Tuesday, February 12, 2013

Living Longer, Living Well is a weak response to senior health issues

I believe that we boomers have more money, better health, better teeth, better nutritional information, we exercise more, We have ability to live and die better. I don't see our generation suffering like those for whom I provide hospice care. We are better educated, and have more saving than our parents who lived through the depression.

This negative ad, promotes fear,
not real data.
I think we must step up and demand that those who can afford to, pay their fair share. I paid for a private room for dad, in a for-profit setting. These are more freely available than semi-private. Many are taking beds, by getting publicity for refusing to step up, sell homes and pay for their care, when they can afford it. The worst are the daughters who expect to inherit the family home, rather than liquidating assets to pay for care. I cannot see that this will get worse, but there are many bad interpretations of PHIPA now.

This strategy has far too much that we already have in place. Forgive me for being cynical. This document contains 169 total recommendations. Several of the recommendations state that the MOHLTC should 'continue to'... and cites several initiatives that are already in place, or currently being created. They didn't meet with "Much of the rest of the recommendations are shop-worn ideas that have been around for years with only mixed success, from transportation and housing support to elder abuse programs and enhanced education programs for front-line providers."

Also, 'support' occurs 80 times in the document. This is a vague term, and does not address the needs of individuals, rural vs. city seniors, or any ethnic groups other than Aboriginal Peoples.
Making the rich pay is a difficult issue. We live off of our savings. We have a very low pension income otherwise. Those in similar circumstances, but living off of family money, won't be required to pay their fair share.

I am not the only cynic:
More controversial is the recommendation Health Minister Deb Matthews seems much more interested in – making wealthier seniors pay for more of their home care and support services. By wealthy, the province defined those seniors earning more than $100,000 a year individually or $160,000 a year as a couple when it came to implementing a similar “make the rich pay” scheme for the provincial seniors drug plan. That was not a slight rattling of the cup either – the plan to be implemented in August 2014 will take three per cent of the net income of so-called rich seniors earning a combined $160,000 or more per year. How much more would the province be adding to that bill for home care costs?

Ontario’s new Seniors Strategy (PDF) 

After extensive consultations with 5,000 Ontario seniors, 2,500 stakeholders and more than 1,000 caregivers, the Ministry of Health and Long Term Care (MOHLTC)  has released its "Living Longer, Living Well" report which looks to redefine care for Ontario's aging population.

While older Ontarians are living longer and with less chronic illness or disability than generations before them, the vast majority of older adults have at least one chronic disease or condition. We know that there exists a minority who particularly struggle with multiple complex and often inter-related health and social care issues.
  • While 77% of older Ontarians recently reported being in good health
  • 10% of older Ontarians with chronic disease accounts for 60% of healthcare
  • The healthiest 50% of our older population accounts for 6%  of expenditures

Five Principles

1. Access, 2. Equity, 3. Choice, 4. Value, 5. Quality

Key Recommendations:

Promoting Health and Wellness
This is old news
Strengthening Primary Care for Older Ontarians
Enhancing the Provision of Home and Community Care Services
Improving Acute Care for Elders
Enhancing Ontario’s Long-Term Care Home Environments
Addressing the Specialized Care Needs of Older Ontarians
Medications and Older Ontarians
Caring for Caregivers
Addressing Ageism and Elder Abuse
Addressing the Unique Needs of Older Aboriginal Peoples in Ontario
Supporting the Development of Elder Friendly Communities
Necessary Enablers to Support a Seniors Strategy for Ontario (p. 18)
Establishing the Mandate, Implementing the Strategy

  1. Support the provision of house calls by primary care providers (p. 10).
  2. Maintain commitment to increase home and community sector funding by 4% (2013) and the next two years 
  3. Support the LHINs, their CCACs and CSS agencies to formalize a Standardized Collaborative Care Model that can allow acuity-based waitlist and care co-ordination assignments between CCACs and select CSS agencies (p.11).
  4. Explore the implications of developing an income-based system.
  5. Develop more Assisted Living and Supportive Housing Units as alternatives to Long-Term Care Home placement for those who would benefit most from these environments.
  6. explore the development and expansion of Community Paramedicine programs across Ontario, especially in northern and rural communities- to avoid ER visits (p. 12).
  7. Promote the adoption of Senior Friendly Hospital principles for hospitalized older adults that deliver better patient provider and system outcomes.
  8. Expedite the implementation of the care transitions standards and processes, outcome and process indicators, as recommended in the Avoidable Hospitalization Advisory Panel’s report Enhancing the Continuum of Care.
  9. Professional Development: support mechanisms to maximize the knowledge and skills of LTC home staff with additional training opportunities (p. 13).
  10. Develop new LTC home-based service models to maximize capacity, increase programs to support older adults living in the community longer, and enhance programs to meet the needs of short- and long-stay residents. This could be more specifically accomplished by: a)  Increasing short-stay respite and convalescent-care program capacity in LTC homes. b)  Enabling LTC homes to provide higher levels of care to individuals with complex care needs. c)  Exploring the ability of LTC homes to serve as community-care hubs that could provide community-oriented services, including home care, that may further assist local residents to age in place.
  11. Establish a provincial working group of geriatricians, care of the elderly family physicians and specialist nurses, allied health professionals, and others to help develop a common provincial vision for the delivery of geriatric services and a prioritization plan to guide local staffing and funding of care models as resources become available (p.14).
  12. Informal and formal tools used to assess the health of older adults: should encourage the inclusion of questions  regarding continence, sexual, oral and nutritional health, and the frequency of falls.
  13. Identify trends regarding inappropriate combinations of drugs and develop best practice guidelines and knowledge transfer mechanisms to improve prescribing practices and reduce the harmful effects of medication interactions in older adults (p. 15).
  14. Conduct a full review of its MedsCheck Program to understand how effective it has been and how this service can be improved to: a) better support patients managing with multiple medications; and  b) provide more added value. 
  15. Continue its work of reforming the Ontario Drug Benefit (ODB) Program to more directly link benefits to income rather than age, and thereby consider expanding this coverage for all Ontarians.
  16. Improve the awareness of services and supports available to unpaid caregivers with improved single points of access.
  17. MOHLTC should encourage the standardization of services and supports offered through the Alzheimer Society’s First Link program.
  18. Ontario Network for the Prevention of Elder Abuse (ONPEA) to support work that a)  Seeks to raise public awareness about the abuse and neglect of older adults; b)  Provides training for front-line staff; and c)  Co-ordinates community services to better assist victims of elder abuse in communities across the province (p. 16).
  19. A variety of programs and supports that will enable them to adapt their residences to  accommodate their evolving functional needs (p. 17).
  20. Enhance the development and availability of non-profit, safe, dignified, and consumer-oriented transportation systems for older Ontarians across urban and, wherever possible, rural communities as well.
  21. Core training programs in Ontario for physicians, nurses, occupational therapists, physiotherapists, social workers, pharmacists, physician assistants, paramedics, personal support workers, and other relevant health and social care providers should include relevant content and clinical training opportunities in geriatrics (p.18).
  22. Finalize development of Alternate Funding Plan (AFP) to support geriatricians in Ontario in a way that doesn’t restrict their numbers, or provide disincentives to those wishing to practice geriatrics.
  23. Support to its Personal Support Worker (PSW) workforce by strengthening its new PSW Registry by requiring mandatory registration, requiring a common educational standard for all future registrants, and developing a complaints process that can protect the public and the profession.
  24. Streamline assessments, referrals: health, social, and community services providers streamline their assessment and referral processes to: a) avoid duplication and burden for patients and clients, and b) to promote greater efficiency in the delivery of services (p. 19).
  25. Require each LHIN to a) appoint a member of its executive team to oversee the implementation of the Seniors Strategy; and b)  establish a steering committee (p. 20).

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