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Residential Care
Canada's commitment to provide quality care to injured, disabled and aging veterans is a long-standing priority, dating to the First World War. As a key pillar of this commitment, Veterans Affairs Canada has been a pioneering force in establishing, managing and supporting long term care facilities that address the evolving needs of veterans and other seniors. Currently, the Department provides assistance to more than 4,300 veterans who reside in approximately 171 Priority Access Bed (PAB) sites across the country and another 3,500 veterans who reside in more than 1,500 community care facilities. HistoryThe federal government's involvement in the long term care of injured and disabled veterans began at the end of the First World War and expanded significantly after the end of the Second World War with the return of thousands of injured and disabled men and women. Initially, the Department's 44 institutions focussed on the need to provide acute care facilities to accommodate the treatment and rehabilitation needs of war service veterans. Over time, the requirement for acute care facilities diminished, replaced by the need to provide veterans with quality, long-term care that best suits their needs. In response to veterans' evolving care needs, as well as to changes to federal-provincial responsibilities for health care delivery, Cabinet approved a policy in 1963 that clearly placed responsibility for health care with the provinces. This resulted in the transfer of departmental health care institutions to provincial jurisdiction. All transfers have taken place, with the exception of Ste. Anne's Hospital, a departmental facility located just outside Montréal, Quebec that has extensive expertise in the specialized clinical care of veterans. As part of the transfer agreements, a fixed number of Priority Access Beds (PABs) remain available to VAC to accommodate eligible veterans. Currently, Veterans Affairs Canada provides funding for qualified veterans who occupy a Priority Access Bed (PAB) or those in receipt of the Veterans Independence Program who reside in a community care facility. Back to TopResidential Care StrategyThe Department's Residential Care Strategy responds to clients' evolving needs, as well as to concerns raised by the Senate Subcommittee on Veterans Affairs' report, Raising the Bar: Creating a New Standard in Veterans Health Care, the 1996 Report of the Auditor General, findings in the Department's Review of Veterans Care Needs, veterans' organizations and discussions with the Department's Gerontological Advisory Council. The strategy reinforces VAC's concern for veterans' care without duplicating existing quality assurance processes and according to six guiding principles:
Key elements of the Residential Care Strategy include:
Back to TopResidential Care ModelIn this model of care, health care professionals, like Registered Nurses, become team leaders, coaches and quality assurance monitors to health care aides who provide direct patient care. This differs from the more traditional clinical care model in which Nurses are the actual providers of care. Increasingly, provinces are adopting the residential care model to respond to health care reform in long-term care settings and VAC is encouraging its larger Priority Access Bed (PAB) facilities to move toward this model, where appropriate. However, it is important to note that clinical care needs will not be abandoned; rather, access to it will be focussed in larger PAB sites. Back to TopQuality of CareIn recognition of federal-provincial responsibilities, Veterans Affairs Canada defers to provincial governments for the delivery of health care services to veterans and respects provincial standards of care that are in place. Consequently, VAC does not define national standards of care; however, to ensure that the level of care in all regions continues to meet the needs of veterans, VAC has made it a priority to develop and implement a Residential Care Strategy which encompasses quality assurance and improvement measures, such as:
Resident Care Outcome Standards As part of its residential care strategy for long term care, the Department is committed to annual reviews of community care and contract facilities providing long-term care to veterans. As part of this review process, VAC has identified 10 key Care Outcome Standards where the Department sees a need for ongoing monitoring. They are:
Client Satisfaction Questionnaires Using these Outcome Standards, VAC's Residential Care Directorate has developed a questionnaire to evaluate the satisfaction of clients who reside in these facilities. Family members may also be included in the process where veterans are unable to participate themselves. In May 2003, VAC and the Royal Canadian Legion signed a contract when by trained RCL surveyors visit up to 4000 Veterans residing in community LTC facilities across Canada. Questionnaires are completed in person through visits with residents. Facility Questionnaires A detailed facility questionnaire has been developed for district office or regional office health professionals to conduct regular reviews of long-term care facilities where veterans reside. These questionnaires were also developed based on the ten care outcomes. During the veteran interview related to the client satisfaction questionnaire, should the RCL volunteers have concerns over the quality of care in a long-term care facility, the issue is referred via Head Office who will then do a detailed review with the facility administrator to resolve any outstanding issues, and/or carry out a complete review with a facility questionnaire. Director, Quality of Care In April 2001, a Director, Quality Care was created as a pilot in the Ontario Region to monitor quality of care. The Director, Quality Care works closely with the three larger Priority Access Bed facilities in Ontario - The Perley and Rideau Veterans' Health Care Centre, Parkwood Hospital and Sunnybrook and Women's College Health Sciences Centre and with various stakeholders to resolve any outstanding issues. Accreditation Veterans Affairs Canada has partnered with the Canadian Council on Health Services Accreditation to include veteran specific issues into the new national health care accreditation program, the Achieving Improved Measurement (AIM) standards. Through contractual arrangements, the Council agreed to integrate the Department's 10 care outcome standards - ranging from safety and security to food quality - into its national accreditation process, giving the Department a standard of care much sought after by Veterans' groups. Through the Council, VAC has produced and distributed Working Together, Quality Care for Veterans, an information booklet for Priority Access Beds facilities administrators. It has been sent to all of VAC's 171 Priority Access Beds sites across the country. As part of its quest for quality care, the Council will work with Veterans Affairs Canada to evaluate the quality of care provided to Veterans and to ensure the maintenance of quality care standards. Back to TopExemplary PracticesVeterans Affairs Canada is committed to establishing a national network of PAB facilities to share information and learn about best practices among long-term care contract and community facilities as well as our departmental facility which provide long-term care to veterans. In response to a need for sharing exemplary practices, and to suggestions from a variety of sources including the Senate Subcommittee on Veterans Affairs report Raising the Bar: Creating a New Standard in Veterans Health Care, the Department hosted a long term care meeting in May, 2000 in Calgary, Alberta attended by the larger PAB facilities in Western Canada. Building on the success of this inaugural meeting, Veterans Affairs Canada has since sponsored three National Long-Term Care meetings for PAB facilities. The first took place in Montréal, Quebec in April 2001 the second in Victoria, British Columbia, in November 2002, and the third in Halifax, Nova Scotia in May 2004. PAB facilities, under contract with VAC, are invited to attend these national networking and learning sessions and participants have an opportunity to showcase their exemplary practices in the areas of dementia, palliative, respites food services, etc. Back to TopResidential Care "Wait List" InitiativesOverseas Service Veterans "at Home" Project - This project was implemented by the Department in 1999 to provide home care benefits and access to the VAC Treatment Program for veterans who have been assessed as needing long-term care but who are residing at home waiting placement in a Priority Access Bed (PAB) facility. This project applies to all sites where long wait lists for PABs exist. Overseas Service Veterans (OSVs) who participate in the project are provided with Veterans Independence Program services and access to the VAC's Treatment Program. Overseas Service Veterans Wait List Management Initiative In June, 2000, it was announced that up to 2,600 additional Priority Access Beds (PABs) would be made available to eligible veterans. In response to this commitment, an initiative was launched in July, 2000, to provide veterans who are currently only eligible for long-term care in a PAB facility with a long-term care bed in a community facility at departmental expense. This initiative provides Overseas Service Veterans who are in a community bed and on the waiting list for a PAB with the same benefits they would have received if a PAB had been available. Day Program Pilot Project Development of a "day" program at Victoria, BC's The Lodge at Broadmead provides respite care for families who are caring for a veteran at home. Under the program, families can place the veteran in The Lodge for one to two days per week. This program gives families some respite in their caregiving duties and it has the added benefit of introducing veterans to The Lodge prior to the time when a permanent placement is required. This has greatly reduced the stress that veterans and families often experience with such a change in living arrangements. Allied Veterans now Eligible for Long Term Care Back to TopCapital ImprovementsCapital improvements to PAB facilities that have been transferred to the provinces are the responsibility of the facility and the province. In some cases, however, VAC may consider providing financial support for costs associated with establishing and delivering specialized care for the cognitively impaired, respite or for and palliative care. VAC may also consider providing assistance to PAB facilities to advance VAC's 10 Resident Care Outcome Areas or to help convert clinical care environments to an environment that is based on the residential care model in keeping with VAC's Residential Care Strategy.
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