On Monday, September 10, RNAO submitted a comprehensive approach to the MOHLTC for developing an evidence-based and integrated Seniors’ Care Strategy with the goal of improved mental, physical and social health outcomes, while leveraging existing resources, minimizing structural duplication and upholding a stronger publicly-funded, not-for-profit health system.
RNAO proposed that such a strategy needs to align with the following principles:
Integration and co-ordination across the health system;
A strengthened publicly-funded and not-for profit health system;
Focus on health and wellness;
Social, environmental, economic and indigenous determinants of health;
Driven by evidence and best practices, equity and access to services;
Dignity, respect, independence and self-determination;
Cost-effective and appropriately resourced; and
Community and family orientation
RNAO's Submission to the Government of Ontario's Seniors Care Strategy
September 6, 2012
The Registered Nurses’ Association of Ontario (RNAO) welcomes the government’s decision to develop a Seniors’ Care Strategy, as Ontario’s nurses have long advocated to ensure that every senior in Ontario has the opportunity to live in dignity as a respected and independent member of the community.
RNAO calls on government to implement a Seniors’ Care Strategy that increases access to home care and support services to benefit seniors; most of whom would rather stay in their homes than be institutionalized. Moreover, RNAO urges that a broad focus be used to reinforce the underlying concepts embodied in the five identified priorities by government to maximize their impact. The focus on “doctors’ house calls”, should be reconsidered to embrace the desired outcome of 24/7 access to primary care for Ontario’s seniors, where house calls are more appropriately and efficiently led by primary care Registered Nurses (RNs) and Nurse Practitioners (NPs) in collaboration with physicians and other members of the interprofessional team. Furthermore, simply encouraging seniors to eat well and exercise regularly will produce very little impact unless government addresses the overriding effects of social and environmental determinants of health and the day-to-day reality that many older persons live in poverty. Nurses know that “blaming the victim” policies are not only ineffective but also damage self-efficacy, resilience, and the sense of connectedness we all need with the broader community to experience social inclusion – a pivotal social determinant of health. Based on substantive evidence, RNAO cannot endorse a strategy that wrongly assumes every senior has equal access to nutritious food or the ability to access physical activity supports.
RNAO calls on government to take a comprehensive approach in developing an evidence-based and integrated Seniors’ Care Strategy with the goal of improved mental, physical and social health outcomes, while leveraging existing resources, minimizing structural duplication and upholding a stronger publicly-funded, not-for-profit health system. Such a strategy needs to align with the following principles: Senior-centredness; integration and co-ordination across the health system; a strengthened publicly-funded and not-for profit health system; focus on health and wellness; social, environmental, economic and indigenous determinants of health; driven by evidence and best practices; equity and access to services; dignity, respect, independence and self-determination; cost-effective and appropriately resourced; and community and family orientation These principles must inform a combination of system-level and multi-sectoral recommendations that prompt action from government to produce a Seniors’ Care Strategy that maximizes health outcomes and health system cost-effectiveness.
RNAO, like many other organizations within the health system, is ready and eager to work with government to implement cost-neutral solutions that leverage the potential that already exists within the system. For example, full implementation of RNAO’s ground-breaking provincial task force report, Primary Solutions for Primary Care will ensure the full scope of practice utilization of RNs and RPNs in all primary care settings and significantly improve the capacity of Ontario’s primary care sector to meet the complex needs of an aging population. Utilizing the competencies, knowledge and skills of primary care RNs already in the system and maximizing/expanding inter-professional primary care models will result in cost-effective care co-ordination and improved health system navigation for Ontario’s seniors.
Similarly, reducing role duplication by adopting RNAO’s Enhancing Community Care for Ontarians (ECCO) model and transitioning the roles and functions of Community Care Access Centres (CCACs) to existing structures, such as LHINs, primary care, home health care, and hospital discharge planning, would advance system cost-effectiveness, while enhancing care co-ordination, system navigation, same day access to primary care and expanded home care services. This model offers comprehensive and continuous RN-led care co-ordination across the lifespan to all Ontarians and especially to those in greatest need, such as seniors living with complex chronic illness. Effective care co-ordination within primary care will support seniors’ independence within the community by ensuring that the appropriate resources and supports are there at all times. If the time comes that living at home necessitates assistance, the ECCO model facilitates co-ordination of home health care services and when living at home is no longer possible, the ECCO model facilitates long-term care (LTC) placement in a way that increases efficiency and continuity while improving both resident and system-level outcomes.
The government’s priority for evidence-based policies and practices, is also a long standing focus of RNAO -- since its renowned Best Practice Guideline program was created in 1998. The positive outcomes, at the patient, organizational and system levels are substantive. There is no question that the care provided to seniors across the health system must be aligned with best available evidence, and embedding RNAO's rigorously developed and effective Best Practice Guidelines as the cornerstone of an evidence-based Seniors’ Care Strategy, is imperative if Ontario is to optimize results for its seniors. Examples of the impact of RNAO’s evidence-based work include the Falls Prevention Program for LTC in partnership with the Canadian Patient Safety Institute (CPSI), RNAO’s Prevention of Elder Abuse Program, and the widespread implementation of RNAO’s Clinical BPGs relevant to the other adult, such as: Client Centred Care; Assessment and Management of Pain; Assessment and Management of Stage I – V pressure ulcers; Caregiving Strategies for Older Adults with Delirium, Dementia and Depression; Collaborative practice among nursing teams; Developing and sustaining nursing leadership; End of life care during the last days and hours; Oral health nursing assessment and intervention; Preventing and managing violence in the workplace; Prevention of Constipation in the older adult; Prevention of falls and fall injuries in the older adult; Promoting continence using prompted voiding; Promoting safety: Alternative approaches to the use of restraints; Risk assessment and prevention of pressure ulcers; Screening for delirium, dementia and depression in the older adult.
The solutions offered in this submission will significantly strengthen the development of a comprehensive and impactful Seniors’ Care Strategy that nurses can fully support and lead, and RNAO is eager and ready to work with government to make it a reality.
Registered Nurses’ Association of Ontario (RNAO) Submission to the Government of Ontario on the Seniors’ Care Strategy
The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses (RNs), in all settings and roles across Ontario. It is the strong, credible voice leading the nursing profession to influence and promote healthy public policy. RNAO is proud of its long history of advocating with government and others to improve seniors’ health through a comprehensive and integrated strategy. RNAO welcomes the opportunity to influence and shape Ontario’s Provincial Seniors’ Care Strategy.
Starting with the Government’s Action Plan for Health Care the proposed strategy aims to ensure seniors have access to the right care at the right time and in the right place. Specifically, the strategy aims to deliver the following: (1) expanding doctors’ house calls; (2) increasing access to home care for seniors in need; (3) establishing care co-ordinators to work with health providers to ensure seniors receive the right care, particularly following hospitalization; (4) creating a Healthy Homes Renovation Tax Credit to help seniors adapt their homes to meet their changing needs; and, (5) helping seniors stay healthy by eating well and exercising regularly.
RNAO goes on record that these five deliverables fall short of a Seniors’ Care Strategy worthy of Ontarians’ respect. RNAO recommends that a comprehensive and integrated seniors’ strategy be based on principles that strengthen a publicly-funded and not-for-profit health system; advance evidence-based practice, and reduce structural duplication that hamper system integration and access to care for older persons. These principles guide RNAO’s recommendations aimed at producing optimal results for government, tax payers, and most importantly Ontario’s seniors.
Throughout this submission, reference is made to the Enhancing Community Care for Ontarians (ECCO) model (Appendix A) that RNAO is leading in consultation with a wide range of stakeholders across the health system. In broad terms, ECCO involves transitioning the current functions of Community Care Access Centres (CCACs) to existing structures over a three year period. These structures include: LHINs, public health, primary care, hospitals, home care/support organizations, and long-term care. It is proposed that this transition be supported by a temporary Primary Care Secretariat within the LHIN structure as the capacity of interprofessional primary care models are simultaneously strengthened to embrace its new and expanded role. This unique model leverages the strength of RN Care Coordinators in primary care to assist seniors in navigating the sometimes daunting complexities of the health system, while also coordinating care needs across multiple providers. ECCO’s evidence-informed model aligns closely with the requirements for a principled, comprehensive and integrated Seniors’ Care Strategy that focuses on improving health outcomes and strengthening Ontario’s publicly-funded and not-for-profit health system.
To view RNAO's full submission to the Government of Ontario's Seniors Care Strategy including references, please download the pdf below.