NDVA Committee Report

GOVERNMENT RESPONSE

 

 

LONG-TERM CARE FACILITIES

 

 

A. The Responsibilities of Veterans Affairs Canada

 

Recommendation 1

 

Veterans Affairs Canada review its policies on waitlists to ensure that it has the necessary level of information in all provinces in order to be as up to date as possible on the number of Veterans in priority beds and those waiting to have access to such beds.

 

Response

 

The Government of Canada takes it responsibilities and commitments to Veterans seriously. Veterans Affairs Canada (VAC) agrees that it is necessary to have up-to-date information on Veterans in Priority Access Beds (PABs) and those awaiting placement.  To this end, VAC has updated their information system to track the number of Veterans in long-term care beds.  More importantly however, are two initiatives: the Overseas Service Veterans (OSV) at Home Pilot Project and the OSV Wait List Management Initiative.  The OSV at Home Pilot Project launched in June 1999 provided Veterans Independence Program (VIP) and treatment benefits to eligible Veterans.  The regulatory amendment implementing this initiative on a permanent basis received approval in principle and was pre-published in the Canada Gazette on 16 August 2003.  Final approval is expected shortly. The OSV Wait List Management Initiative began in July 2000.  These initiatives have increased VAC’s flexibility to either provide care to Veterans in a community bed or to meet their health care needs at home while they await placement.  Through these approaches, there should be no Veterans with “unmet health care needs”.  As well, these initiatives reduce the urgency to be placed in a facility and enable those with the most urgent needs to be placed in a more timely fashion.

 

Recommendation 2

 

Veterans Affairs Canada review its procedures in order to ensure that it can effectively monitor conditions in all the facilities across Canada providing long-term care to Veterans and that it can take corrective measures in a timely fashion if and when a situation develops which threatens to reduce the access of Veterans to priority beds or the quality of care given to them.

 

Response

 

The Government of Canada is committed to ensuring that quality long-term care is available to meet the health needs of Veterans.  PABs are reserved for Veterans as long as they are needed by Veterans.  There are currently 4,310 such beds in 171 facilities across Canada.

 

Since 1998, staff at VAC’s district offices have been visiting Veterans residing in long‑term care facilities on an annual basis to complete the client satisfaction questionnaire. Should the Veteran not be able to complete the questionnaire, the Veteran’s legal representative is interviewed. The questions were developed based on VAC’s ten care outcome standards: Safety and Security, Food Quality, Access to Clinical Services, Medication Regime, Access to Spiritual Guidance, Socialization- Recreation, Activation and Ambulation, Personal Care, Sanitation and Access to Specialized Services. In the process of the interview, should the district staff member identify specific care issues, they will request that a district office health professional conduct a review.

 

In 2000-2001, interviews were conducted with 1,500 clients and/or their family members.  A national satisfaction rate of 93% was achieved. This increased to 94% in 2001-2002, based on interviews with 2,200 clients and/or family members.

 

On May 9, 2003, the Royal Canadian Legion (RCL) was awarded a one-year contract, with a possible additional year renewal, for its trained members to conduct VAC’s client satisfaction questionnaires with more than 4,000 Veterans residing in community care facilities across Canada. This will provide VAC with a broader picture of client satisfaction in community facilities.

 

As well, district office nurses conduct a facility questionnaire with the facility administrators to ensure programs and services offered meet Veterans care needs.

 

VAC strongly encourages all its PAB facilities to obtain their accreditation from the Canadian Council on Health Services Accreditation (CCHSA). Accreditation is one component of  VAC’s Residential Care Strategy. Of our 4,310 PABs, 96% (representing 4,155 beds) are located in accredited facilities. VAC, in partnership with the RCL, has worked with the CCHSA to include VAC’s ten care outcome standards into the CCHSA’S Achieving Improved Measurements (AIMs) accreditation process.

 

In April 2001, a Director of Quality Care position was created to monitor quality of care in the Ontario Region. The Director of Quality Care works closely with the three larger PAB facilities in Ontario: the Perley-Rideau Veterans’ Health Care Centre, Parkwood Hospital, and Sunnybrook and Women’s College Health Sciences Centre; and various stakeholders to resolve any outstanding issues. Consideration will be given for a further expansion of this type of role to other regions as required.

 

Furthermore, VAC encourages, and in some cases participates in, the work of various committees such as the Residents’ Councils and attends meetings with Veterans and their families.

 

Every concern and complaint expressed to VAC’s officials is investigated with the facility.

 

Recommendation 3

 

Veterans Affairs Canada explore with regional and provincial health authorities ways of standardizing as much as possible the gerontological assessment process used to determine the level of care required by Veterans seeking a place in a long-term care facility to reduce discrepancies from one region or province to another in terms of access.

 

Response

 

The Government of Canada is committed to working with its partners to ensure that Veterans can access the care they require. The process for assessment for admission to long-term care for Veterans is standard. In order to be eligible for the federal long-term care programs, Veterans must be assessed as requiring Federal Level II or Federal Level III care standard. Federal Level II care indicates that the Veteran requires daily nursing and personal care and 90 to 150 minutes per day of supervision by a health professional, personal care and therapeutic services as well as assistance with the activities of daily living.  Federal Level III care standard requires daily nursing and personal care, therapeutic services, approximately 150 minutes per day or more of supervision, personal care and therapeutic services and assistance with the activities of daily living.  This assessment criteria is used nationally by VAC staff for program eligibility and in determining the priority of client admissions.  The District Office Health Care Teams (DOHCT) base the priority of admission first on the assessment of the client’s health needs; those with the greatest health needs are given first priority.  When health assessments indicate that clients have similar health needs, the DOHCT will recommend that they be admitted in the following order of priority: 

 

1) Veteran pensioners who need the care for a war-related pensioned condition;

2) income-qualified Veterans; and

3) overseas service Veterans and Veteran pensioners for care not related to war-related pensioned conditions.

 

Recommendation 4

 

Veterans Affairs Canada ensure that Veterans seeking access to a long-term care facility are not taken off the wait-list or sent to the bottom of the line if they refuse to accept a placement at a facility because it is not the one they requested or because they were given less than three days to agree to and move to the location offered to them.

 

Response

 

The Government of Canada is committed to ensuring that care is available to meet the health care needs of Veterans. As the policy for admission differs from province to province and between some Health Authorities within provinces, it is difficult to ensure that the preferred location is always available.  However, the health care needs of the Veterans can be addressed or be assured either through services at home or an alternative bed placement with VAC funding assistance while the Veteran awaits the preferred location.

 

When Veterans are ready to consider admission, they can have their names placed on the admissions wait list.

 

Recommendation 5

 

Veterans Affairs Canada explore with regional and provincial health authorities ways to quickly identify Veterans among individuals seeking access to long-term care facilities, including a box on the application forms asking if the applicant is a Veteran, so that the onus will not be mostly on the Veterans themselves to determine what services they are entitled.

 

Response

 

The Government of Canada is committed to working with its provincial partner, in this case, Quebec, to resolve this matter.  In June 2003, VAC contacted all provinces and was advised that all provinces but Quebec either have a Veteran self-identification block on the application, or an opportunity during the long-term care assessment process when applicants can self-identify as Veterans.  VAC will work with Quebec to determine the most appropriate manner in which Veterans from this province can self-identify.