Supporting George and Betty:An Integrated Management Strategy for

Seniors Supports, Housing and Care in Alberta

Alberta Network of Senior-Related Organizations (ANSRO)

Edmonton, Alberta December 2011

Table of Contents

Foreword.....................................................................................................................................................1

Executive Summary.....................................................................................................................................2

1. Introduction: George and Betty's "Aging in Place" Challenges............................................................4

2. State of Seniors Supports in Alberta....................................................................................................5

3. Guiding Principles................................................................................................................................9

4. ANSRO's Proposed Approach...........................................................................................................14

5. Plan for Seniors Support in Alberta....................................................................................................16

6. Call to Action.....................................................................................................................................20

7. Evaluate Progress...............................................................................................................................22

8. Build on Success................................................................................................................................22

Concluding Waypoint: George and Betty on a Supportive Living Pathway.................................................23

Appendices..................................................................................................................................................25

Supporting George and Betty: An Integrated Management Strategy for Seniors Supports, Housing and Care in Alberta

Foreword

Supporting George and Betty: An Integrated Management Strategy for Seniors Supports, Housing and Care in Alberta, a living document, was prepared collaboratively by members of the Alberta Network of Senior-Related Organizations (ANSRO), a group of service providers concerned about the availability, accessibility and affordability of services* for seniors. It was developed as a living document for groups and individuals who wish to see service-funding issues resolved and improvements made in the way seniors access the services they require, be they support, housing and/or care. As such, it is intended to assist provincial leaders in making strategic, client focused policy decisions for Alberta seniors.

Supporting George and Betty: An Integrated Management Strategy for Seniors Supports, Housing and Care in Alberta is based on the premise that how systems of service delivery are structured, organized and resourced can have a major, positive impact on the accessibility, efficiency, effectiveness, and quality of the services provided to those served—the senior and their family. The overarching goals of the proposal made herein include ensuring availability of, and enabling ready access to, services; enhancing the quality of the services; increasing efficiency; improving user satisfaction; and, achieving better outcomes all through a seamless, integrated management strategy for seniors supports, housing and care.

The proposed strategy contained herein draws on existing provincial initiatives, particularly Alberta’s 2010 Aging Population Policy Framework, which has been designed to define and articulate government’s roles and responsibilities in addressing the needs of an aging population. These roles include: (a) setting province-wide, strategic policy directions; (b) facilitating collaboration among individuals, communities and governments; and (c) providing supports and services to Alberta’s seniors. While the framework identifies a number of desired outcomes in support of these goals, the following are specifically addressed within this document:

Alberta seniors have the opportunity to enjoy an optimal quality of life.

Alberta seniors are able to reside in a living environment that is appropriate for their circumstances and of their choosing.

Alberta seniors have access to a range of supports, housing and continuing care services that enable them to reside in an environment that is appropriate for their circumstances.

Alberta seniors are supported in maintaining an optimum state of wellbeing as they age.

Supporting George and Betty: An Integrated Management Strategy for Seniors Supports, Housing and Care in Alberta

Alberta seniors are able to easily access Alberta government as well as community-based support services and housing.

Development of Supporting George and Betty: An Integrated Management Strategy for Seniors Supports, Housing and Care in Alberta involved numerous organizations including: the Alberta Association of Seniors Centres, Alberta Council on Aging, Alberta Senior Citizens Housing Association, Alberta Seniors United Now, Edmonton Seniors Coordinating Council, Seniors Association of Greater Edmonton, Seniors Housing Association of Alberta.

* The term service(s), as used in this document, pertains to community supports and/or housing and/or health care.

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Executive Summary

ANSRO issues the following Clarion Call to Government:

Recognizing the implications of the projected increase in the population of older adults, especially the elderly, frail and vulnerable, the challenges faced by community service providers, and the well-documented research on the needs that accompany the natural process of aging, ANSRO calls on the Government of Alberta and its agencies to (a) immediately resolve the funding and operational issues service providers have to deal with on a daily basis, and (b) implement a pilot project of a provincially standardized, community-based, Regional Seniors Resource Centre, and to make appropriate supporting regulatory and policy changes, thereby enabling seniors to enjoy an optimal quality of life as they age in the living environment of their choosing.

To expand on this statement, this living document includes the following components:

1. An overview of Alberta’s aging population, the state of seniors services in Alberta and the challenges faced by service providers.

The demographic context of Alberta’s aging population is well documented and discussed in the public sphere. Statistical research presents a picture of a clearly diverse and dynamic demographic. This is reflected in the wide range of needs, variations in income, health status and level of independence of seniors today; circumstances, when added to service-funding issues, give rise to challenges service providers need to address on a daily basis.

2. Service provider issues requiring immediate resolution.

Seniors service providers face service-funding challenges on a daily basis as they endeavour to address the needs of their clients, particularly as they age in place in the community or seniors’ residential settings. The projected growth in Alberta’s population of seniors serve to reinforce the significance of appropriately addressing current service-funding inadequacies through necessary and sufficient resources in a manner that enables service providers to fully address seniors needs.

3. A plan for an integrated network of services for seniors.

Considering the diversity of Alberta’s aging population, and in light of the current challenges related to senior service provision, ANSRO proposes the following plan to better integrate management strategies for seniors supports, housing, and overall care. This plan takes the form of a network of Regional Seniors Resource Centres. These Centres might well be existing Seniors Centres, where they exist in communities and have the organizational capacity to provide the recommended services. These centres would include the following components:

Provincial oversight through a multi-sectoral, cross-ministry steering committee consisting of provincial representatives, municipal representatives, and seniors service providers.

Single provincial funding agency administered by the participating provincial ministries, i.e., at minimum, Alberta Seniors, Human Services, and Health and Wellness.

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Community delivery by local Seniors Centres that exist in the community and have the administrative capacity to provide these services. Where there is not a Seniors Centre that is in a position to assume these roles, another Senior-serving organization would be selected or a new organization would be established.

Local governance by the boards of local Seniors Centres or other stakeholders in seniors service provision. Members of the local Boards should also include individuals from the local seniors population.

Provincially standardized business model that can be replicated in other communities.

Information service to provide information about locally available healthcare, housing and community support services for a range of needs.

Infrastructure to support robust information sharing across health, housing and community services.

Referral, supportive pathway navigator and case management service provided by qualified staff.

Integrated assessment at two levels: preliminary and comprehensive.

Co-located, multi-disciplinary staff composed of a team of nurses, social workers, mental health workers, housing advisors, therapists, elder abuse professionals and others.

4. A call to action in support of this plan.

As a way of moving toward this described plan for seniors services in Alberta, ANSRO is calling on provincial and municipal governments and community service providers to work together to implement the Regional Seniors Resource Centre model on a pilot basis. The pilot project would include the following activities:

Establishment of a multi-sectoral steering committee.

Development of a business model.

Selection of appropriate pilot communities, both urban and rural.

Identification of potential local partners.

Examination of local seniors population, services and service gaps.

Development and implementation of a seniors service plan.

Development of a marketing/communications plan.

A preliminary evaluation plan.

Pilot expansion directed toward province-wide implementation.

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1. Introduction: George and Betty’s “Aging in Place” Challenges

George and Betty, aged 86 and 84, are of modest means and have been married for 66 years. They live in the same house in which they raised their family, however, their three children are adults with families of their own and reside in other parts of Alberta. While they have enjoyed good health for most of their lives, Betty has been living with mild but progressive dementia for the past two years and there is an apparent steady decline in her ability to function. For his part, George has type ll diabetes. He manages his condition well, but it recently caused a vision impairment called macular degeneration. As a consequence, George had to stop driving.

George and Betty are happy to still be living at home, enjoying their garden and visiting with friends at the local seniors centre. However, they have found it difficult to adapt to the public transit system: small tasks like getting groceries and going to church have required them to alter their routines significantly. As Betty’s primary caregiver, George is responsible for ensuring that she gets to her medical appointments and takes her medication properly. He also has his own appointments and medications to manage.

A friend at the seniors centre suggested that homecare services could help George and Betty manage their medications. He asked for the phone number, but when he called, he learned that the service was private, and he would have to pay for the service out of pocket. The person who took his call referred him to a publicly funded service, but when he in turn called this new service, he was told that he would need an assessment. This kind of run-around is very frustrating for George, but he knows he should follow up with his doctor—who recently announced his pending retirement.

George sometimes thinks about selling and moving out of their house and into a smaller, more central apartment. Their children are concerned about his ability to care for Betty, and have suggested that an assisted living facility, preferably one with a dementia care unit, might help them both cope. George is not sure whether they can afford this kind of place, especially considering the mounting costs involved with both of their medical conditions and support needs. He is also worried that, due to his and Betty’s differing care needs, they may eventually become separated. George knows people who have moved into a similar facility; he’s heard that it has a long waiting list.

The graphic to the right illustrates some of the services and amenities that George and Betty might need to access in a typical week. The question marks illustrate service needs (i.e., information about homecare and housing options) that are currently unmet.

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Diversity among Alberta Seniors

Varied income levels

Varied health states, and increasingly complex /chronic conditions

Urbanization

Cultural diversity

Varied service needs

Accessibility concerns

2. State of Seniors Supports in Alberta

Between 2011 and 2021, the percentage of Albertans aged 65 and older will increase from approximately 11 per cent to 15 per cent of the total population. By 2031, when the last member of the baby boomers reaches 65 years of age, it is projected that about one in five Albertans will be a senior. Alberta’s future seniors are expected to be more diverse than ever before, with varying skills, abilities, support systems, living arrangements, levels of education, health and wealth — all influenced by their diverse experiences and differing circumstances.

Government of Alberta, Aging Population Policy Framework, 2010

The demographic context of Alberta’s aging population is well documented and discussed in the public sphere. In the next twenty years, the proportion of seniors to non-seniors in Alberta is expected to double: up to 20% (923,000) of Alberta’s total population from the current figure of 11% (410,000). This change represents a net increase of approximately 513,000 additional senior citizens requiring support in the next twenty years.1

When examined more closely, these statistics present a picture of a clearly changing demographic. The overarching characteristic of today’s seniors is diversity. Twenty years ago, a typical senior was retired, living on a moderate income after working in a career that did not require a university degree. While this is still the norm, a growing number of seniors enjoy higher income and education levels, working later in life and living with relatively good health. At the same time, a significant proportion of seniors live in the low-income range, experiencing isolation due to a shrinking social network, elder abuse or chronic health conditions. This picture of diversity can be illustrated further, as follows:

Seniors’ financial situations can vary greatly 2

The average pre-tax income of senior families in Alberta increased from $46,700 in 1986, to $60,870 in 2006. It is expected that in the future, seniors’ income will continue to increase, albeit at a slower rate, due in large part to the participation of baby boomer women in the labour force. There will continue to be seniors who face low-income situations, though it is important to consider that income is only one component of financial security. A senior’s expenditures must also be considered, especially as costs associated with food, shelter, medications and other items can vary greatly depending on choice,

1 Government of Alberta, Embracing an Aging Population. Website: www.seniors.alberta.ca/Seniors/AgingPopulation. Accessed 5 August 2011. 2 Adapted from the Government of Alberta, Aging Population Policy Framework, 2010.

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availability and need. A couple’s financial situation is heavily dependent on the health of both partners, as some healthcare conditions can cause serious strain to a couple’s finances.

Longer life expectancy brings a range of health conditions 3

The overall life expectancy and health of seniors continues to improve due to gains in preventive care, treatment and management of chronic conditions. Moreover, determinants of health such as educational attainment and income have been improving over time, making it likely that a greater proportion of future seniors will report they are in very good or excellent health. However, the incidence of certain conditions in the general population, including obesity, type II diabetes, high blood pressure, arthritis and other chronic conditions, means that many of tomorrow’s seniors may experience significant and varied health issues. While many younger seniors enjoy good health, they will often develop multiple, complex and/or chronic health conditions as they age.

Greater percentage of seniors today live in urban areas 4

Approximately 81.5% of Alberta's seniors were located in urban areas in 2006. 61.1% lived in the two Census Metropolitan Areas (CMAs) of Edmonton and Calgary. Seniors accounted for 11.1% of the population in the Edmonton CMA and 9.4% of the population in the Calgary CMA.

A greater proportion of older seniors live in urban settings. In 2006, 88.3% of seniors aged 90 years and older resided in urban areas, an increase of 2.1% from 2001. Male seniors made up a greater proportion of the seniors population in rural areas, whereas female seniors made up the majority in urban areas. In 2006, 53.8% of seniors in rural areas were male, while in urban areas, only 43.7% of seniors were male.

Greater percentage of seniors than non-seniors are immigrants 5

Findings from the 2006 Census indicate that Alberta's seniors were more likely to have been born outside of Canada than the Alberta population in general. Overall, 28.2% of seniors aged 65 years or older were born outside of Canada, compared to 16.0% of the total population.

In 2006, the percentage of seniors born outside Canada and residing in urban areas was more than twice that of rural areas (31.5% versus 14.0%). Canmore had the highest percentage of foreign-born seniors at 40.4%, followed by Calgary with 39.0% and Edmonton with 33.7%.

Seniors access a wide array of services

The number and type of services that seniors access varies widely according to their levels of health, mobility and independence. Some of the most common services accessed by seniors include: 6

3 Adapted from the Government of Alberta, Aging Population Policy Framework, 2010.4 Government of Alberta, A Profile of Alberta Seniors, 2010.5 Ibid.6 City of Edmonton, Edmonton Seniors: A Portrait, 2010; also Alberta Seniors Citizens’ Housing Association, Seniors Living Transition Planning Guide Framework: Final Report, 2011.

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Healthcare services, including physician services, rehabilitation services, access to aids and specialized equipment, and allied health services such as audiology, podiatry, and denture services.

Social services, including home visitation programs (in person or by telephone), mental health counselling, peer support, and bereavement support.

Homecare services, including medication support, assistance with scheduling appointments, bathing or dressing, personal grooming, application of bandages and compression stockings, assistance with oxygen, and care of mobility aids.

Housing information, including information about housing options ranging from independent and supportive living including assisted living, and long-term care.

Home support services, including meals (preparation or delivery), housekeeping and yard maintenance including snow removal.

Recreation services, including social interaction, physical fitness activities, education and training, cultural events, and emotional and spiritual development.

Coordination services, including coordination of community supports, referrals, guidance/advocacy/advisory services, and transportation services.

These services are provided either by healthcare or social service providers, by housing providers, by family members, or by other community-based service providers. In each case, seniors access these services in a range of ways, including independently, with the help of family members, or through a referral by other service providers. Depending on the individual, as well as the location and type of services being sought, availability and accessibility can be significantly restricted and vary widely across the province.

Some seniors experience difficulties accessing the services they require

Some of the most common difficulties that seniors face when accessing services include: 7

Service gaps. In many communities, there is a shortage or complete lack of required services. The most common of these are some of the healthcare services including mental health, seniors transportation services, supports for daily living, support programs for families and caregivers, and social services for isolated seniors.

Lack of awareness. Many seniors are not aware of the services that are available to them. Current sources of information generally are passive in nature.

Lack of coordination of services. Seniors services are not coordinated among funders and/or providers, because of “siloing” of housing, health care and community services, and also because of privacy legislation requirements. Seniors can experience duplication of services while at the same time some of their needs go unmet.

7 Adapted from the Government of Alberta, Demographic Planning Commission Findings Report, 2008; also Alberta Seniors Citizens’ Housing Association, Seniors Living Transition Planning Guide Framework: Final Report, 2011.

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Complex care needs. An increasing number of seniors live with multiple chronic conditions that require regular review and management rather than medical treatment. Primary care can be difficult to access, and does not provide holistic care to address multiple concerns peripheral to medical issues, such as aids to daily living and social interaction support. There is also a shortage of trained staff in congregative residential settings.

Transportation and mobility. Transportation can be a barrier to seniors across the province, but it is a particular concern to seniors in rural and northern areas. Transportation to medical appointments and daily living and/or social activities is necessary for health and quality of life.

Lack of available housing options. Independent and supportive housing providers are strained by high demand, staff shortages, aging or inadequate facilities, and outdated technology. A senior looking to transition from independent living to supportive housing can face lengthy wait times. Support navigators are not funded to assist seniors in addressing their housing challenges.

Seniors service providers face their own challenges

The Alberta government’s Continuing Care Strategy: Aging in the Right Place describes a shift towards increased support, health and personal care services in homes and community-based housing settings. Seniors service providers face a number of service-funding challenges that have been difficult to address given the tenuous relationships that exist between them and their major partners including government and Alberta Health Services. Some providers, including ANSRO members, have felt a lack of support required for the commitment and efforts providers make to meet the increasing levels of need of their clients and the difficulty having their legitimate concerns heard in efforts to effect solutions. In this context, some of the more specific challenges faced by providers include:8

Lack of communication and integrated information systems – Clients having to apply for service and to be reassessed at each point in the seniors care continuum are seen as onerous and as delaying timely access to services.

Organization of services – Government organizational entities tend to organize services in bureaucratic silos, focusing on their own areas of responsibility, acting independently and not on working to reduce duplication or to enhance broader system efficiencies.

Single entry, assessment and case management – Gaps and insufficiencies exist in the area of case management. The issue of standardized assessment is also important because it would save people from having to go through an assessment each time they enter a new type of service. At times because of different assessments seniors are placed in inappropriate settings.

Human resources issues – Issues regarding the availability of qualified workers, and training and turnover, are seen to constitute barriers to clients receiving good-quality and timely care services.

8 Hollander, Marcus J. and Michael J. Prince, “Organizing Healthcare Delivery Systems for Persons with Ongoing Care Needs and Their Families: A Best Practices Framework.” Healthcare Quarterly. Vol. 11, no. 1, 2008, pp.44-54.

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Differences in philosophy – Differences in underlying philosophies, for example, a philosophy of medical care versus one of psychosocial enablement and personal independence, can pose formidable barriers to appropriate and integrated care.

Turf and power issues – Turf protection and issues of relative power inhibit the smooth flow of clients across sectors. Concerns about losing power, independence and resources might even take precedence, in some cases, over matters related to the needs of clients, particularly when one is trying to access resources outside the existing system of care designated for the client.

Rural/urban differences – Seniors in rural areas have access to fewer types of services than do seniors in urban centres. There are also issues of transportation for health care and proximity to family members for home care in rural areas.

Funding issues – Blockages to client transfers occur if there are gaps or insufficiencies in necessary funding. One cannot coordinate care and support between two independent service components if one component does not exist, is not accessible in a timely manner, is insufficient or has a limited capacity to take on new clients.

Challenges faced by housing providers

In 2010 the Alberta Seniors Citizens’ Housing Association (ASCHA)9 initiated a project to assess the extent of the impact of the policy shift towards increased support, health and personal care services in homes and community-based settings. The following have been identified as the top nine barriers and challenges being faced by housing operators and which need to be addressed immediately.

Increasing Complex Care Needs. Increasing complex care needs such as aggressive and difficult behaviours, dementias, cognitive decline, mental illness, incontinence, medication administration, special diets, developmental disabilities, etc.

Increasing Staffing Requirements. Increasing staffing requirements such as qualifications/scope of practice (HCA/LPN/RN, OT/PT/RT/SW, etc.), staffing levels/surge capacity, shiftwork/scheduling, recruitment/retention, aging/succession planning, training and education, etc.

Increasing Demands on Buildings and Infrastructure. Increasing demands on buildings and infrastructure such as aging buildings, barrier-free access and movement within (bathroom, hallways, dining rooms that can accommodate mobility aids), security/emergency call systems, resident/tenant lifts, etc.

Increasing Technological Demands. Technological demands such as computers (hardware and software), access to IT support, use of electronic charting, staff training, resident/tenant security /safety systems, etc.

Increasing Transportation and Mobility Requirements. Increasing transportation and mobility requirements such as accessible and affordable transportation for medical appointments/social /community events, special needs of disabled residents/tenants, etc.

___________________________9 Alberta Senior Citizens Housing Association, Seniors Living Transition Planning Guide, Edmonton, June 2011

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Increasing Collaboration and Communication Needs. Increasing collaboration and communication needs such as working relationships among stakeholders/partners, health professionals, service providers, programs, residents/tenants/families; sharing of resources among organizations, etc.

Increasing Demands on Available Funding. Increasing resident/tenant service needs due to an aging population and the medical instability of the population have resulted in a greater need for additional services, additional staffing, and renovations to buildings. Flexible and appropriate funding is needed to support these additional services.

Increasing Willingness to Provide Additional Services. Numerous operators are willing to undertake a greater role in the provision of health and hospitality services to residents, at a level appropriate to their facility.

The major issues, obstacles and proposed solutions are summarized for each area as outlined below.

Issues Obstacles Proposed Solutions

Complex care needs are increasing, e.g.:

Dementia/cognitive issues

Mental illness

Incontinence

Special diets

Behavioural

Lack of funding / funding inconsistencies

Shortage of trained staff

Lack of appropriate settings

Limited access to professionals and services

HIA and FOIP limit communication between health care providers and operators

No environment for innovation in meeting health needs

Consistent and fair funding models

Sufficient accommodation and service options

Sufficient levels of trained staff

Timely assessments and follow-up

Smooth transition process when care needs increase

Timely access to health professionals and services, e.g., Home Care, Dietician, Mental Health

Open communication regarding resident health needs

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Complex Care Needs

Issues Obstacles Proposed Solutions

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Upgraded, and sufficient quantities of computers, software and other technology are required

Purchasing, installing and maintaining new technology is costly

Management and staff comfort levels for technology use may be low

Computer systems across the province are not compatible

Limited IT support is available

Centralized registry for available funding for technology upgrades

Develop a provincial technology strategy

Standardize hardware and software systems across the province

Develop education and training for all staff

Staffing shortages - constant recruitment

High turnover

Insufficient funding to hire appropriate staff levels

Lack of appropriately trained staff

Limited compensation, benefits and education opportunities

Difficulties recruiting to night shifts and for coverage/on call

Limited FTE's - staff hold several jobs

Perception of lack of prestige working in supportive living

Fund staffing models that reflect resident needs

Innovation to develop training programs

Develop a central pool of staff to provide coverage and for surge capacity

Contracts to be on par with hospitals for compensation

Education grants and industry specific education opportunities

Promote and market the industry as a career option

Technology

Staffing

Issues Obstacles Proposed Solutions

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Aging buildings create challenges in meeting resident needs

Operators are limited in the types of residents they can accommodate

Buildings not barrier free and do not meet current codes

Resident expectations and needs have changed

Difficult to obtain funding for renovations

Mobility aid storage and use creates difficulties

Renovations are done in a piecemeal approach

Equipment maintenance and repair is difficult

Security and safety systems may be lacking

Adequate funding for renovations and upgrades

Flexibility in building codes to meet resident needs

Creativity and innovation for infrastructure changes

Examine cost for renovating vs. new building

Realistic solutions for building maintenance

Long term vision for construction and renovation

Transportation issues occur across the province, but particularly affect rural and northern areas

Transportation to medical appointments and social activities is necessary for resident health and quality of life

Limited or no funding

Limited staff availability to accompany residents

Rural areas have fewer options

Family members may not be in proximity to assist

Scheduling of community transportation may not meet resident needs, and may mean long waits for pickup

Funding for a standardized provincial transportation program

Set transportation standards

Involve communities in developing solutions

Improve central booking of community transportation via technology

Bring service providers into settings rather than seniors travelling out

Transportationand

Mobility

Buildingsand

Infrastructure

Issues Obstacles Proposed Solutions

From the foregoing it is clear that a range of issues experienced by housing operators are significant and must be resolved.

3. Guiding Principles

ANSRO believes that support for seniors in Alberta should reflect the following guiding principles10:

Independence and Choice – There must be recognition that individuality and diversity of needs, circumstances, abilities and aspirations of each individual senior are paramount. While there may be gradual changes over time, the desire for independence remains strong. Seniors want to enjoy their independence, make self-directing decisions and experience the opportunities of daily living as they choose. The opportunity for seniors to make informed choices requires that information on timely, affordable and effective options is widely available and easily accessible.

Dignity and Self-Respect – Being accepted as one is, regardless of age and health status, being appreciated for life accomplishments, being respected for a continuing role and contributions to family, friends and community and being treated with fairness, creates the sense of dignity and self respect necessary to maintain full and active societal participation.

___________________10 Adapted from the Principles for Aging in Place, Seniors Association of Greater Edmonton (SAGE), 2011.

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Need for increased communication, collaboration and information sharing among:

Government

Municipalities

Operators and Boards

Service Providers

Residents and Families

Limited information available on seniors transition strategies

Provincial inconsistencies in processes for meeting housing and service requirements

Limited information sharing between operators and service providers due to HIA and FOIP

Limited collaboration around contracts

Regular meetings with stakeholders

Create a culture of mutual respect and openness

Centralize and standardize flexible contracts

Develop a process for resolving issues

Collaborate with communities to share resources

Market and promote supportive living and create educational opportunities for the public and service providers

Collaboration and Communication

Safety and Security – Having a safe and secure living environment is fundamental for all seniors. This also includes having the financial security to meet daily needs and the funds to make minor modifications to a home allowing for easier access or mobility as one ages. Safety and security also requires ready access to family, friends and community connections that can be called upon when required.

Integration and Coordination – Services or supports provided as a contribution to an aging in the right place initiative are most effective when they are well integrated and coordinated. This requires that service provision consider the holistic state of seniors. Services should meet all identified needs without overlapping. The messages from international research suggests that integration is most needed and works best when it focuses on a specifiable group of people such as seniors especially the elderly, frail and vulnerable with chronic and/or complex needs that require regular review and management.

Connectivity and Social Interaction – As seniors grow older their social network generally shrinks resulting in heightened social isolation that can dramatically increase physical and mental health problems. Remaining involved in activities of daily living, participating in available programs and services, taking part in the affairs of the community, celebrating its cultural and social diversity are all essential contributions to enjoying what life has to offer.

Community Based Approach – Services are delivered most effectively by organizations that are governed and managed locally. Community agencies should have ownership of the way they respond to identified local needs and how they resource their programs.

These principles are reflected in ANSRO’s Quality of Life Framework, which integrates three core requirements: independence, safety/security, and wellbeing supported by three integrated service sectors: healthcare, housing /amenities, and community supports. These can be illustrated by the image of a three-legged stool, as illustrated to the right. See Appendix 3 for explication.

4. ANSRO’S Proposed Approach

ANSRO’s approach to integrating the current silo approach to the provision of seniors services in Alberta follows the well established Plan-Do-Study-Act (PDSA) cycle. This approach aligns with key outcomes of the Aging Population Policy Framework by supporting the development and implementation of a pilot

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Plan

Act Do

Study

project, evaluation of its effectiveness, efficiency, impact, and eventual rollout throughout the province.

PDSA is a successive cycle that starts off as a pilot to test potential effects on processes, but then gradually leads to larger and more targeted change. It follows this four-stage cycle to promote continual improvement. The ‘plan’ stage includes gathering data on the current situation and past history. The ‘do’ stage is an experimental stage where possible improvements are tested as pilots on a small scale. In the ‘study’ stage the results of those experiments are studied. And the ‘act’ stage is used to adopt improvements if the pilots found successful methods.

When applied by ANSRO to plan and implement change, this approach can be described as follows.19

Plan – ANSRO recognizes an opportunity for change and develops a plan to better integrate management strategies for seniors supports, housing and overall care.

Do – ANSRO proposes that these changes be field tested by carrying out a pilot project. ANSRO develops a plan to better integrate management strategies for seniors supports, housing, and overall care.

Study – The pilot project will be studied through a systematic evaluation process. The evaluation findings will be reviewed and analyzed to identify key learnings and recommendations.

Act – ANSRO proposes that these findings be used to make recommendations to inform a wide expansion of the pilot to additional provincial sites.

Following the completion of one PDSA cycle, evaluation learnings will be applied to subsequent cycles of planning, implementation and evaluation. ANSRO proposes the following timeline for the first rotation of this cycle:

Plan Refine the proposed pilot plan April 2012 – July 2012

91? Adapted from the American Society for Quality (ASQ)’s description of the Plan-Do-Check-Act cycle. Website: asq.org/learn-about-quality/project-planning-tools/overview/pdca-cycle.html. Accessed 5 August 2011.

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Governance Aspects of Resource Centres

Provincial oversight

Single funding source

Local governance

Replicable business model

Do Implement the pilot August 2012 – April 2013

Study Evaluate the pilot May 2013 – June 2013

Act Expand the pilot using evaluation findings July 2013

The following sections expand on each specific component of the PDSA cycle.

5. Plan for Integrating Seniors Services in Alberta

Considering the diversity of Alberta’s aging population, and in light of the current challenges related to seniors service provision, ANSRO proposes the following plan to better integrate management strategies for seniors supports, housing, and overall care. This plan takes the form of a network of Regional Seniors Resource Centres. Through this plan, ANSRO intends to align with and build on existing initiatives that seek to integrate seniors services in Alberta. Integrated services

describes the delivery of seniors services in a manner that enables seniors to optimize their independence, safety and security, and wellbeing. Integrated services are especially important for seniors who are elderly, frail and vulnerable and who require services from a variety of organizations or service providers. The plan for seniors supports in Alberta addresses three key areas:

1. Governance

2. Operations

3. Service Delivery Features

5.1 Governance

The Regional Seniors Resource Centres would feature the following governance aspects:

Provincial oversight – The network of Centres would be guided by a multi-sector, cross-Ministry steering committee consisting of provincial representatives (from Health and Wellness, Seniors , Human Services, and possibly relevant others), municipal representatives, seniors service providers, and significant community involvement. This committee would employ a provincial coordinator, who would ensure that Centres fulfil their accountabilities to the provincial body.

Single funding source – The network of Centres would be funded through a single provincial funding envelope resourced by the participating provincial ministries.

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Plan

Operational Components of Resource Centres

Information services

Information sharing

Case management services

Integrated assessment

Partnerships

Co-located multi-disciplinary staff

Integrated management information system

Local delivery and governance – Wherever possible, existing Seniors Centres would be contracted to provide Regional Seniors Resource Centre services. Where there is not an existing Seniors Centre with the interest and/or administrative capacity to perform these functions, other senior-serving organizations or new organizations would be contracted. Each Centre would be governed by local board consisting of local community leaders and seniors. The board would be accountable to the appropriate agency for the funds it receives and to the local community for the scope and quality of services provided. The board’s primary responsibilities would be to oversee planning, evaluation, management, service delivery and reporting activities.

Provincially standardized, replicable business model – Although each Centre would be locally based, the Centres would be developed according to a business and funding model that can easily be replicated in jurisdictions across Alberta. The model would include provincial oversight of local service provision, as well as appropriate governance at both levels. While the staffing model and service focus might vary from Centre to Centre, each would share common characteristics related to funding, governance, and intake procedures.

5.2 Operations

Each Regional Seniors Resource Centre would include the following operational components:

Local, community-based information services – Each Centre, located in a different community in Alberta, would be designed to provide information about locally available healthcare, housing, preventative and community support services for a range of needs

The Centres would produce and distribute print and online resources that list services of particular interest to local seniors, as well as access/assessment procedures, eligibility requirements and the costs for each. These resources would position seniors to become better informed about services that could support them, in effect creating a tool for self-management. The resources would also assist providers when responding to inquiries that require a greater degree of assistance. All resources would need to be continually researched and regularly updated. Staff would be available for one-on-one consultation, either on site or by telephone.

Information sharing – Infrastructure will need to be in place to support robust information management across health and community services. The integrated information system must support standardization across multiple assessment and data entry points and comply with existing privacy legislation.

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Referral and case management service – While some seniors would be able to access the services they require on their own, others would need more personalized assistance. In the latter case, professional staff would be available to provide referrals, case management services or assistance with pathway navigation. This might include a comprehensive needs assessment that considers multiple health indicators, and/or an assessment of the senior’s eligibility for a particular support service. Once the appropriate service(s) has been identified, the case manager would assist the person to access the service and, if appropriate, monitor the outcomes. The overarching responsibility of the case manager would be to actively ensure that an individual receives the right support to address their identified need(s).

Integrated assessment – A key component of each Centre’s success will be its approach to needs assessment. ANSRO envisions dual levels of assessment:

o A streamlined intake assessment that allows staff to quickly assess an individual’s situation.

o As required, more in-depth assessment that aligns with the requirements of multiple service providers. This in-depth assessment would be coordinated to reduce the time, money and energy normally involved in separate assessments for different services. There may be multiple service assessments aimed at specific service sectors (i.e., housing, homecare, etc.), but common information would be shared across each.

Partnerships – To operationalize this model, new or existing agencies could be effectively involved as direct service providers with each Regional Seniors Resource Centre’s registry of providers. This collaborative partnership would be reflective of oversight by local and provincial governance bodies. Innovative potential partner relationships could include non-profit and community organizations in a number of ways.

Co-located multi-disciplinary staff – Staff composition would include a team of nurses, social workers, housing officers, seniors advocates, dieticians, occupational therapists, mental health and elder abuse professionals, and others who are knowledgeable about the services available locally, including homecare, specialized medical care, alternative healthcare, supportive and long-term care facilities, seniors community programs, transportation services, and meal and housekeeping services. These staff members would also be familiar with eligibility requirements, access procedures, and costs of each of these services.

Integrated information management system—Information sharing across sectors—support, housing and care—is critical to the success of the integration management strategy. Integrated services must enable their staff to share information quickly and easily, particularly about individual service users. It is a generally accepted fact that to facilitate service delivery as well as planning, monitoring and evaluation, an integrated management information system makes it easy to share client information without compromising client privacy. This way a full picture of each senior can be put together quickly and easily before new action can be planned and taken.

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Service Delivery Features of Resource Centres

Non-duplication

Multiple referral points

Continuity of support

Flexible levels of service

Accessibility

Accountability and evaluation

5.3 Service Delivery Features

The Regional Seniors Resource Centres would reflect the following service delivery features:

Non-duplication – ANSRO recognizes that numerous government and non-government services currently exist to provide information to seniors about services that are available to them. These include Alberta Supports, HEALTHLink, municipal 311 telephone lines, and community-based service directories. The Resource Centre concept is not intended to replace any one of these. Rather, it aims to build on the strengths of these models and, where appropriate, partner with them to connect seniors to the information they provide.

Multiple referral points – The Resource Centre would be accessible from a number of points. Seniors would be able to easily access the Centre directly, and connect with a staff member or case manager who can help. Other people would also be able to help a senior in need make the connection to the Centre, including primary care providers, homecare workers, emergency medical professionals, staff members in assisted living facilities, family members, and neighbours in the community.

This one-stop, open door approach requires a seamless, highly effective needs assessment procedure that allows staff to easily assess an individual’s situation. It also requires a targeted awareness campaign to inform service providers and members of the public about the services offered at the Centre.

Continuity of support – Successful case management requires service providers to share relevant client information with the case manager, and in some cases, with each other. This enables providers to deliver wrap-around services even though their involvement is focused on one aspect of the client’s wellness. Working within existing professional and legal structures related to information sharing, the Centre’s case managers would provide assistance to service providers in integrating their client care information to ensure that holistic wellbeing is addressed. This would require the provision of technological supports to facilitate information sharing among providers.

Flexible levels of service – While some seniors would only require information about a service to address a specific concern, others might need assistance to access the service and ensure it meets their needs in the long term. The Centres would be able to meet varying levels of need, from single referrals to ongoing case management.

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Accessibility – Accessibility would be a key component of the Centres. Seniors with physical disabilities would be able to visit or call the Centre easily, as facilities and telephone services would be barrier-free. Staff would be trained to respond to the needs of people with various disabilities. Home visits may be provided on an “as needed” basis. Services and print resources would be available in numerous languages, and all services would reflect the cultural diversity of the local seniors population. Direct centre services would be provided at no cost to the client.

Accountability and evaluation – Through performance monitoring and feedback cycles, Regional Seniors Resource Centres need to be monitored and adjusted to ensure clients’ needs are fully addressed and services are provided as efficiently as possible. The accountability process must be transparent.

6. Call to Action

As a way of moving toward this described plan for seniors services in Alberta, ANSRO is calling on provincial and municipal governments and community service providers to work together to implement a minimum of two or three Regional Seniors Resource Centres on a pilot basis.

6.1 Pilot Project

The proposed pilot project would include the following activities:

Establishment of a multi-sectoral steering committee – The steering committee would be composed of provincial representatives (Seniors, Health and Wellness, Municipal Affairs), municipal government representatives, and community supports and housing providers.

Development of a business model – The pilot Centre’s business model would feature:

o Provincial and local governance models (e.g., local boards, advisory committees).

o A sustainable funding model, and identification of project sponsors.

o A strategy for contracting with local Seniors Centres for providing Regional Seniors Resource Centre services. This may require an examination of existing provincial model examples such as Alberta Supports and/or Office of the Public Guardian.

o Establishment of provincial guidelines, standards and regulations.

o Establishment of an operational model, including mandate of the Centres, roles and responsibilities of board and staff, and policies and processes including evaluation, assessment and performance monitoring processes.

o A service delivery model, including a staffing model. A reallocation of human resources from relevant agencies may be a consideration.

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Do

o Supporting technologies, especially related to information sharing to facilitate referrals and case management.

Selection of appropriate pilot sites – In order to maximize learning, pilot communities should be representative of other communities with similar service delivery contexts. ANSRO suggests establishing pilots in communities with:

o A wide variety of existing seniors services to support a manageable and meaningful pilot project.

o A population that is representative of those in other communities in Alberta.

o Sites should consist of medium to large urban populations as well as rural areas.

To that end, ANSRO suggests establishing initial pilot sites that may be drawn from communities such as Camrose, Lethbridge, Red Deer, Edmonton, or Calgary.

Identification of potential local partners – Strong local partnerships will be critical to the success of the pilots. Existing service providers can contribute in a number of ways, including in an advisory capacity, by sharing knowledge of the local service delivery context, and by sharing knowledge of existing models of information management and collaborative service delivery. They may also provide in-kind contributions of space, expertise and resources. Partners might include Alberta Health Services, primary care networks, housing providers, seniors transportation services, community service providers, and local seniors centres.

Examination of local seniors services and service gaps – Once the pilot communities have been selected, the context in which services are delivered locally will be examined through an environmental scan. This will itemize an inventory of existing services for seniors, highlighting those where strong models of information sharing and collaborative service delivery exist. A Request for Proposals or similar approach would be utilized to select each local pilot site organization.

Development and implementation of a service plan – The primary services that the Regional Seniors Resource Centre will provide to seniors are (1) information sharing about existing services and (2) ongoing case management. However, once major service gaps have been identified through the pilot study, the Centres may decide to support existing organizations to offer new services to fill these gaps, or offer services directly through the Centre. These decisions will be made through an initial service plan development process that can be repeated and updated regularly in the future.

Development of an engagement and communications strategy – This strategy will outline how awareness of the Regional Seniors Resource Centre will be established and built within the community. It will identify specific target audiences, including seniors and their families, healthcare providers, housing providers, and community service providers. It will also describe methods for building awareness among these targeted groups, including information sessions and media campaigns.

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7. Evaluate Progress

A preliminary evaluation plan will include both formative (ongoing) and summative (end-of-pilot) evaluation activities. In its preliminary form, the plan will outline evaluation questions that can then be used to develop indicators and evaluation methods that will describe the learnings from the pilots. The main objectives of the evaluation will be to inform the future implementation of similar projects, and to provide policy

recommendations.

Some of the findings of the pilot evaluation may have policy implications that are relevant to the Aging Population Policy Framework. Although this is beyond the scope of ANSRO’s recommended action, it is recognized that government must collaboratively engage seniors and seniors serving agencies to ensure that policies and processes reflect the identified needs of communities.

8. Build on Success

Upon completion of the pilot phase, an implementation plan for each additional community resource centre will be developed. Implementation will be led by the same steering committee, with additional representation from participating communities. It is recommended that expansion sites receive continued support through their full start-up cycles to maximize initial investments in facilities, personnel and resources.

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Study

Act

$Independent

Advisor

Volunteer Support

Housing Counselling

Concluding Waypoint: George and Betty on a Pathway to “Aging in the Right Place”

One day while at the Seniors Centre, George attended a presentation about a Regional Seniors Resource Centre that had recently opened in their community. The presenter said that Centre staff provides information about services for seniors, and could help connect them to a wide range of health and social support services. George was particularly happy when he heard that some of the services included diet counselling, transportation, home support and mental health counselling as well as the provision of required services. He called the number on the pamphlet, and set up an appointment to talk to an intake officer.

When they met, the intake officer spent time asking questions about George and Betty’s health, their home situation, how much support they receive from family, and what were their most immediate concerns. After listening to them, she made some phone calls to a few different assisted living facilities, and advised him about the intake process, waiting list and cost of each one. As well she told George he could talk with a housing advisor as to what living environment would be most appropriate for his and Betty’s circumstances. She also indicated that, if he preferred, an appointment with an independent financial advisor could be made to discuss how they could finance this kind of move. She then advised George that since their home was owned jointly by himself and Betty, that Betty, given her progressive dementia, should seek legal advice re power of attorney. While George thought about the different options, the intake worker also helped him connect with a home care provider who would be able to assist them both with their medications and perform some light housekeeping. She set up an appointment with a dietician to ensure George’s diet was enabling him to best manage his diabetes and provided Betty with a referral to a mental health clinic specialized for seniors.

She also advised George that since he would soon be looking for a family doctor for both himself and Betty that she could put them in contact with the local primary care network. George consented to having himself and Betty assigned to a case manager who would be their permanent contact person and who would follow up in a week to check on their progress. When George left, he was also provided with information about a community transportation service that he wasn’t aware of:

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a local volunteer would pick them up at home, drive them to appointments, wait for them, and then take them home.

Now he and Betty had some decisions to make.

George feels pleased to have found a single point of contact that can help him and Betty navigate the various confusing and cumbersome pathways to the service options available to them. Having one knowledgeable person to call at the Resource Centre has made a big difference to his peace of mind as he contemplates the decisions he and Betty had to make. George and Betty were certain their family would be pleased and relieved.

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APPENDICES

By way of further comment...

Appendix 1. The lead-up to ANSRO’s proposal .

In 2008 the Demographic Planning Commission confirmed that Albertans, as seniors, want to live in their own homes for as long as possible. In order for them to successfully remain in their own home, seniors need affordable housing and services, access to adequate supports and more choice in living environments. Accordingly, the Commission proposed its first policy theme: ENABLING SENIORS TO REMAIN IN THEIR OWN HOME.

A follow-up response to the Commission’s Findings Report was the release of Alberta’s Aging Population Policy Framework which asserted: “A number of government ministries currently work in collaboration to meet the needs of seniors through the development and delivery of policy, programs and services…in eight key areas of significance for Alberta’s aging population.” The eight areas as well as the respective outcome for each are as follows:

Financial Security and Income: Albertans have access to adequate resources to meet their needs in their senior years.

Housing and Aging in the Right Place: Alberta seniors are able to reside in the place that is appropriate to their circumstances.

Continuing Care: Alberta seniors have access to a range of continuing care services that enable them to reside in an environment that is appropriate for their circumstances.

Healthy Aging and Health Care: Alberta seniors are supported in maintaining optimum health as they age.

Transportation and Mobility: Albertans have access to safe, affordable, appropriate and accessible transportation options during their senior years.

Safety and Security: Alberta seniors are supported in maintaining optimum independence in making decisions about their lives and are free from abuse.

Supportive Communities: Alberta seniors are engaged as full and welcome participants in their communities.

Access to Government: Alberta seniors are able to easily access Alberta government programs, services and supports.

At the same time the Framework made the following observation:

“Alberta seniors may not be aware of the services and supports that are available in their community. Some seniors may be aware of these services, but have difficulty locating and connecting with them. It can also be challenging for aging Albertans, their families and support networks to navigate multiple ministries and application processes to access the services and supports they require.” In reality, to the degree that collaboration is taking place between ministries having senior-related responsibilities and a working relationship exists, there is no apparent commonly shared, holistic view of

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a senior’s housing, support and care needs; actions and decisions are arrived at independently and without coordination; and, there is no sense of coherence nor shared point of contact with the senior requiring a range of services from various providers. Essentially, housing, support and care services for seniors are fragmented and provided in an uncoordinated fashion. The end result is that Alberta seniors, wherever they may reside, are not being served in accordance with their needs. Continuing with the current mode of services delivery, the desired outcomes as outlined in the Framework will remain as such—desired outcomes.

THE MEANS: Integrated Community-Based Housing, Support and Care for Seniors Management System

The Demographic Planning Commission made it abundantly clear that the “Alberta government departments and agencies need to work in more integrated ways to better connect seniors with services…The Alberta government must also develop an interdepartmental coordinating committee or other mechanism that ensures policies, programs and services for seniors are planned and implemented in a coordinated fashion.”

The appropriate response is to implement a viable whole system approach to community-based housing, support and care for seniors. In other words, a comprehensive, coherent, and totally coordinated, that is, a fully integrated approach to the management and provision of support and care services within the context of community-based, senior-friendly housing that provides genuine options and real choice for the senior served.

An integrated approach, as shown in Figure 1 can readily be achieved through a government structure that unifies various departments (agencies and functions) and appears as one to the public, effectively operating as a single “one-stop shop” for seniors. Integration of department functions—serving as a means to an end and not an end in itself—reflects a coherent, coordinated relationship between those integrated: the point of connection is a clear focus on the needs of the senior served.

BEST PRACTICES

In an extensive review of service delivery models Hollander and Prince (2007) concluded that a consistent message concerned the negative effects of organizing services in bureaucratic silos. They have identified a number of key administrative and service delivery best practices for organizing integrated systems of community based supports and care:

Administrative Best Practices

A single, highly coordinated administrative structure A single funding envelope An integrated information system An incentive system for evidence-based management

Delivery Best Practices

A single/coordinated entry system A single, standardized, system level assessment and service authorization A single, system level client classification system

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An ongoing, system level of case management Communication with the senior—and family—served

Service Providers Service Providers

Figure 1. Integrated Housing, Support and Care for Seniors Framework

THE BOTTOM LINE

ANSRO is of the view that how seniors experience the currently distinct and disparate housing, support and care services has a lot to do with how the services are or are not structured or organized. The fragmented scope, structure and functions of the current service delivery systems are affecting the effectiveness, efficiency and equity of the services provided as well as the seniors’ quality of life. Hollander and Prince (2007) suggest that all services for a given population group, seniors as such, should be under the administrative and financial control of one entity. The desired end-state is a viable, whole system of community-based housing, support and care for seniors. Markle-Reid et al., in reviewing the findings of the 2008 Continuing Care Research, concluded, “The evidence is clear that proactive…comprehensive [integrated community-based housing, support and] care for older people can result in better health outcomes for the same, or lower cost.”

The basic premise underpinning ANSRO’s proposal is that senior-friendly housing and supports preferred and chosen by the senior served, whether in the form of general independent housing, supportive living or community services, is crucial in providing an appropriate context for the provision of required support and care services if a wholesome quality of life for seniors is to be ensured and maintained.

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Municipal Affairs – Seniors – Health and Wellness

Seniors ServicesAuthority

Directorate

Regional Senior Resource Centre

Quality of Life

Community Supports

&Housing

Alberta

Health

Services

Senior Served

SeniorsSeniors

APPENDIX 2. A Schematic of Client Flow Through the Integrated Housing, Support and Care Management System (Seniors Services Authority)—an adaptation of Hollander and Prince (2007)

Client Flow Through an Integrated Management System

The above schematic outlines how George and Betty would proceed through an integrated housing, support and care management system as being proposed by ANSRO. George and Betty may refer him/herself or be referred by family members, health professionals, housing operators or other

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Client • Self-Referral

• Community Referral• AHS Referral

IntegratedSingle-Entry Portal

Eligible for Residential Support/Care &

Assessment Conducted

Interdisciplinary Team Development/Review ofSystem-Level Support-Care Plan

Client Enters Housing-Support-Care System

Long Term Care Acute Care & Specialized Assessments

Case ManagedCommunity-Based Support/Care

Reassessment

Ineligible: Leaves System

Ineligible: Referred to Community Resources

Referred to SocialCare Outside the

System

Consultation: Physician

Client Leaves System

concerned parties. The referral would generally be made to the local or regional seniors resource centre operating as an integrated, single entry portal, one-stop shop for seniors.

Usually, a general, informal face-to-face or telephone screening is done to gather information regarding the need for housing, support and/or care services as well as inquire about eligibility. Should the information indicate George and Betty are potential candidates for housing, support and/or care, they would then be assessed using a comprehensive, system-level assessment instrument.

Using the assessment information as a base, along with a discussion with George and Betty and his/her family, and consultation with the family physician and/or specialist, an accommodation, support-care plan is developed and reviewed by an interdisciplinary team. This plan would then be discussed with George and Betty and his/her family to determine the most appropriate course of action and placement that would enable George and Betty to enjoy an optimal quality of life. George and Betty then enter the system. If either George or Betty has complex needs, he/she may be referred to a specialized assessment such as a geriatric assessment and treatment unit. Once assessed in the specialty unit George and Betty may be admitted to acute care, long-term care or referred to a community-based housing, support and care provider/operator.

Client-seniors who do not require specialty acute care services may be admitted to a residential support-care facility or receive home support-care services in their community of choice, and may be referred to or provided with additional support-care from service providers outside the integrated support-care system such as community centres with programs for seniors. Over time, George and Betty will be reassessed on a regular basis. Their support-care plan would be revised as deemed necessary and, if required, referred or provided accordingly. George and Betty may also leave the system with the option of returning at any time.

Benefits of Integrated Services to the Person Served (Seniors and Their Family)

Convenient and easiest access to advice, assistance and service: one-stop shop for seniors

Simplest and most direct processes for assessment and decision making

Swiftest delivery of whatever service is required

Least risk of errors and unnecessary stages (and no passing the buck)

Maximum opportunity for controlling events/activities/procedures

Reduced communication failures

Simplified decision making process by involving fewer people

Putting the senior—the person served and their family—first.

Added Value from Integrated ServicesThere are indications that in comparison with coordinated services, integration may add value in the following ways:

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By changing the identity or branding of services to create more positive user responses and staff allegiances, suggesting a clearer break with the past.

By organizational efficiencies, for example in the shape of shared support services, integrated management, innovative response processes, and emerging hybrid roles.

By defining a focus of action that includes clearer processes of accountability, less prone to distraction by individual organizational concerns.

By introducing more robust arrangements for teamwork and leadership—pulling together if the going gets a bit tough.

By creating new opportunities for investment, for example in Information Technology systems and opening access to new resources.

By having a greater capacity to advocate and negotiate on behalf of individual seniors, for example with service providers, regulators or funding agency.

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Appendix 3. OVERALL DESIRED OUTCOME: Wholesome Quality of Life for Alberta’s Seniors

Quality of life can mean different things to different people at different times.

“When I use a word,” Humpity Dumpity said, in a rather a scornful tone “it means what I choose it to mean—neither more nor less.” Through the Looking Glass Lewis Carroll

Adapted from the University of Toronto’s Quality of Life Research Unit, Centre for Health Promotion in the Department of Public Health Sciences definition of quality of life (www.utoronto.ca/qol/), the following working definition is used herein:

Quality of life (QoL) is the degree to which a senior enjoys the important possibilities of his or her life—the important possibilities for seniors are independence, safety and security, and personal wellbeing—in a living environment of their choice.

The primary principle underpinning this definition is that Alberta seniors are deserving of timely and equitable access to community-based housing of their choice, supports, and health care. A graphic representation this framework is best presented as a “three-legged milk stool” (see Figure 1.) with Quality of Life of the Person Served being the seat.

Figure 1. Seniors Quality of Life Framework1

The three main “legs” are:

1. Independence: Seniors value very highly being their own person, autonomous, self-directing, dependant on no one. And they very much expect to be treated with dignity and respect.

2. Safety & Security: Seniors are very concerned as to the safety and security of their person, property and privacy.

3. Well-being: Seniors are desirous of being considered in a holistic manner relative to six fields: S-social C-cultural P-physical

I-intellectual E-emotional S-spiritual

For these three “legs”—independence, safety and security, and wellbeing—to function as a robust whole requires an integrated system of spanners. The spanners that serve to maintain the integrity of the three-legged milk stool are:

1. Housing: Seniors’ living options of choice—essentially housing—should be aesthetically pleasing, clean, age friendly, comfortable and convenient so as to make for a wholesome lifestyle. Included are features such as social inclusion/ support networks as well as life enrichment programming.

2. Community-based Supports: Seniors are motivated/invigorated by a sense of belonging expressed in terms of local services: e.g., hospitality, housekeeping, transportation, maintenance, and information services, including civic opportunities for their active participation.

3. Health Care: Seniors expect and are deserving of care that focuses on the person served and his/her family. This means delivering care in a manner that best supports seniors throughout their care path and in achieving their optimal outcomes so they may enjoy an optimal quality of life. Such care speaks to an integrated support and management system for seniors which closes gaps in care and services, better supports people and enables comprehensive assessments, provides greater choice of living options and results in more fulfilling life outcomes.

Appraising Senior’s Quality of Life. In appraising a senior’s quality of life it is essential that the person-served (the senior and their family) have the opportunity to indicate the degree of importance and satisfaction with each element of the quality of life framework.

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REFERENCES

Aging Population Policy Framework, Government of Alberta, Edmonton AB, November 2010.

Bringing the NHS and Local Government Together, A practical guide to integrated working, Care Services Improvement Partnership-Integrated Care Network, nd. www.icn.csip.org.uk/practicalguidetointegratedworking

Demographic Planning Commission--Findings Report. Government of Alberta, Edmonton AB, December

2008. Hollander, Marcus J., J.A. Miller, M. MacAdam, N. Chappelle and D. Peller. Increasing Value for Money in the Canadian Healthcare System: new findings and the case for integrated care for seniors, HealthCare Quarterly, Vol. 12 No 1, 2009.

Hollander, Marcus J. and M. J. Prince. Organizing Healthcare Delivery Systems for Persons with Ongoing Care Needs and The Families—a best practices framework , Healthcare Quarterly, Vol. 11 No. 1, 2007.

Hollander, Marcus J., N. L. Chapplle, M. J. Prince and E. Shapiro. Providing Care and Support for an Aging Population: Briefing Notes on Key Policy Issues, Healthcare Quarterly, Vol. 10 No. 3, 2007.

Markle-Reid, M, G. Browne, R. Weir, A. Gafni, J. Roberts, and S. Henderson. “Seniors at Risk: The Association Between the Six Month Use of Publicly Funded Home Support Services and Quality of Life and Use of Health Services for Older People.” 2008 Continuing Care Research Project, Canadian Journal on Aging 27(2): 207-24, Summer 2008.

More Choice, Greater Voice, a toolkit for producing a strategy for accommodation with care for older people, Care Services Improvement Partnership-Housing Learning and Improvement Network, February 2008. www.icn.csip.org.uk/housing

NSW Department of Health, Framework for integrated support and management of older people in the NSW health care system, North Sydney AU, July 2004. www.health.nsw.gov.au

University of Toronto’s Quality of Life Research Unit, Centre for Health Promotion in the Department of Public Health Sciences. www.utoronto.ca/qol/

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