1/20/13

Seniors recommendations head off in wrong direction


The government's new senior's "action plan" discussed in the last post follows on from Dr. Samir K. Sinha’s report  for the government “Living Longer Living Well”.  Sinha's report is labelled only as “Highlights and Key Recommendations”.   A “full report will present considerably more detailed findings and recommendations that will enable the government to expand upon and provide some specific means of implementing the themes and recommendations set out in this Highlights and Key Recommendations document.” So there may be more to come.  

The "Highlights" report makes numerous recommendations in 13 areas.  Indeed the recommendations are stated in a distinctly vague way.  Moreover, they generally follow the well tread path in existing government policy.   

Despite some recognition that the elderly population is growing very rapidly, there is no recommendation for expanded LTC or hospital services and no call for new funding.   

Significant proposals regarding the role of LTC are made, including more movement towards shrinking the traditional role of LTC facilities, while also moving LTC into hospital services, as recommended by the for-profit LTC sector.  

The report also contemplates increasing the number of LTC facilities selected by prospective residents.  With the backlog in the LTC wait lists, this apparently is part of a broader push to get seniors to accept less desirable LTC homes – i.e. generally the for-profit homes.

There is much greater emphasis on means testing in several areas, despite such provisions being long proven as more expensive and less effective. This is especially vexing regarding home care: the government claims it is replacing universal and comprehensive hospital services by home care services  -- i.e. by home care services which are actually very limited.  Now, it seems, they want to means test even those limited home care services.    

 The most noteworthy recommendations in my view are the following:
  • Explore the implications of developing an income-based system towards for home care and community support services 
  • Enhance access to clinic-based physiotherapy services in every LHIN, especially for those on limited incomes who often forgo this therapy
  • The Ministry of Health and Long-Term Care, in partnership with the Ministry of Municipal Affairs and Housing and the Ministry of Community and Social Services, should encourage the development of more Assisted Living and Supportive Housing Units as alternatives to Long-Term Care.
  • The Ministry of Health and Long-Term Care, in collaboration with Local Health Integration Networks (LHINs) and local municipal Emergency Medical Services (EMS) programs should explore the development and expansion of Community Paramedicine programs across Ontario, especially in northern and rural communities.
  • The Ministry of Health and Long-Term Care, with LHINs’ collaboration, should support the development and launch of the Hospital at Home model in Ontario. A successful proof of concept of this model in Ontario will provide the information required to further implement this model across the province if deemed successful.
  • Develop an evidence-informed capacity planning process to meet the needs of current and future eligible long-term care (LTC) populations who could be better supported in supportive housing, in assisted living residential environments, or in their own homes with home care.
  • 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 accomplished by increasing short-stay respite and convalescent-care program capacity in LTC homes.
  • Enable LTC homes to provide higher levels of care to individuals with complex care needs.
  • Explore 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.
  • Improve the flow to and from LTC long-stay and short-stay services by reviewing the existing application and transfer processes and policies. Consider increasing the number and type of homes selected; and better support potential residents in the selection process.
  • Broaden the range of palliative care settings available in their regions
  • Reform 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 
  • Strengthen the 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
  • Require health, social, and community services providers streamline their assessment and referral processes.

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