Roundtable Stakeholder Engagement

Stakeholders Invited to Participate

• Association francophone des établissements des soins spéciaux du N.-B.
• Association of NB Licensed Practical Nurses
• NB Association of Nursing Homes
• NB Association of Social Workers
• NB Home Support Association
• NB Medical Society
• NB Special Care Home Association
• Nurses Association of NB (Nurse Practitioners of NB)
• NB Association of Occupational Therapists
• Atlantic Physiotherapy Association
• Canadian Gerontological Nursing Association - NB
• NB Health Council

Challenges Discussed

1. Seniors are prematurely entering Nursing Homes
2. Seniors experience delays in transitioning between care settings
    

Key Themes Emerging

a)      Early targeted Interventions

•  Look at stats by zone rather than provincial
•  Interventions closer to the individual – client centred

b)      Enhance services to allow aging in place (to solve the problem that is preventing them from aging in place)

• Services at home
• Convalescent Equipment
• Additional support in ARF or at home

c)      Workforce

• Recruitment and retention
• More support and training
• Standardization of training

d)     Navigation and Planning for Aging

• Communication and awareness of the help available - programs and services
• Conversations early in the process, at opportunities – to discuss what are the needs at home that would allow the person to age in place (safely)

Stakeholders Invited to Participate

1.  Ability NB
2.  Alzheimer Society of New Brunswick
3. New Brunswick Association of Social Workers
4. Canadian Mental Health Association - NB
5. Economic and Social Inclusion Corporation
6. New Brunswick Home Support Association
7. Loch Lomond Villa, Inc.
8. Université de Moncton - Population Aging, Department of Research
9. Community Health Clinic – Horizon Health Network
10. Association of New Brunswick Licensed Practical Nurses
11. Paramedic Association of New Brunswick
12. New Brunswick Pharmacists' Association.
13. New Brunswick Medical Society
14. Nurses Association of New Brunswick
15. New Brunswick Association of Occupational Therapists
16. New Brunswick Association of Respiratory Therapists
17. Nurse Practitioners of New Brunswick

Challenge Discussed

Enhancing Community Based Care and Support to Seniors 

Key Themes Emerging

a)    Access to Care and Support Services

• The continuum of care includes the services available to seniors in the community
• Needs are not just medical but include social supports such as transportation and options to engage and participate in the community
• Language of choice must be addressed in the provision of services
• There should be a person-centred coordinated integration of care
• Health promotion and prevention programs can flourish in the community
• Services may be available in communities, but people do not know about them or how to access them if they are aware of the services
• The need for services, when needed, to help seniors age at home must be normalized and not seen as a negative
• The institutional model needs to be reassessed

b)    Information, Navigation and Coordination

• It is important to understand how seniors receive information. Not all seniors have the capacity to access information through technology
• An in-person/virtual community care coordinator can be helpful
• Research demonstrates that there is a need for a person-centred approach to providing seniors with information about what services are available to them
• There needs to be consistency in the messages being provided to seniors
• There needs to be coordination and sharing of information in the health and social systems
• Collaborative community centres could meet the needs of seniors in one place

c)    Transportation

• Transportation is a critical element to assist seniors to age in place
• Seniors living at home need transportation to access services in their community
• A collaboration among partners needs to take place to implement a transportation strategy for New Brunswick
• There needs to be a coordinated approach to ensure that the needs of seniors can be met within the community and within the existing system

d)    Enhanced Home Care / Community Support

• Human resources within the home care system are at an all-time critical level and many agencies are in danger of closing their door.  Home care wages are often advocated, what is not advocated for is proper funding for the home care agencies
• Home care should be normalized, giving seniors active choice in what they need to stay at home safely and longer.  Seniors need to be involved as an active participant in the decision about their care plan – not just the family
• We need to change our thinking around aging in place to consider the risk of social isolation of seniors in their home
• Home support workers are being required to encroach into medical territory – especially since the pandemic
• Many seniors in the community need social supports and do not necessarily have medical needs
• Food security, transportation, home maintenance including snow removal and suitable housing options are issues. Many seniors opt not to age in place as their home is too difficult to maintain but there are few options in their community
• Seniors often see home care as being thrust on them by medical staff and family concerned for their safety.  This causes seniors to lose a sense of self and a loss of independence.
• Good home care needs to be a normal part of the support system in the continuum of care not just a long-term care facility or hospital
• Purposeful home care is needed – not just providing a sitter for seniors
• Many services offered could be provided outside of a hospital or nursing home – it requires collaboration to make it work
• Seniors who are not connected to the system need to be able to access services close to their home to maintain their independence.
• The nursing home without walls concept could allow seniors to access services like foot care, baths, meals, and transportation – to name a few
• The unique needs of a community must be looked at and partners should bring their skills to the table to address the needs together

Stakeholders Invited to Participate

• Ability NB
• Adult Day Program (York Care Centre)
• Alzheimer Society of NB
• Canadian Mental Health Association NB
• Healthy Aging Champion - Senior Volunteer
• Meals on Wheels of Fredericton Inc.
• NB Health Council
• NB Home Support Association
• NB Hospice Palliative Care Association
• Research Lead – NBCC  HSPP informal caregiver initiative
• Long Term Care Social Workers (Dept. of Social Development)
• Bien vieillir chez soi Cocagne (Aging Well at Home Cocagne)
• Coordinator - Discharge Planners – Vitalité Health Network
• Mouvement acadien des communautés en santé du N.-B.
• Research Chair in Community Health & Aging - St. Thomas University
• Research Chair in Population Aging - University of Moncton

Challenge Discussed

• Supports for Informal Caregivers

Key Themes Emerging

a)     Peer Support, Education and Training

• We need to learn from First Nation communities who do an excellent job at taking care of elders via community support strategies
• Getting time off is needed.  Informal caregiver’s own health issues pose a challenge
• Support is needed to assist caregivers in accepting they need help before it becomes a crisis and they ‘crash’.  It is a struggle running 2 households.  We need to find ways to preserve the morale of the informal caregiver
• A big challenge is a perceived lack of counselling support for the informal caregiver - Finding peer support is a challenge especially finding the time for the caregiver to access what support may be out there – challenging to find support groups (rural and urban NB) –
• Persons with dementia are on the rise and most people don’t have the proper training to deal with dementia
• Caregivers face interpersonal conflict and question their own ability to fully care for their loved one. Many informal caregivers have expressed a desire to learn how to communicate with older adults in terms of the difficult conversations that are necessary to have

b)     Flexible Options

• More financial options for the middle class. Be flexible – do not always need a program to offer support. More flexible funding under the long-term care program is needed  - allow more flexibility in programs and policies
• Lack of senior day centers or respite care so that informal caregivers can work, run errands, do self care, etc.  When supports "lack" in the community, clients are admitted to hospital and new issues arise
• We need to identify how home support agencies can provide more respite – look at what is needed and what is not being provided now through formal home support and enhance services
• Special Care Homes with vacancies could possibly provide overnight respite for caregivers
• Lack of evening/over-night support - difficulty finding resources even if overnight care will be supported by the Department of Social Development
• Caregivers who are still working and don’t have the flexibility in their job to be there when the senior needs them like to go to a medical appointment etc. is a challenge
• Need to leverage technology – especially for families who don’t live close
• Home modification dollars need to increase – clients need flexible financial options to help achieve their goals that will help them remain at home
• We need to promote what exists such as alternate family living arrangements as an option for respite – it us currently underutilized – we need to grow this program
• It is not always about the money in providing care for a family loved one – it is more about recognizing the role that the informal caregiver plays in the system
  

c)     Communication, information and system navigation

• Communication is critical - we need to hear from the caregivers to find out what they need and we need to rethink the way we get information out and input from seniors – proposing online is not always the best approach for many seniors.  The voice of many seniors will not be heard if we only seek input online and they may miss information regarding program and services
• More information is needed for caregivers so they are aware of programs, such as the fact that there is a ‘self referral’ option for Extra Mural Program services - people need to know where supports are
• System navigation is a challenge.  There is uncertainty around how to advocate for senior loved ones.  Figuring out where to go for service between if it is health or social services can get confusing
• It can be difficult for the informal caregiver to access medical advice if the senior does not have a doctor - not all will use the Evisit NB app to seek medical advice
• Information on financial service options are unknown – particularly for middle income families is not easy to find

d)     Human Resources

• More human resources are needed to help provide care to seniors. We should get post-secondary schools to add senior care navigation to their curriculum
• Additional stress is created for the informal caregiver if there is a personal support worker in place for some of the hours and the worker does not show up
• There is an opportunity to work with the various Deans of Health (NBCC, UNBSJ, DMNB) to add curriculum and include-integrated learning experiences where health students gain knowledge and competence in senior care navigation (not just nursing care skills). Health students could include BN, PN, PSW, Social Work, Medicine, etc.  Senior health students can also increase our capacity to teach informal care givers about navigation within work-integrated learning opportunities that are interprofessional.  
• Make it easier for international students to gain access to NB and ensure that supports such as transportation to educational programs they apply for and housing are consistent for international students.  As we try to increase the number of Personal Support Workers in our province, this is a key issue.

e)     System changes

• Investigating all areas of our system would be valuable.  Systemic issues are challenging if there is no alignment across departments (Health & Social Development) regarding eligibility for respite
• We must evaluate programs and service to determine what’s working / what is not working, monitor performance, ensure consistent application of the self-managed care option, address eligibility issues for getting supports and ensure there is awareness of cultural diversity and enhance culturally appropriate services and supports
• Consider re-implementing the Caregiver Benefit program. The health and social systems must recognize that burnout and mental health are reasons the caregiver needs respite support  - burnout and increased stress are real challenges
• Improve care planning to include the informal caregiver
• A multi-pronged approach is needed – not every senior can remain at home.  There is a stage at which a senior must move to another level of care.  We need to ensure there is information available so that families have / know the options
• Standards are needed regarding the training for those looking after seniors – special skills are required.  We need better / more standards
• Every municipality should be required to introduce Age Friendly Communities as part of their strategic plan