Canadian Research Network for Care in the Community CRNCC A. Paul Williams University of Toronto Janet Lum Ryerson University Ontario Community Support Association Conference 2005 Nottawasaga Inn, Alliston November 23, 2005

Women and Home Care: Facts, Issues and Future Marginalization of home and community care parallels marginalization of “women’s work” in society and health care system  Tradition of voluntary service  Less ill took care of more ill  “Poor cousin” of medical care  Outside of Medicare entitlements  Outside of publicly funded home care

March Symposium: Community Services in Continuum of Care Minister’s challenge: “give me ammunition to make the case for community care” Need to demonstrate costs and outcomes  For health care system  For individuals  Not “if” community services make sense, but when and under what conditions

The Evidence Game Difficult to measure quality of life, independence, well-being Multiple, complex factors affect outcomes Diverse needs  Substitute for acute care  Substitute for long-term care  Prevention and maintenance Canadian evidence anecdotal, contradictory, inconclusive

Personal Social Services Research Unit (PSSRU), UK When properly targeted, managed and integrated within continuum of care, community care  Can be cost effective alternative to institutional care for “at risk” individuals  Can reduce demand for more costly hospital and emergency services  Can positively impact on health and well-being, independence and quality of life  Can improve satisfaction of workers including primary care MDs

The Balance of Care PSSRU finds that majority of seniors in residential care homes appropriately placed But 20% could be cared for in community given integrated care packages  At equal or lower cost to system  With equal or better outcomes for individuals and carers

When Home is Community: Seniors in Supportive Housing High risk seniors – all eligible for LTC facilities placement  80% women  40%, 85+ years  low income  multiple physical and mental health problems Minimal services  25% -- bathing, eating, toileting, dressing  80% -- vacuuming, cleaning, laundry  Most continued to receive help from family

When Home is Community: Seniors in Supportive Housing Outcomes  High social connectedness – visits, activities  Self-reported health status “better” than peers  Confident about receiving help when needed  Less use of 911 and emergency departments Key Conclusions  Targeted intervention -- high risk seniors  Active care management  Integrated care budgets

The Balance of Care All elements of continuum are important  Doctors, hospitals, LTC facilities, professional home care services, community support How can we manage the balance of care to make best use of our investment?  What % of children with LTC needs can be cared for in community? Local Health Integration Networks  Opportunity to set “balance of care”

CRNCC Canadian Research Network for Care in the Community Partnership of academics, providers, consumers  Funded through Medicare to Home and Community Research Unit, University of Toronto, CIHR Focus on continuum of care Knowledge generation and knowledge translation  Growing body of knowledge needs to get into hands of decision-makers

CRNCC Canadian Research Network for Care in the Community Raise profile of home & community care sector within care continuum Engage community partners in research Build evidence base Transfer knowledge to providers, consumers and policy-makers Provide evidence to facilitate advocacy

CRNCC Canadian Research Network for Care in the Community Web site Newsletter In Focus fact sheets (e.g., falls prevention) Research-in-progress Seminars, symposia, speakers  Women and Home Care with OCSA

Community Services at the Margins Community Research Partners  Community Care City of Kawartha Lakes  Canadian Pensioners Concerned  Care Watch Toronto  Etobicoke Services for Seniors  Neighbourhood Link-Senior Link  Ontario Association of Community Care Access Centres  Ontario Community Support Association  Ontario Coalition (Society) of Senior Citizen’s Organizations  Peel Senior Link  St. Paul’s L’Ameroux Centre

CRNCC Canadian Research Network for Care in the Community Special thanks to:  Susan Thorning, OCSA  CRNCC Steering Committee  Atiqua Ilmas, Joanne Jasper, Anne Lotz, Janet Lum, Fern Teplitsky, Susan Thorning, Georgina White  Raisa Deber, Director, Medicare to Home and Community (M-THAC) Research Unit  Silvia Carfora, CRNCC

Canadian Research Network for Care in the Community CRNCC Ontario Community Support Association Conference 2005