Continuing Care: The Common Challenge Ahead John G. Abbott, CEO Health Council of Canada

2  Our Strategic Priorities  Informing  Communicating  Collaborating  Having Impact

3 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

4 Integration Across the Health Care Continuum for Seniors Source: Hollander, M.J. and M.J. Prince, Organizing healthcare delivery systems for persons with ongoing care needs and their families: A best practices framework. Healthcare Quarterly, (1): p Hollander and Princes’ framework depicts an integrated system of care across various sectors and at multiple levels, linked through case management.

5 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

6 Seniors need support to age at 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

7 Home care services for seniors vary across Canada

8 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

9 Family caregivers provide the majority of care received Source: RAI-HC 2.0 (2010 data for the Yukon, the Northern Health Authority in British Columbia, and Ontario; 2007 data for Nova Scotia and the Winnipeg Regional Health Authority.)

10 Home Care vs. LTC Spending in OECD Countries

11 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

12 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

13 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

14 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

15 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

16  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: More to come…