Reports/Research

Click on bold font or the Download button to access the full report.


Excerpt:
The absolute horror stories emerging from Canada’s long-term care facilities have focused our attention as never before on the vulnerability of the residents that rely on these institutions.

But every one of these incidents came from media reports that predate the pandemic. They reflect Canada’s system of care for the elderly and people with disabilities in “normal” times, not times of crisis. In worsening this system’s failures, the coronavirus crisis is opening our eyes to realities that far too many Canadian families have long known all too well.

In his response to the gut-wrenching revelations that recently emerged at a Dorval nursing home (the same one where the woman choked on her food), Quebec premier François Legault stated that the situation “looks a lot like major negligence.”

The negligence Legault referred to was that of the privately owned company that ran this home. 

While our politicians can claim to be saddened over the tragedy that is now unfolding in long-term care homes around the country, none should claim to be surprised at this situation. Unions and organizations that advocate for the various people that depend on long-term care have for years decried the worsening conditions of these facilities. Many have also been extremely clear about the central reason for these worsening conditions — privatization.

Indeed, every one of the examples mentioned at the beginning of this article occurred at one of Canada’s privately owned for-profit facilities. While the number of for-profit care homes varies from province to province, such facilities house 37 per cent of Canada’s long-term beds.

The connection between private ownership and diminished standards of care has been documented in numerous studies and reports. One recent study from the peer-reviewed journal PLOS Medicine found that for-profit facilities not only provided “inferior” care but also were more likely to have been cited for serious deficiencies than facilities making less profit.

To read more, click on: Privatization the pre-existing condition killing seniors in long-term care

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Click on bold font or the Download button to access the full report.

Assisted Living in British Columbia 
Trends in access, affordability and ownership

February 2020

Andrew Longhurst

Access to publicly subsidized assisted living in British Columbia has fallen since 2008 for British Columbia seniors.

Between 2010-2017 BC added only 105 units of publicly subsidized assisted living despite a growing seniors’ population while—more than 10 times that number—1,130 private-pay units were added. Seniors who cannot afford to pay privately may go without care altogether or wait until their health deteriorates to the point of requiring a nursing home or hospitalization, this report explains.

These are among the key findings of Assisted Living in British Columbia: Trends in access, affordability and ownership by Andrew Longhurst, who notes that access to subsidized assisted living dropped by 17 per cent province-wide between 2008 and 2017 (measured as the number of units per 1,000 seniors age 75-plus).

The study raises concerns about the growing role of for-profit companies and corporate chains in the assisted living sector. For-profit corporations provide the vast majority of private-pay units, while non-profit organizations provide the majority of publicly subsidized units.

The report makes two key recommendations to address the growing access problem in BC. The first is the creation of new capital and operating funding opportunities for non-profit organizations and health authorities to increase the supply of publicly subsidized assisted living units as part of a home and community care funding plan. The second focuses on requiring detailed disclosure to improve transparency and accountability in both assisted living and long-term care.

Download full report
or summary
ccpa-bc_AssistedLivingInBC_summary.pdf

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A Prescription for Canada: Achieving Pharmacare for All

MESSAGE FROM THE CHAIR

{Excerpts]Canadians have considered the idea of universal drug coverage, as a complement to universal health care, for over five decades. For such a long-standing debate there is a surprising level of consensus. After hearing from many thousands of Canadians, we found a strongly held, shared belief that everyone in Canada should have access to prescription drugs based on their need and not their ability to pay, and delivered in a manner that is fair and sustainable. That’s why our council has recommended that Canada implement universal, single-payer, public pharmacare.

There is no single, uniform method in Canada for a child with asthma to get her inhaler. It depends on her family’s coverage. There is no one consistent way that all cancer patients obtain take-home cancer drugs or medicines for coping with chemotherapy side effects. Some pay more. Some pay less. Some don’t have access to those medicines at all.

There is a cost to universal pharmacare and we understand that governments have fiscal limits. But universal, single-payer, public pharmacare can save billions by lowering the price we pay for prescription medicines and by avoiding the greater costs that accumulate when a manageable condition becomes a serious health crisis or when complications develop because someone could not afford to take medicine as prescribed. It might be the person recently laid off who stops taking medicines for preventing heart attack or stroke. They don’t feel an immediate, daily difference when they take those pills. So, they question the expense when money is tight. They mean to get back on the medicine when they get back on their feet. But time runs out. They end up in an emergency room in crisis. They may now need ongoing home care. Any return to work is delayed or maybe never happens. Barriers to accessing prescribed medication can and do result in additional visits to the doctor’s office, emergency departments and hospital inpatient wards, all costing our society much more than the cost of that preventive medicine. Improving access to prescription medicine improves health outcomes, reduces health care visits, and saves billions in downstream health care costs.

Our current fractured system also weakens Canada’s negotiating position with pharmaceutical companies. We pay some of the highest drug prices in the world. Other countries with universal pharmacare get better deals for the same drugs. 
Dr. Eric Hoskins

Final Report of the Advisory Council on the Implementation of National Pharmacare:
https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html

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In hospitals, housekeepers are truly the ‘keepers of the house’

By NEIL PROSE and RAY BARFIELD
FEBRUARY 5, 2020

Malcolm cleans patient rooms and offices in the large medical center where we both work as pediatric doctors.

After finishing our respective rounds one afternoon, we noticed that Malcolm was deep in conversation with the parents of one of our very sick patients. We met him later in the hall, and the three of us began to talk. After Malcolm told us a bit about the concerns of our patient’s family, he mentioned the ways he often supports and cares for the children being treated on our ward.

“I don’t call myself a housekeeper,” said Malcolm, who has been with the hospital for 10 years. “I am the keeper of the house.”

To read the full article click on In Hospitals Housekeepers are truly the ‘Keepers of the House’

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From Residential Care to Hospital: An Emerging Pattern
“After careful review of multi-year data, a consistent pattern emerges that shows a demonstrably greater use of the emergency department and hospital beds by residents from contracted long term care facilities versus residents from publicly run facilities and a stunning 54% greater likelihood that you will die in the hospital if you live in a contracted care facility versus a publicly operated facility,” stated Mackenzie.

Listen to the Teleconference Audio with Q&As

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PRIVATIZATION AND DECLINING ACCESS TO BC SENIORS’ CARE
An Urgent Call for Policy Change 

By Andrew Longhurst March 2017

Seniors benefit physically, mentally and emotionally when they can age at home. And when that’s not possible, quality assisted living and residential care are equally important. Having these essential services in place contributes to the most-effective use of our public health care resources and reduces pressure on hospital and emergency services—the most-expensive parts of the health care system.

For the past 16 years, underfunding, privatization and fragmentation of the system have left many seniors, their families and communities patching together care—and even going without.

Four previous CCPA–BC reports—published in 2000, 2005, 2009 and 2012—documented de- clining access to home and community care services in BC. Updated statistics obtained from the Ministry of Health for this report show the downward trend has continued.

Research shows ownership of residential care facilities affects care quality and staffing levels, and that for-profit residential care is generally inferior to care delivered in public or non-profit facilities.

To access the full report, click on:
PRIVATIZATION AND DECLINING ACCESS TO BC SENIORS’ CARE

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Care Outcomes in Long-Term Care Facilities in British Columbia, Canada
Does Ownership Matter?

Margaret J. McGregor, MD, MHSc, Robert B. Tate, PhD, Kimberlyn M. McGrail, PhD, MPH, Lisa A. Ronald, MSc, Anne-Marie Broemeling, PhD, and Marcy Cohen, MEd

Objectives: This study investigated whether for-profit (FP) versus not-for-profit (NP) ownership of long-term care facilities resulted in a difference in hospital admission and mortality rates among facility residents in British Columbia, Canada.

Results: We found that, overall, FP facilities demonstrated higher adjusted hospitalization rates for pneumonia, anemia, and dehydration and no difference for falls, urinary tract infections, or DCU/gangrene. 

FP facilities demonstrated higher adjusted hospitalization rates compared with NP facilities attached to a hospital, amalgamated to a regional health authority, or that were multisite. 

This effect was not present when comparing FP facilities to NP single-site facilities. 

There was no difference in mortality rates in FP versus NP facilities.

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Many residents in rural communities have to travel to other communities for general and specialized care, but this process has its own challenges, such as how to ensure reliable transportation. Alex Vanderput

UBC Rural Evidence Review aims to identify highest-priority health needs in rural BC communities
As BC continues to face gaps within its rural healthcare system, UBC researchers are working to amplify rural communities’ perspectives in high-level planning processes.

Since starting a year ago, the group of researchers working on the Rural Evidence Review (RER) project has been surveying rural residents from across the province on their experiences and priorities accessing healthcare. Newspapers from communities ranging from Revelstoke to Fort Nelson have been calling for participation from their local residents.

For RER Co-Director Dr. Jude Kornelsen, it’s this grassroots approach that differentiates the project from the numerous studies that have already been done about rural healthcare.

According to Kornelsen, previous systemic reviews have seen large influence from health authorities while the team now wants to engage mainly with on-the-ground stakeholders. She added that most studies she has seen also tend to come from an urban focus, losing some nuances about rural populations — which include numerous Indigenous communities — along the way.
“Rural is not just small urban,” said Kornelsen.

As the co-director of the UBC department of family practice’s Centre for Rural Health Research, she has researched rural healthcare needs extensively.
“And you can’t really group them together. ‘If you’ve seen one rural community, you’ve seen one rural community’ is something that we often say,” she added.

Edward Staples — President of the BC Rural Health Network (BCRHN), which provides support for RER’s research — agreed with Kornelsen. In fact, he said this is represented in BCHRN’s structure itself, which brings together 16 autonomous organizations working in 14 different communities.
NOTE: currently – January 29. 2020, the BCRHN has grown to represent 34 communities, organizations and individuals.

To access the survey for out of pocket costs, click on:
Out of Pocket Costs for Rural Residents Accessing Health Care

To read the Abbotsford News article, click on:
Health care access, cost of travel top concerns for B.C. rural residents

To read the interim report that highlights concerns of rural folks when it comes to health services, click on the download button:

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To access this paper, click on:

Review of Family Medicine Within Rural and Remote Canda: Education, Practice, and Policy

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Citizen-Patient-Community Participation in Health Care Planning, Decision Making and Delivery through Rural Health Councils
Policy Brief Rural Evidence Review (RER)
September 2019
To: British Columbia Ministry of Health & Health Authorities Policy Makers
From: Rural Evidence Review Project Centre for Rural Health Research, UBC

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To access the report, click on the bold text or the download button

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To access healthcare articles, videos, etc. click on: BC Rural Centre – Healthcare

To access the BCRC Featured Report
Click on: Rural Health Initiatives in BC

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South Okanagan Similkameen Primary Care Network Issues Paper 
September 2019
The South Okanagan Similkameen (SOS) Primary Care Network (PCN) encompasses the entire SOS region. It serves approximately 90,000 residents in 8 communities.

The following paper contains an environmental scan of issues that have surfaced in our region. Input was given by physicians, Nurse Practitioners, Interior Health, Indigenous partners, local government, and patient voices. 
Similar concerns were echoed by other Wave 1 communities.

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South Okanagan Similkameen PCN – Vulerabilities and Solutions
September 201
The first five months of Primary Care Network funding have been full of great progress, allowing our region to address vulnerabilities and to strengthen our existing network of care, as we continue our shift towards team-based primary care delivery.

For context we have highlighted each of our networks of care, their vulnerabilities, and solutions to address those vulnerabilities. Some of these solutions pre-date Primary Care Network funding, some are being shored up by Primary Care Network funding, while still others are being introduced as a result of Primary Care Network funding.

We have also highlighted some process issues and proposed solutions in order to increase the success of Primary Care Network implementation, which began in Penticton, Summerland and Okanagan Falls, with service plan deveopment underway with the communities of Oliver, Osoyoos, Osoyoos Indian Band, Keremeos, Lower Similkameen Indian Band, Upper Similkameen Indian Band, Hedley and Princeton.

Link: South Okanagan Similkameen Primary Care Network
Vulnerabilities and Solutions
 

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Provincial Health Care Partners’ Planning Retreat
Summary Report
January 27, 28, 29, 2019
This event was co-sponsored and organized by the Rural Coordination Centre of BC, Doctors of BC, and the BC Ministry of Health. 
The purpose of the gathering was to “engage in learning about primary health care re-design and transformation, with a focus on rural and remote communities.”
 A provincial planning team was formed under the leadership of the Rural Coordination Centre of BC, which included: Dr. Ray Markham (RCCBC), Dr. Alan Ruddiman (GPSC), Dr. Granger Avery (Doctors of BC), Meghan Hunt (First Nations Health Authority), Paula Carr (Doctors of BC), Ed Staples (BC Rural Health Network), Kim Williams (RCCBC), Anne Lesack (RCCBC) and Scott Graham (SPARC BC).
Videos collected during the gathering have been produced and can be viewed here: https://www.youtube.com/playlist?list=PLzlI0dvViPsXhEmOSEk44-PximyO2tOFt

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Report on the Policy Discussion between the BC Rural Health Network and the BC Ministry of Health – June 21, 2018

The BC Rural Health Network would like to thank the BC Ministry of Health for providing the opportunity to participate in the policy discussion on Community Health Centres.

Report by Edward Staples – President of BCRHN and SOHC (Support Our Health Care) – Princeton

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Putting Our Minds Together: Research and Knowledge Management Strategy
This document serves as the response to the Ombudsperson’s recommendation 35 of Misfire: The 2012 Ministry of Health Employment Terminations and Related Matters:
By December 31, 2017,  the Ministry of Health publicly released a plan, to address the gaps.

It signals the Ministry’s commitment to work with the research community, including the Michael Smith Foundation for Health Research, as well as other stakeholders, to co-develop solutions for the health system’s toughest challenges.

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Report on the Health Sciences Association Conference, April 2018
Achieving High-Performing Primary and Community Care: the Critical Role of Health Science Professions (Summary)
Edward Staples, President of SOHC (Support Our Health Care) and
BC Rural Health Network Lead.

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Rural Health Services Research Conference, May 2018, Nelson
May 31  – June 1, 2018

A two day conference, organized by the Rural Health Services Research Network http://www.rhsrnbc.ca

A sampling of the symposiums, panels and workshops: 
– Responding to Adult Vulnerability in Rural Communities
– Poverty Reduction and the “Living Wage”.
– Exploring Rural Health Systems
– Exploring Issues of Equity in Rural Health Services
– Emerging models of care
– Breaking new ground for Telehealth Programming
– Patient Engagement in Research
– The Rural Catchment Project: Strengthening local evidence through a catchment methodology

Keynote speaker Dr. Lesley Barclay, from the  National Rural Health Alliance in Australia https://www.ruralhealth.org.au gave a presentation called Insights on Establishing Alliances and Partnering for Healthy Rural Communities.

During this conference it was possible to have a side meeting with the BC Rural Health Network members who were present. Dr. Barclay was able to attend this meeting to give us valuable information re rural networks.

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Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals
Background and objectives – Recent years have seen increasing calls for more proactive use of patient complaints to develop effective system-wide changes, analogous to the intended functions of incident reporting and root cause analysis (RCA) to improve patient safety. Given recent questions regarding the impact of RCAs on patient safety, we sought to explore the degree to which current patient complaints processes generate solutions to recurring quality problems.
Jessica J Liu, Leahora Rotteau Chaim M Bell, Kaveh G Shojania

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Seniors Advocate BC – Residential Care Facilities – 2018
The British Columbia Residential Care Facilities Quick Facts Directory lists information for 293 publicly subsidized facilities in British Columbia.

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UBC Rural Evidence Review aims to identify highest-priority health needs in rural BC communities
Written by Alex Nguyen

As BC continues to face gaps within its rural healthcare system, UBC researchers are working to amplify rural communities’ perspectives in high-level planning processes.

Since starting a year ago, the group of researchers working on the Rural Evidence Review (RER) project has been surveying rural residents from across the province on their experiences and priorities accessing healthcare. Newspapers from communities ranging from Revelstoke to Fort Nelson have been calling for participation from their local residents.

For RER Co-Director Dr. Jude Kornelsen, it’s this grassroots approach that differentiates the project from the numerous studies that have already been done about rural healthcare.

According to Kornelsen, previous systemic reviews have seen large influence from health authorities while the team now wants to engage mainly with on-the-ground stakeholders. She added that most studies she has seen also tend to come from an urban focus, losing some nuances about rural populations — which include numerous Indigenous communities — along the way.

“Rural is not just small urban,” said Kornelsen.

As the co-director of the UBC department of family practice’s Centre for Rural Health Research, she has researched rural healthcare needs extensively.

“And you can’t really group them together. ‘If you’ve seen one rural community, you’ve seen one rural community’ is something that we often say,” she added.

Edward Staples — a lead of the BC Rural Health Network (BCRHN), which provides support for RER’s research — agreed with Kornelsen. In fact, he said this is represented in BCHRN’s structure itself, which brings together 16 autonomous organizations working in 14* different communities.
* updated Feb 2, 2020 : 34 communities/organizations/individuals

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Physician retention and recruitment outside urban British Columbia (Thommasen 2000)
BC Medical Journal, vol. 42 , No. 6 , July August 2000

ABSTRACT: A cohort of 1979 family physicians and general practitioners from 78 communities was identified from 21 College of Physicians and Surgeons of British Columbia medical directories—1978–79 to 1998–99. Except for the past 3 years, in communities with less than 7000 people, there has been a more or less steady overall increase in total number of physician listings since 1979 in all community groups. The lowest population communities have the lowest year-to-year retention rates and the highest recruitment rates. Typical retention rates for communities of fewer than 7000 people are between 70% and 80%. Typical retention rates for communities with 7000 or more people are between 85% to 90%. Typical recruitment rates for communities of fewer than 7000 people are between 20% and 30%, and can be as high as 38%. Recruitment rates for communities of 7000 or more are typically between 10% and 15%.

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Workforce retention in rural and remote Australia – determining factors that influence length of practice (Humphreys et al 2002)

Abstract
OBJECTIVES: To ascertain which factors are most significant in a general practitioner’s decision to stay in rural practice and whether these retention factors vary in importance according to the geographical location of the practice and GP characteristics.
DESIGN: National questionnaire survey. The method of paired comparisons was used to describe the relative importance of the retention items.
SETTING: Non-metropolitan Australia, September 2001.
PARTICIPANTS: A stratified sample of all rural GPs practising during April-June 2001
MAIN OUTCOME MEASURES: A rank ordering of factors influencing how long GPs stay in rural practice, and an index of their relative perceived importance.
RESULTS: Professional considerations — overwhelmingly, on-call arrangements — are the most important factors determining GP retention in rural and remote areas. Rural doctors consistently ranked on-call arrangements, professional support and variety of rural practice as the top three issues, followed by local availability of services and geographical attractiveness. Proximity to a city or large regional centre was the least important factor. Retention factors varied according to geographical location and GPs’ age, sex, family status, length of time in the practice, and hospital duties.

CONCLUSIONS: A broad, integrated rural retention strategy is required to address on-call arrangements, provide professional support and ensure adequate time off for continuing medical education and recreation.

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Delivery models of rural surgical services in BC (1996-2005) – are general practitioner-surgeons still part of the picture (Humber and Frecker 2008)

Objective: To define the models of surgical service delivery in rural communities that rely solely on general practitioner (GP)–surgeons for emergency care, to examine how they have changed over the past decade and to identify some effects on communities that have lost their local surgical program.

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The Entrepreneurial Activities of Citizen Led Coalitions
Kathy L. RushMike ChiassonMary ButterfieldSilvia Straka & Barbara Jean Buckley

International Journal for Equity in Health volume 18, Article number: 119 (2019)

May 2017 – Kelowna

The principal investigators of the study were Kathy Rush, PhD, RN Associate Professor at the School of Nursing UBC Okanagan and Dr. Mike Chiasson, Professor, Faculty of Management, University of British Columbia Okanagan.

Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys.

Citizen-led coalitions can be viewed as democratic publics or voluntary groups that form as a result of citizens sharing the consequences of an identified social problem [13]. One of the key roles of community coalitions is representing service users who are often marginalized, hidden or, ignored [14,15,16] and ultimately lack recognition. The role of coalitions in bringing recognition to marginalized groups has been implicit and tangential in the literature. In a case study of the strategic role of third-sector agencies, “being at the top table” (pg. 227) was critical in developing a strong third sector and user presence [16]. Third sectors were viewed as bringing something extra, such as volunteers and access to funding.

The emergence and existence of health coalitions have been implicitly linked to inequitable distribution of health services and resources [20]. The purpose of this study was to understand the entrepreneurial experiences and strategies of rural coalitions to effect change in the delivery of health services for older adult populations within their communities.

Note: it was at this meeting in Kelowna, on April 27, 2017 that discussion began that led to the formation of the BC Rural Health Network, officially launched seven months later on December 1, 2017.

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The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

April 14, 2020

Excerpts
Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. 

The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.
Dr Cath Cosgrave PhD

To read the full report, click on: The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

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