from dialogue to action€¦ · dialogue on health and aging summary report 3 letter from the...

From Dialogue to Action

Summary Report of the Working Group and Framework for Change

Dialogue on Health and Aging in British Columbia

Oct. 28 to 29, 2004 Morris J. Wosk Centre for Dialogue

Vancouver

Copies of this report may be downloaded from the Ministry of Health Services

website at: www.healthservices.gov.bc.ca/hcc/dialogue.html.

Dialogue on Health and Aging Summary Report 3

Letter from the Minister

British Columbia is creating a new care system that values and honors

seniors. If we, as British Columbians, are to benefit from the tremendous

wealth of knowledge and life experience seniors have to contribute,

we must ensure they have ways to remain active, independent, respected

members of our communities.

This focus on seniors represents a new direction in care, one that

acknowledges that the care system our government inherited is outdated

and out of step with modern day seniors. It acknowledges that seniors want

to remain in the community as long as possible and that government needs

to provide options that allow those who rely on publicly-funded care to do

so, while encouraging the private sector to provide care for those who want

more than government can provide.

The redesign of seniors’ care underway in British Columbia right now

is a necessary step in achieving this objective. It recognizes that a strong

care system relies on a foundation of housing and care services that are

based on the best evidence we have about what works in seniors’ care

and that provide a range of options that respect the skills and abilities

of today’s generation.

Redesign builds on the reforms occurring throughout the health care

system to provide more accessible, responsive care. Today, our government

has increased spending for hip and knee replacements, increased access

to cardiac procedures like angioplasties and enabled more seniors to have

vital cataract surgery because we understand that, as our population grows

and ages, seniors are living longer, healthier lives.


These changes are key to creating a dynamic, seniors-friendly society where

older adults can enjoy some of the most productive and satisfying years

of their lives.

Redesign is a long-term commitment, but health authorities are making

positive progress in improving the quality of care for seniors in their

communities.

Dialogues such as this provide us with the information government needs

to promote progressive seniors’ care. I would like to personally thank

all those who contributed to and participated in the Dialogue on Health

and Aging in British Columbia.

We, as government, look forward to continuing the momentum of change

stimulated by this dialogue, as we move towards our goal of better, more

accessible and appropriate care for seniors.

Shirley Bond Minister of Health Services


Contents Executive Summary ............................................................................. 7 Summary of Proceedings .................................................................... 11

What We Learned.......................................................................................... 13

Discussion ............................................................................................... 13

Directions................................................................................................ 22

The Individual and Their Family Caregiver ............................... 25

The Health Care System................................................................ 26

The Community.............................................................................. 29

Society .............................................................................................. 30

From Dialogue to Action ....................................................................31 Next Steps....................................................................................................... 31

Leading the Province in Change ................................................................. 32

A Plan of Action............................................................................................ 33

Appendices......................................................................................... 35 Presenters........................................................................................................ 35

Participant List ............................................................................................... 41


Executive Summary

British Columbia is preparing for a seniors’ boom that will significantly

change the way seniors’ care services are planned and delivered.

As the baby boom generation retires in the next decade and beyond,

governments are being faced with new challenges in caring for a healthier

and more active seniors’ population. With changes to home

and community care services already occurring throughout the province

to accommodate this major societal shift, the British Columbia Ministry

of Health Services wants to ensure its strategies are consistent with

contemporary thinking and research on seniors’ care.

British Columbia seniors are healthier, better educated and living longer

than at any time in past.

A growing and aging population, changing public expectations

and technological and scientific advancements provide both

challenges and opportunities for how our health care system cares

for and supports seniors.

Seniors will make up an estimated 22 per cent of British Columbia’s

population by 2026, good reason to plan, act and evaluate our progress

now. The province wants to ensure its health system is flexible, responsive,

sustainable and able to meet seniors’ care needs. Government also wants

to support seniors to age in a healthy way by encouraging wellness

and promoting strategies that prevent or reduce illness.

8 Dialogue on Health and Aging Summary Report

To ensure seniors are receiving the right care in the most appropriate

setting, British Columbia began a redesign of its seniors’ care services

in 2001. The success of redesign depends on its ability to deliver needed

care in a timely and effective way.

In October 2004, government brought together national and international

seniors’ care planners with over 100 representatives of leading seniors’

care and advocacy organizations, researchers, academics, health authorities

and government policy makers to review the direction and shape of seniors’

care in this province.

The outcomes of that Dialogue on Health and Aging in British

Columbia are presented in this report. The summary of proceedings

reports on the discussions and directions that emerged from

the symposium. It outlines key findings from the Dialogue on Health

and Aging in British Columbia, as well as discussion among presenters

and participants about the elements necessary to ensure an effective seniors’

care system. The report outlines the next steps the province will undertake

to advance seniors’ care in a direction that will ensure better care, today

and in future.

Our Objectives

o To ensure the direction British Columbia is taking addresses

its rapidly growing and aging population.

o To identify, based on clear evidence, research and practice, areas

for further development, including program improvements,

public policy issues and research initiatives.


Summary of What We Learned From the Dialogue

o British Columbia is heading in the right direction with its home

and community care redesign.

o While significant progress has been made in bringing together

and developing services, further change is required. The health

care system needs to refocus on a model that supports

the needs of people with chronic conditions. This has significant

implications for:

o primary care;

o acute care;

o home and community care;

o end-of-life care; and

o health human resource planning.

o People are willing and able to care for themselves

and their families as long as they know they can get support

when needed and that this does not present an unfair

financial burden.

o Improved prevention and health promotion efforts

can encourage healthier aging and relieve pressure on care services.

o Success in moving towards British Columbia’s vision

for health and aging will require multisectoral action –

this is not just a health care strategy.

o The province must build on the dialogue’s momentum

and participants’ goodwill and sense of optimism

Summary of the Dialogue Proceedings and Next Steps


What We Learned

Discussion

British Columbia is heading in the right direction with its home and community care redesign.

British Columbia’s redesign, based on extensive research and consultation

with seniors, their families and health care professionals, is the first major

provincial government initiative in planning for an aging population.

Presenter after presenter told the symposium that British Columbia’s

direction is consistent with changes occurring throughout Canada

and the world. They emphasized that demand for independent care options

will increase as technological advances improve the population’s health

and as seniors’ life spans increase.

Aging adults need senior-friendly acute care (hospital) services

and community-based services that enable them to remain well, active

and connected to their communities While some frail, elderly seniors will

always require traditional facility care, the concept of entering a nursing

home for life is out of step with many modern seniors’ lifestyle.

British Columbia envisions a home and community care system where:

“Individuals will have the support and services they need to live fully,

independently or interdependently, as engaged/valued members

of their communities.”


What British Columbia’s Redesign Will Achieve

Increase the use and funding of home-based care and supportive

living options. Residential care will continue to be available

for seniors, and people with disabilities, who require 24-hour

professional nursing care.

Reduce financial barriers for seniors who require home-based services.

Co-ordinate, and where appropriate, provide seniors with

a combination of home and community care and acute care services

to ensure seniors receive appropriate care.

Ensure seniors are directed to the right level of care by developing

alternatives to acute care (hospital) beds and ensuring seniors

are discharged from hospital as quickly as possible, with

appropriate supports.

Encourage seniors to remain independent, whether in their homes

or supportive living environments, and provide greater opportunities

for personal choice and to participate in decisions about their care.

Modernize government strategies and policies that underpin home

and community care services to better support health authorities.

To achieve this, information systems, client application, assessment

and classification processes and waitlist management for residential care

must be improved.

Ensure family caregivers and service providers receive the support

and education they require to deliver quality care.

“British Columbia’s general approach is pretty thoughtful…the emphasis

on connecting primary care and chronic disease management is an excellent

starting point……”

Presenter Steven Lewis


While significant progress has been made, further change is required. The health care delivery system needs to refocus on a model that supports the needs of people with chronic conditions.

There was broad consensus that British Columbia’s health

care system needs to shift from one that favors acute care

(hospital-based health care solutions) to one that responds

to seniors with chronic health conditions.

Making this shift calls for significant change to many

of the cornerstones of seniors’ care, including: • home care; • primary care; • acute care; • assisted living; • end-of-life care; and • the province’s human health resource strategy.

“We have never invested enough in community care in this country to reduce

our dependency on beds. The investment is not irreversible, so why aren’t we taking

the gamble?”


Home Care

Home health care is a cornerstone of a responsible community

care system. Its cost effectiveness has been clearly demonstrated

and there is considerable room for creative models. Presenters spoke

of the need for more home care services focused on the needs

of seniors with chronic health care conditions.


“We need to provide supports in the form of information technology,

office redesign and decision support. The powerful part occurs when

satisfied physicians recruit others.”

Presenter Chris Rauscher, Physician Consultant in Geriatric Medicine,

Vancouver Coastal Health

Primary Care

A common theme was the need to move to a primary care model

that supports the needs of people with chronic health conditions.

Among issues raised was adequately compensating professionals

working with elderly people. Research on positive outcomes

of physician visits with groups of seniors was presented.

Creating the right incentives, linking funding models to quality

and outcomes, leveraging the benefits of technology

and addressing the significant challenges related to culture,

training and role clarification were all identified as key factors

in an effective primary care system.

Acute Care

Participants emphasized the need to improve episodic acute care

for the elderly. Many expressed interest in the progress made

in Sweden. During the late 1990s, despite having one of the oldest

populations in Europe, Sweden reduced its acute care beds

by 45 per cent. The change stimulated the development


"Home care is humanitarian and cost effective. The future lies in moving more acute

care out into the home through 'advanced home care programs.’”

Presenter Dr. Henrik Bjurwill, CEO, Nackageriatriken Limited, Sweden

Acute Care continued

of acute geriatric rehabilitation services, linked to both primary

and home care. This approach dramatically reduced the number

of seniors in acute care hospitals awaiting placement in residential

or other types of care.

The key to acute episodic care is hospitals that focus on the needs

of the elderly as a primary concern. Speakers and participants

stressed the importance of rehabilitation, restoration and sub-acute

care as part of a strengthened health care system for seniors.

Assisted Living

The development of quality and affordable housing with supports

was seen to be critical by presenters and participants alike.

Attention is required to seniors’ ability to choose the level of risk

they are prepared to accept. Participants agreed that while British

Columbia is on a learning curve around assisted living, progress

to date has been successful.


“End-of-life care shouldn’t bankrupt families. But money is not often the biggest

problem. We need to deal with serious problems of co-ordination. This is harder

for end-of-life care. Fragmentation of service is the real challenge.”

Presenter John McCallum, Member, National Health and Medical Research

Council, Australia

End-of-Life Care

The dialogue addressed the need to strengthen community-

based hospice/palliative care and increase support

for patients dying at home and in the community. The need

for a more multidisciplinary approach, reduced financial barriers

for physicians, co-ordination of services and the need to provide

more options for seniors were all seen as part of a comprehensive

end-of-life strategy.

Health Human Resource Strategy

Concerted action and planning is needed to ensure appropriate

human resources are in place to meet the needs of an aging

population. A health human resource strategy is required that would

allow and support the most appropriate caregiver to deliver care,

while recruiting more geriatric specialists, encouraging primary care

physicians to practice seniors’ care and ensuring a role for nurse

practitioners.


People are willing and able to care for themselves and their families as long as they know they can get support when needed and that this does not present an unfair financial burden.

Increased support for family caregivers – through respite, education,

tools/aids and in-home support – is seen as vital to an effective seniors’

care system. The ministry was called upon to explore the feasibility

of payment to family members who provide care. Volunteers and seniors’

advocacy groups also spoke highly of approaches to self-managed care,

such as BC HealthGuide, a reference guide to common health problems,

and the BC NurseLine, a toll-free, 24/7 telephone service that links callers

with registered nurses for information on managing health concerns. Falls

prevention strategies by health authorities focus on reducing the personal

and health-related costs of falls, which can be a major source of short-term

disability and, in some cases, even death for seniors. These self-managed

care initiatives help seniors to have better health and reduce the cost to the

health care system of preventable illness and injury. Participants agreed that

fostering mutual support between seniors and their family caregivers and

providing aids/tools for self-management would assist family caregivers.

Improve prevention and health promotion efforts and encourage healthier aging.

The symposium identified the need to ensure seniors remain well

throughout their lives by improving prevention and health promotion

efforts and encouraging healthy lifestyles. Participants spoke

of the importance of going beyond the traditional care provided by

physicians and nurses by including community health workers in prevention

efforts, such as falls prevention programs. Understanding the links between

a seniors’ health and determinants of health, such as income, gender,


housing and personal health practices, was seen to be crucial in planning

for an aging population.

Success in moving to our vision requires action by many groups – this is not just a health care strategy. A recurring concern was the importance of addressing determinants

of health. There was clear recognition that governments, industry,

professional groups, research and advocacy groups need to work

in partnership, using the best evidence about seniors’ care, to make

necessary changes.

Bring research and the provider community closer together to mobilize knowledge.

Participants acknowledged that, beyond conducting research

and testing models, knowledge needs to be mobilized to effect change.

They told government that networks that engage health care providers,

patients and the public are needed so that new knowledge may be

transferred to those who work with seniors. Ministry of Health Services

deputy minister Penny Ballem applauded the climate of interest and

collaboration among university-based health researchers at the University

of British Columbia, University of Victoria, Simon Fraser University and

the University of Northern British Columbia. She called for the academic

communities’ support in determining directions and future actions

for home and community care redesign.


“We have a lot of resources and a lot of data. We need to bring these closer together

and help use the evidence/data we have to help us understand and guide choice.”

Participant Charlyn Black, Centre for Health Services and Policy Research,

University of British Columbia

Build on the momentum, goodwill and sense of optimism shown through the dialogue session. Participants expressed a strong sense of momentum and optimism arising

from the dialogue. In calling for government to act on the dialogue’s

findings, participants noted the many productive ideas and suggestions

stimulated by the sessions. It was suggested a think tank environment

would allow for continued collaboration between Canadian seniors’

care planners.


Directions

Discussion at the dialogue underscored the importance of a co-ordinated,

multisectoral approach to planning. Such an approach involves as many

sectors of society as possible and builds seniors’ care capacity at

the individual, health system, community and societal levels. These

levels are referred to as spheres of influence.

In order for seniors to be supported at home, in the community

and in facility care, all four spheres of influence need to work together.

• At the centre of these spheres of influence is the individual and family caregiver sphere. Strategies targeted at the individual

and family caregiver improve seniors’ ability to self-manage their

care, encourage seniors and family members to be mutually

supportive and provide support for caregivers. They improve

the care experience for those who need health services

and maintain a strong focus on keeping people healthy.

• Individuals and family caregivers are supported within

a health care system sphere, which addresses the needs

of people with chronic health conditions. Strategies developed

in this sphere are intended to improve the health care system’s

performance, improve access to care and quality of care,

optimize the use of health care resources and prepare

the workforce for changes arising from the aging of British

Columbia’s population.


A key goal of this strategy is ensuring the health care system

remains sustainable so that it may respond to potential growth

in demand related to increased numbers of seniors, many

of them older than in past, as a result of lifestyle changes

and medical advances.

• Strategies in the third circle – the community sphere –

are intended to build a supportive community system. Healthy,

informed and “activated” (or involved) communities, with

a strengthened and connected volunteer sector, are key elements

of this strategy.

• The society sphere acknowledges the importance of determinants

of health. It envisions a society that values seniors, where

opportunities to be contributing members of our society know no

age boundaries. Engaging the public in dialogue around difficult

policy questions and building healthy public policy are all potential

elements of this sphere.


Spheres of Influence in a Potential Health and Aging Framework for British Columbia1

1 This framework evolved from British Columbia’s expanded chronic care model.

Individualand Family Caregiver

• Informed and activated

• Improved health and wellness

• Improved experience with health system

Health Care System

• Optimal use of resources • Improved access • Improved system

performance • Improved quality of care • Sustainable system • Prepared and productive

care providers

Community Society

• Healthy communities

• Informed and activated communities

• Strengthened and connected volunteer sector

• Healthy public

policy

• Society that

values elders


While many of the suggestions that emerged from the symposium

focused on activities that would improve care in each sphere of influence,

it is recognized that achieving these objectives would require action

and leadership by organizations other than the Ministry of Health Services.

The following section presents highlights of those discussions and examples

and ideas discussed at the symposium.

The Individual and Their Family Caregiver

Desired Outcomes

• Informed and activated individuals and family caregivers.

• Improved health and wellness for seniors.

• Improved experience with the health care system for those who need it.

Highlights and Proposed Directions

The dialogue heard that British Columbians are willing and able to care for

themselves, and their families, provided they have the resources to do so

and aren’t faced with an unfair financial burden. Participants suggested

change is needed to address the challenges family caregivers face.

• Support to family caregivers could be increased through the expansion

of respite programs, more education, more tools and more active case

management and support.


• Individuals and family caregivers need to be informed and involved

through programs that increase support for self-management of health

care problems, mutual support between seniors and family caregivers

and peer support.

• Seniors could be kept healthier, longer, through programs and services

that enable or enhance their independence and through social

opportunities. In particular, participants commented on the desirability

of expanding home support services and developing expert patient

programs for chronic disease self management.

“We need to recognize that people have different coping capacities. It is a challenge

to frame policies that address and accept such diversity and ambiguity.”


The Health Care System Desired Outcomes

• Optimal use of resources. • Improved access. • Improved health care system performance. • Improved quality of care. • Sustainable health care system. • Prepared and productive workforce.


Throughout the dialogue, there was significant support for British

Columbia’s redesign and for its sponsorship of initiatives such

as chronic disease collaboratives. Collaboratives consist of physician-led


teams train other physicians in how to improve patient care by

incorporating best practices into their patient care practices.

The recent agreement between government and the BCMA (BC Medical

Association) opens the door to new opportunities. Further, universities

are working together in unprecedented ways – both in research

and in education – that will enable them to better contribute

to seniors’ care planning.

A number of the key findings in this report speak to the directions

proposed by dialogue participants. • Increasing home and community care services – bringing more choice

and flexibility.

• Developing and introducing an evidence-based, end-of-life

care strategy.

• Improving acute care services for the elderly, with more intensive

management, including pre-/-post care and rehabilitation, reactivation

and restoration of seniors’ health. • Improving government’s ability to manage the health care system

and to optimize how resources are used by linking clinical

and management information systems and through translating

knowledge into practice. • Making changes to the primary care system that support chronic

disease management. Examples include incentives for health care

professionals to practice primary care, increasing training for care

providers and strengthening support systems for care providers.


• Increasing the ability to bring knowledge into practice

by creating networks, forums and communities of practice

for health care providers.

• Allowing and supporting the most appropriate caregiver to deliver

the necessary care, creating care teams that include a much broader

range of care providers and planning, supporting and monitoring

caregivers as they make the transition to new approaches to care.

“We realized we couldn’t just keep working harder. We needed to work smarter

and group medical appointments presented a great tool. Group medical

appointments work because they improve the doctor-patient relationship

and promote trust. They provide more surface contact time for information

exchange. They create the therapeutic milieu, without doing therapy. Shared

appointments instill hope in patients who see peers surviving and coping well

with the same illness. They learn that they are not unique. The information received

allays anxiety. The groups also provide an opportunity for altruism: patients enjoy

helping each other and seniors have much experience, but no opportunity to share

it. There are no taboos, so patients talk about everything. They can model their

behaviour after that of those who are coping well.”

Presenter Dr. John Scott, Director of Primary Care Redesign, Kaiser Permanente,

United States

Among other steps presenters suggested are:

• linking clinical and management information systems to improve both

clinical and policy decisions; and

• organizing information to ensure both care providers and patients have

the data they need to make decisions.


The Community

Desired Outcomes

• Strengthened and connected volunteer sector.

• Informed and activated communities. • Healthy communities.


A consistent interest was the need to develop more informed

and activated communities that would support the province’s health

and aging framework. This calls for a change in caregiving approaches

and for educating all British Columbians about the process of aging.

Such as an approach would expand the range of perspectives brought

to bear on dialogues about healthy aging.

British Columbia has been advocating for a healthy communities approach

for many years. This strategy provides a foundation for the ongoing work

of all levels of government in building more livable communities. Support

and engagement of the voluntary and non-governmental organization

sectors, and connecting the voluntary sector into health care planning

and services, helps to build “social capital” or improved social relationships.

It encourages informed and activated communities. “Not only are (seniors) the largest per capita donors to charities, almost one-quarter

of them provide unpaid care to other seniors in the community. Perhaps most

important, our elders hold the collective wisdom of our society.”

Presenter Cori Paul, Clinical Nurse Specialist/Manager, Good Samaritan Society

Seniors’ Clinic, Canada


Society

Desired Outcomes

• Healthy public policy. • Society that values elders.


The value of seniors to society was underscored by many participants

and presenters. Several participants talked about the importance

of widening the debate to involve and engage the public by supporting

their understanding of health and health care issues. They suggested

the public be involved in discussions about difficult policy questions,

such as the level of risk seniors choose to assume in an effort

to remain autonomous, means testing for seniors’ care services

and issues of regulation and oversight compared to alternate models

of quality assurance. “Choice, independence, privacy and individuality are universal values that transcend

ethnic groups, countries and socio-economic groups and are by no means unique

to older people.”

Presenter Dr. Keren Brown Wilson, Advisor, Pan American Health Organization,

United States


From Dialogue to Action As British Columbia moves forward with its home and community care

redesign, the province’s strategic direction needs to be renewed to ensure

its approach to seniors’ care, and care for people with disabilities, truly

involves health care providers, planners, researchers, seniors and their

families. Best practices in primary care, chronic disease management and

specialized acute care for the elderly need to form the foundation of

services for seniors as British Columbia responds to the call for action and

leadership by government.

Next Steps In response to the Dialogue on Health and Aging in British Columbia,

the Ministry of Health Services will:

• refine the province’s home and community care redesign strategy

to carry through the next phase of redesign;

• determine a feedback mechanism to ensure representation

in the strategic planning process by advocates for seniors, people

with disabilities, health care professionals, researchers and others;

and


• continue to work with health authorities to foster the development

of evidence-based best practices in health promotion, disease

prevention, self-care, episodic care, rehabilitation, chronic care

and end-of-life care for seniors.

Leading the Province in Change Strong provincial leadership is important to moving from dialogue

to action in meeting the challenges of providing quality seniors’ care.

Provincial leadership is essential to:

• co-ordinate the many related initiatives within and external

to the ministry;

• leverage opportunities related to the 2004 federal health accord;

• leverage opportunities related to the BCMA and other

professional groups;

• link to national and provincial initiatives; and

• link to other ministries, the BC Academic Health Council

and the Michael Smith Foundation for Health Research.

Various care experts and others may be called upon as it becomes apparent

that their expertise would contribute to the working group’s activities.


A Plan of Action An updated home and community care redesign strategy will detail

the broad plan of action for seniors’ care.

The updated redesign strategy will address the importance of moving

forward on change and on building relationships between seniors, their

families, care providers and planners in achieving the goal of providing

seniors, and people with disabilities, with better care and more options.

As the province, health authorities and the Ministry of Health Services

continue their efforts to improve seniors’ care in British Columbia,

they recognize that this effort requires a long-term approach that values

and respects seniors and their families. The next phase will build

on the experiences of the Dialogue on Health and Aging in British

Columbia, on the knowledge the province and care planners already have

and on the many contributions that seniors, their families, care advocates,

health care professionals and others have made to our understanding

of seniors’ care needs, now and in the future. “While we haven’t all the answers, we have enough knowledge

to move forward – and we need to move forward boldly.”

Presenter Dr. Robert Kane, Endowed Chair, Long Term Care and Aging,

University of Minnesota, United States


Appendices Presenters

Dr. Réjean Hébert Dr. Réjean Hébert is currently Dean of Medicine and a professor in the Department of Family Medicine at the University of Sherbrooke and also a National Research Fellow of the Québec Health Research Fund (FRSQ). From 2000 to 2003, he was the first scientific director of the Institute of Aging of the Canadian Institutes of Health Research. Previously, he was the founding director of both the research centre at the Sherbrooke Geriatric University Institute and the Québec Research Network in Gerontology

and Geriatrics. He has been a member of several boards and committees such as: The administrative board and the executive committee of the Québec Health Research Fund; the advisory committee of the Senior Independence Research Program (Health Canada); and the advisory committee on health services of the conference of Ministry of Health in Quebec. His research focuses on functional decline in the elderly, including epidemiology and evaluation of services. He is currently engaged in evaluative studies on the efficacy of health services and program, particularly integrated networks of services for the elderly and disabled. He is involved in research on caregivers of demented patients and is the principal investigator of a multi-centre study on the efficacy of a new support group program. He developed and validated the functional autonomy measurement system (SMAF), a disability rating scale used in Canada and in other countries for clinical and research purposes. He is one of the principal investigators of the Canadian Study on Health and Aging, one of the largest studies on the epidemiology of dementia.

Dr. Peter Coyte Dr. Peter C. Coyte is a professor of health economics at the Department of Health Policy, Management, and Evaluation, University of Toronto. He publishes widely in the areas of health economics, health policy and health services research. His studies have included the measurement of regional variations in health service utilization, evaluations of the cost


effective provision of health care services and assessments of health service finance, delivery and organization for organizations and governments both in Canada and internationally. In 2000, Coyte co-founded the Home and Community Care Evaluation and Research Centre with his colleague, Dr. Patricia McKeever. In 2002, McKeever and Coyte launched the CIHR (Canadian Institutes of Health Research) strategic training program in health care, technology and place, which complements the activities of the Canadian Health Services Research Foundation/Canadian Institutes of Health Research Chair.

Dr. Keren Brown Wilson Dr. Keren Brown Wilson is widely known as the architect of the ‘Oregon model’ of assisted living and for her work with affordable assisted living. Her Oregon-based assisted living companies have provided development and management services to over 200 projects in 17 states, with more than 7,000 residents. Many of the companies serve specialized populations, including native American, Spanish-speaking, African-American, deaf, rural and urban, low-income residents, as well as people with mental illness. Dr. Wilson is also

a recognized expert on negotiated risk agreements. Dr. Wilson most recently developed a course on international health and aging and began a new focused education program abroad in Latin America for policy and direct service (long term care and housing). She serves as an advisor to the Pan American Health Organization and has provided technical assistance to many countries, including Canada, China, Uruguay, Nicaragua and the British Virgin Islands, in the areas of long term care and housing. Her research in assisted living began with two of the earliest studies ever done and she is currently involved in four studies. Dr. Wilson was recently recognized by the Nicaraguan government for developing a long-range plan for aging services, including research, training and programs for the elderly, as well as direct assistance to homes for low-income elderly people.

Dr. Eduardo Bruera Dr. Bruera is a professor of medicine, F.T. McGraw Chair in the Treatment of Cancer and Chair of the Department of Palliative Care and Rehabiliation Medicine at the University of Texas M. D. Anderson Cancer Center in Houston. Previously, he served as Director of the Division of Palliative Care Medicine at the University of Alberta and Clinical Director of the Edmonton Regional Palliative Care Program. After earning his medical degree at the University of Rosario


in Argentina, Dr. Bruera completed his training in medical oncology at the University of Salvador in Buenos Aires. He subsequently began a fellowship in supportive care at the National Institute of Canada at the University of Alberta, followed by an appointment as a professor of oncology and Chair in Palliative Medicine of the Alberta Cancer Foundation. He has a strong interest in the global development of palliative care and has collaborated for many years with the World Health Organization/Pan American Health Organization as a regional focal point for palliative care and as leader of several specific projects.

John McCallum Professor John McCallum has recently joined Victoria University in Melbourne as the Deputy Vice Chancellor of Educational Programs and Director of the Technical and Further Education Division (TAFE). Prior to this, he was Dean of the College of Social and Health Sciences, Campbell town Campus, University of Western Sydney (UWS). John worked at Griffith University, the Research School of Social Sciences and the National Centre for Epidemiology and Population Health at the Australian National University, the Andrus Gerontology Center

at the University of Southern California, Nanzan University in Nagoya and the Tokyo Metropolitan Institute of Gerontology, both in Japan. He joined UWS in 1995 and has established a range of new health science courses, including podiatry, chinese medicine, osteopathy and naturopathy. His major research publications and projects are in the areas of aging, health services research, health outcome measures and Vietnam veteran's health. John is a member of the National Health and Medical Research Council (NHMRC) Australian Health Ethics Committee, as well as the NHMRC health advisory committee. He was a contributor to the Myer Foundation Report 2020: A Vision for Aged Care in Australia.

Steven Lewis Steven Lewis is a partner in Access Consulting Ltd. and sits as a councillor on Canada’s recently-formed Health Council. He is former Chief Executive Officer of both Saskatchewan's Health Services Utilization and Research Commission and the Saskatchewan Health Research Board. Since 1974, he has been a health services researcher, research administrator and health policy analyst and consultant. He has worked in government (provincial and federal), in an applied health research centre, as a granting

agency administrator and as a private consultant.


Dr. John Scott Dr. Scott has served as Chief of Service, Director of Primary Care Redesign and Chief of Service of the multi-specialty clinic with Kaiser Permanente and is currently on the board of directors of Kaiser Permanente. He developed a group model of care for high-utilizing geriatric patients, which became known as the cooperative health care clinic (CHCC) model. The CHCC was established as a national program within the Kaiser system and ultimately stimulated interest in other modifications of the group

visit concept for management of chronic disease. Kaiser Permanente is the largest nonprofit health plan in the United States, serving 8.2 million members, with headquarters in Oakland. Dr Scott uses group visits to take a hard look at ways in which the chronic care model has redefined health care for chronic conditions.

Cori Paul Cori Paul is a clinical nurse specialist/manager for the Good Samaritan Society Seniors' Clinic in Edmonton. Prior to this, she worked with the complex frail elderly as the advanced practice nurse for the Good Samaritan Society CHOICE program, the first of its kind in Canada. Paul was an instructor at the University of Alberta (U of A) faculty of nursing for many years and was a founding member of the faculty of nursing primary health care task force. There, she helped to lay the foundation

for the integration of primary health care into all nursing programs at the U of A. During this time, she was instrumental in establishing the first interdisciplinary international health course at the U of A with Dr. Amy Zelmer. This course exposes students to primary health care concepts and their value. Paul is an instructor with Athabasca University in health promotion, primary health care, health assessment and physical examination in the nursing baccalaureate program.

Dr. Chris Rauscher Dr. Chris Rauscher is a physician consultant in geriatric medicine for the Vancouver Coastal Health. He pursues his work in three related areas: clinical practice seeing frail seniors living at risk at home or in care facilities through home visits, professional practice development and health systems planning. Dr. Rauscher has been a medical director in care facilities and has worked extensively with community health care systems, including home and community


care and community mental health. He has been involved in developing practical practice tools for working with these populations including a risk assessment approach and an ethics framework for clinical practice in the community. In the last few years, Dr. Rauscher has taken a lead in British Columbia in chronic disease management. He is physician-lead for chronic disease management for Vancouver Coastal Health. He chaired a group of health care professionals that wrote the heart failure care guideline for British Columbia and was the co-chair of the first chronic disease management structured collaborative in British Columbia, the BC CHF Collaborative.

Dr. Tony Snell Dr. Tony Snell is currently Medical Director for Birmingham and the Black Country Strategic Health Authority in the United Kingdom. In this role, he takes the lead on public health, inequalities, clinical governance and primary care. He was instrumental in leading a successful quality improvement program in England, which focused on chronic disease management in primary care. This resulted in his being named co-vice chair of a National Health Services Confederation negotiating team leading a quality

and outcomes framework. During this period, he worked with England’s Department of Health in negotiating the new general medical services (GMS) contract with the general practitioners’ committee of the British Medical Association. He was responsible for the development and implementation of the primary care clinical effectiveness project (PRICCE), which became the basis for the new GMS contract quality and outcome framework.

Dr. Robert Kane Dr. Robert Kane currently holds an endowed chair in long term care and aging at the University of Minnesota, where he directs the Center on Aging, the Minnesota Area Geriatric Education Center, the Clinical Outcomes Research Center and an Agency for Healthcare Research and Quality (funded evidence-based practice centre). He has conducted numerous research studies on both the clinical care and organization of care of elderly people, especially those needing long term care. He has analyzed long-term

systems, both in the United States and abroad. His current research addresses both acute and long term care for elderly people (or older people), with special attention to the role of managed care, chronic disease and disability. Dr. Kane is a consultant to a number of national and international agencies, including the World Health Organization's Expert Committee on Aging.


Dr. Henrik Bjurwill Dr. Henrik Bjurwill is Chief Executive Officer and Senior Physician of Nackageriatriken Limited in Sweden. Nackageriatriken is a private health care provider delivering high quality geriatric care to patients. Most of its services are carried out on behalf of Stockholm County Council. Prior to joining Nackageriatriken, Dr. Bjurwill was a geriatric consultant to the National Board of Health and Welfare and to various other organizations. He is a member of the board of the geriatric section

for the Swedish Medical Association.

Dr. Michael Gordon Dr. Michael Gordon, MSc, FRCPC, FRCPEdin, serves as Vice President of Medical Services and Head of Geriatrics and Internal Medicine for Baycrest Centre for Geriatric Care in Toronto. He is a professor of medicine and a member of the Joint Centre for Bioethics at the University of Toronto. Dr. Gordon is also Head of the Division of Geriatrics at Mount Sinai Hospital. He has participated on many professional and government committees on aging and related subjects and is past

chair of the Ontario provincial drug quality and therapeutics committee and an active member of the coroner’s committee on geriatrics and long term care. He is a member of the National Advisory Council on Aging and was recently elected a member of the general council of the College of Physicians and Surgeons of Ontario.


Participant List

Members of the Legislative Assembly Hon. Colin Hansen Former Minister of Health Services Hon. Ida Chong Former Minister of State for Women's and Seniors' Services Rev. Val Anderson MLA, Constituency of Vancouver-Langara John Nuraney MLA, Constituency of Burnaby-Willingdon Valerie Roddick MLA, Constituency of Delta South Katherine Whittred MLA, Constituency of North Vancouver-Lonsdale

Consumer/Seniors’ Organizations Harry Atkinson Peninsula Community Services "Seniors Hotline" Olive Bassett Richmond Seniors Advisory Committee Dr. Charlyn Black Centre for Health Services and Policy Research Renee Bradley Family Caregivers Network Barry Drinkwater City of Penticton Seniors' Advisory Committee Denis Domshy Prince George Council of Seniors Helen Domshy Prince George Council of Seniors Ed Helfrich BC Care Providers Stan Hindmarsh BC Retirement Communities Association Jane Lapinski BC Retirement Communities Association Val MacDonald Seniors Housing Information Program Barbara MacLean Family Caregivers Network Anne Martin-Matthews Institute of Aging Mary McDougall BC Care Providers Deborah O'Connor Caregivers Association of BC Werner Pauls BC Care Providers Paddy O'Reilly Healthy Heart Society Rosemary Rawnsley Alzheimer Society of BC Lorna Romilly WHIN Ann Syme BC Hospice Palliative Care Association Carolyn Tayler BC Hospice Palliative Care Association Barry Thomas CARP Canada's Association for the Fifty-Plus Colleen Tracy Assisted Living Centre of Excellence Ava Turner BC Care Providers Hendrik Van Ryk BC Care Providers Janice Waud Loper BC Hospice Palliative Care Association Cathy Weir WHIN Mary Segal Lionsview Seniors' Health Planning Society Marilyn Slade BC Care Providers Health Care Organizations Laurel Brunke Registered Nurses Association of BC Tom Crump Health Care Leaders' Association of BC Derek Desrosiers BC Pharmacy Association Dr. Douglas C. Drummond BCMA Stan Dubas BC Care Providers George Eisler BC Academic Health Council


Steve Gardner Health Care Leaders' Association of BC Robert Hulyk BCMA Pat Kasprow Health Care Leaders' Association of BC Dr. Dan MacCarthy BCMA Marnie Mitchell BC Pharmacy Association Dr. Akber Mithani Providence Health Care Linda Myers BC Psychogeriatric Association Dr. Duncan Robertson BCMA Geoff Rowlands Health Care Leaders' Association of BC Patricia Ryan Kits Point Consulting Dr. Lorna Sent College of Physicians and Surgeons of BC Mary Shaw Registered Nurses Association of BC John Sloan BC College of Family Physicians Dr. Aubrey Tingle Michael Smith Foundation for Health Research

Health Care Planners/Researchers Dr. Martha Donnelly UBC, Division of Community Geriatrics Elaine Gallagher University of Victoria Andrew Wister Simon Fraser University Municipal Government Robert Hobson Union of British Columbia Municipalities Alison McNeil Union of British Columbia Municipalities

Provincial Government

Health Authorities Leslie Arnold Provincial Health Services Authority Anne-Marie Broemeling Interior Health Lynn Buhler Vancouver Coastal Health Betty Ann Busse Fraser Health Don Carlow Vancouver Island Health Authority Janet Davidson Vancouver Coastal Health Alan Dolman Interior Health Jenny English Vancouver Island Health Authority Lorraine Ferguson Interior Health Gerri Fletcher Interior Health Harry Gairns Northern Health Dr. David Gayton Fraser Health Ida Goodreau Vancouver Coastal Health Carla Gregor Providence Health Care Colleen Hart Fraser Health John Heath Vancouver Island Health Authority Dr. Dan Horvat Northern Health Jean Francois Kozak Providence Health Care Penny Lane Interior Health Georgina MacDonald Vancouver Island Health Authority Kim MacDonald Vancouver Island Health Authority Dr. Heather Manson Vancouver Coastal Health Michael Marchbank Provincial Health Services Authority Malcolm Maxwell Northern Health Lynda McCloy Vancouver Coastal Health


Dr. Brian McGowan Fraser Health Michael McMillan Northern Health Michael Pontus Vancouver Island Health Authority Keith Purchase Vancouver Coastal Health Terry Ralph Interior Health Dr. Christine Penney Vancouver Island Health Authority Nancy Rigg Vancouver Coastal Health Timothy Rowe Northern Health Dr. Phil Sigalet Interior Health Bob Smith Fraser Health Dr. Richard Stanwick Vancouver Island Health Authority Celso Teixeira Fraser Health Larry Tokarchuk Northern Health Catherine Ulrich Northern Health Angela Welton Fraser Health Howard Waldner Vancouver Island Health Authority

Ministry of Community, Aboriginal and Women’s Services Kaye Melliship

Ministry of Health Services Susan Adams Keith Anderson Penny Ballem Stephen Brown Andrew Hazlewood Dr. Perry Kendall Craig Knight Catriona Park Patricia Petryshen David Woodward Dr. Eric Young Representatives of performance management and innovation; home and community care; children’s, women’s and senior’ health; capital planning; primary health care and rural policy; chronic disease management; population health and wellness; nursing directorate; aboriginal health; PharmaCare; strategic policy and research; information quality and analytical support; information support

BC Housing Craig Crawford Margaret McNeil Shayne Ramsay

from dialogue to action€¦ · dialogue on health and aging summary report 3 letter from the...

Documents