

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Impact of High Needs Clients on Family Caregivers

At least 30% of home care clients have high or very high needs

As needs of home care clients increase, hours of care provided by family caregivers increase, considerably, but hours of home care increase very little

As a consequence, family caregivers of these high needs clients are becoming distressed

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Family caregivers provide the majority of care received

2018

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20

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Yukon BC NHA WRHA Ontario Nova Scotia

Hours

of C

are

Receiv

ed

Average Family Caregiver Hours Average Home Care Hours

Source: RAI-HC 2.0 (2010 data for the Yukon, the Northern HealthAuthority in British Columbia, and Ontario; 2007 data for Nova Scotia and the Winnipeg Regional Health Authority.)

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Home Care vs. LTC Spending in OECD Countries

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Lessons from Denmark

In 1987, Denmark stopped building new long-term care facilities and focused legislation and resources on developing home care and assisted living options

Health and social care services for seniors are integrated and coordinated through case management, interdisciplinary teams, cross setting care, and common training programs

Denmark’s home care programs have been shown to be cost-effective substitutes for long-term care facilities

Preventive home visits for seniors are provided to all citizens over 75 years

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Integrated continuing care in Canada: PRISMA

The PRISMA model in Quebec is based on six elements: coordination of organizations and services; a single point of entry case management an individualized service plan a standardized assessment; and electronic records

Since 2005, all public hospitals, long-term care facilities and home care agencies in Quebec have been merged under single organizations within a region facilitating the implementation of the PRISMA model

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Health Council’s View

Continuing care is a cornerstone of high-performing health care systems and needs to be integrated

We need to ensure the pillars are strengthened to facilitate integration

Current areas to be addressed: Appropriate balance of spending in LTC, home care

and other continuing care Appropriate training and wages for continuing care

workforce

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The Challenge Ahead: Strengthening Continuing Care

Expand what’s working: Draw on innovative practices in Canada and abroad

Assess needs: inter-RAI assessments are available across sectors and provide a standard tool to assess needs, integrate services, collect comparable data, and evaluate outcomes

Set targets: Concrete targets and goals facilitate progress

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The Challenge Ahead: Strengthening Continuing Care

Shift resources appropriately: Funding should follow the patient, based on needs

Work together: Collaboration within and across sectors and involving Canadians and their families in their care will help to maintain their quality of life

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Seniors in need, Caregivers in Distress: What are the home care priorities for seniors in Canada? (April)

Health Council Presentation at Canadian InterRAI Conference (May 7-10)

Progress Report 2012 (June)

Please visit our website:

www.healthcouncilcanada.ca

More to come…