• Contact information
• Fact sheet

Continuing/Community Care Should Be Recognized as a Major Component of the Canadian Health Care System

The time has come to bring Canada's fragmented home and continuing health care services into the mainstream health care system and to restructure the system accordingly, argues a study commissioned by Health Canada and released Tuesday.

The patchwork system of services that has arisen across the country is failing to adequately or equitably meet the needs of children and adults with disabilities, the elderly, and the mentally ill, all of whom require ongoing care outside the acute care system, the report found.

The needs of these population groups "should be seen as constituting a new and major component of the Canadian health care system," and Dr. Marcus Hollander, who delivered the study at the "Living International Exchange on Home and Community Care" conference in Toronto Tuesday. He and co-author Dr. Michael Prince, of the University of Victoria, said this sector of health care should have equal stature with hospitals, primary care, pharmaceuticals and preventative/public health, with appropriate administrative restructuring at the federal, provincial and regional levels.

"This sector has always been viewed as a poor cousin to the acute care system. It's not just about replacing hospital services with home and community care. It has its own set of problems, solutions and funding criteria," said Sharon Scholzberg-Gray, president of the Canadian Healthcare Association.

"One of the critical challenges facing health care in Canada is how to manage and systematically address the needs of these population groups. Our current health care system is not organized to sustain the onslaught of their needs," said Tim Young, past president of the Canadian Home Care Association. "This report for the first time in Canada provides a roadmap as to how the sector can be better managed."

Researchers conducted more than 250 interviews with leading experts in the four population groups studied, undertook focus groups and interviewed an additional 21 Canadian experts on the health care system for the study, which was commissioned by Health Canada to provide insight into how to improve services, particularly community health services.

The report outlines a comprehensive, system-wide national plan to restructure home and continuing care services in an integrated manner which the authors argue will only be effective if there is a shift in philosophy from the current emphasis on the acute care model of curing disease and treating medical conditions. Instead, policy makers and administrators should accept a supportive model of care that reduces the rate at which individuals deteriorate, providing clients with the best quality of life through health and support services.

"What distinguishes the needs of the people in (these populations) is their requirement for ongoing and long term care, support and enablement," said Hollander. "There should be a clear recognition of the importance of non-medical services and that these services are at least as important to the well being of individuals as medical services. That does not necessarily mean more costs to the system. Our vision is that of a seamless, integrated system of care including community, residential and specialty hospital services, that will reduce demands on hospitals and contribute to the overall cost-effectiveness of the broader healthcare system."

The report's proposed framework for service delivery is applicable to all four population groups, allowing for a new approach to this sector of health care. It calls for a single administrative structure and a single overall budget to allow for a rational and equitable system. A "single-entry approach" would ensure co-ordinated care for clients and alleviate the need for individuals to speak to multiple sources to find out what services are available and how they can be accessed. Improved linkages between all aspects of Canada's complex health care system would ensure client-centered service. Integrated information systems would improve efficiency and eliminate the need for multiple assessments, and clients and families having to tell their stories over and over again. A restructured health system would see senior level positions designated in Ministries of Health and Regional Health Authorities for continuing/community care.

The authors also call for further analysis of how the continuing/community care sector can contribute to the overall efficiency and effectiveness of the Canadian health care system. The fact there is no national data base on home care and almost no comparable national data related to any of the four population groups must be addressed, the authors say.

Taylor Alexander, chief executive officer of the Canadian Association for Community Care, said the current home and continuing care system is inequitable across the country, with variations in eligibility criteria, access criteria, funding criteria, and user fees.

"There are two parallel systems of care in this country: the medical acute care system with guaranteed insured access under the Canada Health Act, and the patchwork quilt of uninsured services in home and community care. We need a commitment to a new model of care and have been calling for federal leadership to establish a national program," Alexander said.

"We now have a proposed blueprint for action that we didn't have before," the report says. "This sector is at a point where action is now both needed and required. And there appears to be a national consensus on the problems and proposed solutions."

"This report makes a very compelling case for major reform to bring the continuing/community care system into the mainstream," said Alexander. "Our association is anxious for this issue to be resolved. We applaud Health Canada for funding the report and the authors for having written it."

page top

Contact Information

For information on the report "'The Third Way': A Framework for Organizing Health Related Services for Individuals with Ongoing Care Needs and Their Families" by Dr. Marcus Hollander, Hollander Analytical Services Ltd. and Dr. Michael Prince, Faculty of Human and Social Development, University of Victoria, contact:

Dr. Marcus Hollander:
Hollander Analytical Services Ltd.
Victoria, B.C.
(250) 384-2776

Dr. Michael Prince:
Acting Dean
Faculty of Human and Social Development
University of Victoria
(250) 721-8050

For comments on the report from home and continuing care organizations:

Sharon Sholzberg-Gray
President
Canadian Healthcare Association
(613) 241-8005 ext. 202

Tim Young
Executive director
East York Access Centre
Past-president of the Canadian Home Care Association
(416) 423-3559
Cellphone: 416-571-5837

Taylor Alexander
Chief Executive Officer of the Canadian Association for Community Care
(613) 241-7510

page top

Fact Sheet

• In the fall of 2000, Health Canada issued a request for proposals for research on information on the continuum of care for four population groups: seniors, adults with physical disabilities, persons requiring mental health services and children with special needs. Over the past 20 years, more and more of the people in these four population groups have come to be cared for in the community rather than in institutions. It was deemed timely to take stock of the existing service delivery systems and to try to find new approaches to improve care delivery.
  
  
• The project was conducted in two phases. The first phase involved the preparation of six technical reports examining interfaces along the continuum of care for the four population groups. The final report, by Dr. Marcus Hollander, of Hollander Analytical Services Ltd., and Dr. Michael Prince, Faculty of Human and Social Development, University of Victoria, developed a new conceptual framework for promoting a continuum of integrated home and community care, with adequate links to hospitals and primary health care. The framework provides the basis for a discussion about "what supports in other sectors are essential to the success of home and community care and what are the policy options to strengthen the interfaces with other sectors."
  
  
• Researchers conducted more than 250 interviews with leading experts in the four population groups. They conducted focus groups with clients and family members and undertook an extensive literature review. In order to confirm the findings, they interviewed another 21 Canadian experts on the health care system. The authors found a high degree of consistency in the recommendations as well as consistency with the findings of other analysts. They believe the documents prepared for this project provide comprehensive, up-to-date and accurate reporting of key challenges and proposed solutions.
  
  
• The researchers identify a list of services that should be included in an appropriate, comprehensive service delivery system for the four populations, from case management and rehabilitation services to transportation and respite care services. They also identify gaps in service, identifying waiting lists for services, inequitable eligibility criteria, financial policies restricting access, and human resources shortages.
  
  
• The researchers identify major impediments to the coordination of care for the four population groups, including restrictive funding mechanisms inhibiting resource transfers between service components to meet client needs, bureaucratic turf wars preventing a focus on broader system efficiencies, and concerns about regionalization creating variability in service mix, portability and accessibility.
  
  
• The final report outlines a conceptual framework that would be applicable to all four population groups and that would allow for a new approach to this sector of health care based on a philosophical acceptance of the role of a supportive rather than a curative model of care. It suggests five best practices relating to administration and five best practices for service delivery. The framework also addresses issues of coordination and linkages among the various systems of care.
  
  
• The researchers conclude there is a national consensus on the problems faced by the four population groups, and the proposed solution. They suggest the time is ripe for new initiatives.

info@hollanderanalytical.com