1. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 1 Quality in the Community

2. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 2 Care in the Community --- Old Frontier  Early Days --- Care in the Home  Home Visits by Physicians  Public Health Nurses  Hospitals --- Hospital Insurance and Medicare  Long Term Care Institutions

3. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 3 Things Changed  Technology  New Drugs  Innovative Physicians  Societal Changes  Pressures on Hospitals

4. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 4 What Happened?  An Explosion of Home Care and Home Support Programs

5. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 5 Governments ---- Provincial  Each Province Developed Independently  Organizational Chaos ---- Social----Health  Cost Savings --- Cost Shifting

6. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 6 Governments ----- Provincial  Unclear Policies ----- Non Policies  Public Health Nursing ---- Decline  Quality

7. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 7 Care in the Community Now --- New Frontier  No Clear Rules  Rapid Change  Inconsistent Behaviours  Anything is Possible  Nothing Seems Possible

8. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 8 Society --- What is Expected?  Services to be Available  Equality of Treatment  Balance the System  Quality Care and Services  A Program like Hospitals and Medicare

9. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 9 Community --- What Has Been Occurring?  Rapid Expansion of Services --- Nursing and Home Support  New Technologies  More Complex Cases  Sicker Patients

10. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 10 Community (Cont’d)  Wage Disparities  Managed Competition  More Government Administrators  Continuous Public Debate

11. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 11 Provider Organizations  Not for Profit and For Profit --- Community  Hospitals  Regional Authorities  Community Health Corporations

12. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 12 Providers Informal (Unpaid)  Volunteers  Caregivers

13. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 13 Who Provides Care in the Home  Nurses and Therapists  Unregulated Workers --- Home Support  Without Universally Approved Standards  Often Minimal Supervision

14. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 14 Characteristics of Formal Providers  Mainly Women  Wage Disparities  Benefits Disparities  Training Gaps  Differentiated Working Conditions

15. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 15 Characteristics of Informal Caregivers  Mainly Women  Family Members and Friends  Greater Incidence of Sickness  Little Training and Support  Lost Incomes

16. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 16 What about New Employees? Nurses  Permanent Positions --- Temporary Positions  Full Benefits ------ No Benefits  Salary Equivalent to Hospital Nurses ------ Differential of 20%  Training as Required ----- No Training

17. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 17 What about New Employees? Home Support Workers  Temporary Position  Irregular Hours  No Benefits  Inadequate Training  Low Salary

18. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 18

19. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 19 QUALITYHOME CARE What about QUALITY in HOME CARE Today? Should we be worried ?

20. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 20 The Telegram Home care shortcoming (St. John's) Tue 15 Feb 2000 After 2 1/2 months in a St. John's hospital, 70-year-old Ralph Andrews is anxious to get back to his Shea Heights home. And his wife Gladys shares that feeling. The only thing, however, is Gladys has been told that in order for her husband to be released from the hospital, he will have to receive medications intravenously at home -- to be administered by her. Ralph had suffered some complications following heart bypass surgery that required extra treatment. ``I'm 70 years old and I find that whole thing (intravenous) complicated,'' Gladys said. ``They said Community Health can't come in and do it. The only other option would be for us to travel back and forth to the hospital every day. `

21. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 21 Things That Impact On Quality  Leadership and Culture  Data  Skills and Training  Systems Development  Technologies

22. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 22 Things That Impact On Quality (cont’d)  History and Tradition  Attitudes and Beliefs  Money

23. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 23 Quality in Home Care --- Current Situation  Lots of Data Being Collected  No Agreement on Standards and Benchmarks  No Common Policy  Great Variations in Services  Uncertain Quality

24. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 24 Current Approaches to Quality---CCHSA  Client Centred Accreditation Program  The AIM Project  Provincial Government Approaches  Contracting Agencies Approaches (CCAC)

25. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 25 What is the Main Factor in Determining the Quality of Services in Home Care Today?  Professionalism and Training of the Nurses and Therapists who provide and supervise the care

26. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 26 What should we do about quality?  National Standards  Improved information system  Investment in Training  Reduced Wage Disparity  Recognition of Need to Support Informal Caregivers

27. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 27 National Principles and Standards  Access to Home Care Based on Physical and Social Needs  Support for Family and Friends who Provide Care  Equity Between Home Care and Hospital Care  Flexible Options for Delivery Based on Individuals Needs

28. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 28 Improved Information and Communication  Common Data Definitions  Investment in Hardware and Software  Compatible Systems  National Standards

29. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 29 Investment in Training and Education  Development of New Training Programs  National Standards  Recognition of New Roles and Relationships

30. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 30 Support for Informal Caregivers  Training  Counselling  Respite  Information  Recognition

31. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 31 Who should be involved?  Governments ---- Provincial and Federal  Providers ---- Community and Institutions  Consumers ---- Clients and Caregivers

32. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 32 Quality Should we be worried about Quality in HomeCare Home Care today?

33. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 33 Quality Should we be worried about Quality in HomeCare Home Care today? You are “darn right” we should be worried!

34. QUALITY AND COMMUNITY RESPONDING TO CHANGE 5 December 2000 CHCA 2000 CONFERENCE Ambrose M. Hearn, CHE CEO, VON Canada 34 Thank You for your Attention Good Luck