Transcript Medicare at the Crossroads: Public Payment and Private

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
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Marginalization of home and community care
parallels marginalization of “women’s work” in
society and health care system
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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
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Minister’s challenge:
“give me ammunition to make the case for
community care”
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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
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Difficult to measure quality of life,
independence, well-being
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Multiple, complex factors affect outcomes
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Diverse needs
 Substitute for acute care
 Substitute for long-term care
 Prevention and maintenance
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Canadian evidence anecdotal, contradictory,
inconclusive
Personal Social Services
Research Unit (PSSRU), UK
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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
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PSSRU finds that majority of seniors in
residential care homes appropriately placed
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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
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High risk seniors – all eligible for LTC facilities
placement
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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
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Outcomes
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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
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All elements of continuum are important
 Doctors, hospitals, LTC facilities, professional
home care services, community support
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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?
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Local Health Integration Networks
 Opportunity to set “balance of care”
CRNCC Canadian Research
Network for Care in the Community
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Partnership of academics, providers,
consumers
 Funded through Medicare to Home and Community
Research Unit, University of Toronto, CIHR
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Focus on continuum of care
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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
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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
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Web site WWW.CRNCC.CA
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Newsletter
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In Focus fact sheets (e.g., falls prevention)
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Research-in-progress
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Seminars, symposia, speakers
 Women and Home Care with OCSA
Community Services at the Margins
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Community Research Partners
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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
www.crncc.ca
Ontario Community Support Association
Conference 2005