Canada’s Ability and Autonomy Assistance Insurance Program

by Anne Thompson

Premise

As part of Canada’s total diversity, ability- and age-diverse persons add value to society and so ought not to be treated as though a burden and a catastrophe in social, economic or even health terms.  Accepting these facts means adjusting our structures and services to this now-accepted reality as we make delivery of a relationship-based practice of ability and autonomy support services that promote an individual’s abilities independence, seamlessly accessible on a systematic basis to anyone assessed as needing them for as long as assessed, including for an individual’s lifetime.

Vision

A country with seamless access to the system of Canadian ability and autonomy assistance devices and services for the procurement of any and all options and forms of individualized care, assistive device, and support personnel, as needed and adaptable to the beneficiary’s needs and preferences, including for an individual’s lifetime: the right care at the right time with the right supports in the right place, as directed by the individual recipient (beneficiary).

Mission Goal

The creation of an empowered, networked organization for the delivery of ability devices and autonomy support care services (the Product) for deemed individuals with an impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment or a functional limitation, whether permanent, temporary, episodic, stable, or progressive in nature, designed to support their dignity—meaning to provide all necessary means to enable each individual to exercise choice and control over their lives and make all decisions for themselves—and to respond quickly to individual needs and preferences with customized devices and services outlined in Purpose, Coverage, Autonomy support services, Expectations, and Obligation sections.

Purpose

To create an innovative non-profit federal Crown corporation that, while incorporating an emphasis on recruitment retention by fostering safe, healthy, fair and inclusive work environments and cooperative workplace relations, provides a single point of access to for the acquisition of a wide-range choice of assistive devices and services that enhance an individual’s abilities and support an individual’s dignity and autonomy through a compulsory insurance plan administered by the Corporation’s Board of Directors that follows their own charter, their Code of Conduct, and other standards, and the explicit rules and regulations as defined by the yet to be penned Canada Ability and Autonomy Assistance Insurance Act in order to guarantee Canadians less expensive, good quality, consistently available assistive devices and care services for the purpose of maintaining an adequate standard of independent living and community involvement anywhere in Canada’s health authority regions, including fly-in and isolated locations.

Leadership

Public agents in the roles of Federal, Territorial, Indigenous, Métis and Provincial Offices of the Advocate for Challenged Individuals and Elders

−        develops, deploys and maintains the Organisational Structure that delivers the Goal;

−        monitors and responds to individual outcome satisfaction with the Product;

−        actively-seeks feedback for the Product;

−        ensures compliance with legal and regulatory requirements;

−        has the authority to compel an investigation by any level of law enforcement authority and/or department;

−        anticipates employee needs

−        actively supports recruitment retention by fostering safe, healthy, fair and inclusive work environments and cooperative workplace relations.

Organisational structure

Success is more assured when the Organisational structure’s approach is consistently supported from the top.  The organisational structure must reflect the belief that its success is even more probable when its purpose follows a clear end-point that is as described in the Vision statement.  It must show what the destination should look like—that is to say, have a clear descriptive outline of what each person is to do, how they are to do it, and why they are to do it (where they fit in the program).  Poorly conceived organizational structures can lead to ineffective misaligned structures that do not support the business of ability devices and autonomy support services delivery.

The Organisational structure’s design principles are to incorporate a decentralized version that will allow it to operate on a self-management paradigm based on trust, development, learning, and support as opposed to one that works on the basis of a paradigm of control, hierarchy and administrative oversight.  From the beginning and unencumbered by any previous administrative legacy, the right culture and behaviours can be installed with an operating system oriented from its inception toward self managed care, thus allowing the support functions and technical infrastructure to be fully attuned to the needs of the frontline service providers and beneficiaries from the start.

Benefit to the government

Some control on the spiraling costs for ageing and for disabled Canadians, as at-home care is about half the cost as the alternative costly long-term care facilities; funding would come from funds currently being spent on long-term care and ability services, therefore cost-neutral; fund augmented each year through premiums and taxpayer contributions;

Benefit to society

Canadians with permanent, temporary or episodic physical, mental, intellectual, cognitive, learning, communication or sensory impairment or a functional limitation, their families and their caregivers facing interaction with various bureaucratic barriers (which may hinder their full and effective participation in society on an equitable basis with others) may also benefit from the Program.

Cautions

(1) Make sure that the services are delivered by competent people and the quality strictly controlled by the government;

(2) Make sure bureaucracy in not increased for private not-for-profit personal care homes for the disabled/elderly;

(3) Make sure the program has regulations to assure against abuse.

Method

Health care specialists, including and not limited to psychiatrists, geriatricians, psychologists, paediatricians, occupational therapists, and physiotherapists, would evaluate people’s degree of ability and autonomy, and determine with them and any invited family members what services are required for them to stay at home if they so desire.

Coverage

A suite of personal, professional, and non-health services, such as nursing, rehabilitation, and nutritional evaluations, to address professionally assessed healthcare needs to the yearly allocation, based on needs and annual income (low-income paying the least) at government set rates.

Autonomy support services

1. basic professional medical care and services;
2. supply, service and maintenance of assistive equipment, orthotics, and prosthetics;
3. services to assist with activities of daily living;
4. services to assist with instrumental activities of daily living (e.g. grocery shopping, transportation options, and cultural and library visits);
5. the provision of technical aids and small devices, determined by government regulation, to compensate for a disability;
6. an education component with referrals to financial services and information about how people can maintain their own health, as well as counseling services to help an individual deal with reconciling that somebody may be continually in their kitchen, their bedroom and their bathroom;
7. caregiver respite support; and
8. an expanded basket of services including heavier household tasks (e.g. companion animal care, minor indoor/exterior home maintenance, minor yard work, snow removal).

Procurement

Government pays the private company or non-profit group, or community organization, or forms a partnership contract with government healthcare workers and/or unions to deliver the services.

Expectations

Service providers are expected to be truthful in all interactions and communications, completing all reports in an honest, complete and timely manner.  Service providers are expected to carry out their assigned work obligations.  Services are expected to be made seamlessly accessible on a systematic basis to anyone assessed as needing them, with individual- and family-centred care that maintains and prioritizes an individual’s capability, choice, and dignity, and under policies that place the individual’s and family preferences above institutional or agency procedures.

Obligations

Service providers and their workers must recognize

–  designated caregivers as essential partner or partners in care who are actively and regularly participating in providing care—which may include the support of feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision-making – and that their number may include family members;

–  that “impeccable” means beyond reproach of the code of ethics and the standards governing their job; and

–  that “individual” means a natural person who is a client or a resident or a patient or a beneficiary of services.

Service provider workers must, while simultaneously carrying out impeccable and ongoing assessment of the individual, provide application of culturally-appropriate trauma-informed knowledge within the scope of training received, and perform, as part of a team, those activities, appropriate for the individual’s age and cognitive ability, that contribute to the benefit of the individual’s body, mind and spirit, and that assure the following are provided in non-specific locations and in such a manner as would an individual perform unaided if the individual had the necessary strength, will or knowledge:

(a) an effective broad multidisciplinary consultative approach based on beneficiary guidance and active participation, that allows input from family members or designated caregiver, and that makes use of available community resources that offer a support system to help the individual live as actively as possible until death;

(b) support to the family members and the designated caregiver of the individual;

(c) services that ensure the individual is not left alone or is monitored, so as to give a family member/designated caregiver time off for rest or respite, or an opportunity to receive services determined by government regulation, such as support, assistance and training services;

(d) health providers evaluate and alleviate the individual’s physical, psychological, and social distress, recording, and reporting to supervisors any untoward or unusual behaviour seen or sensed;

(e) personalized point of care quality-of-life assessment, that is routinely reviewed and updated in response to individual condition;

(f) the cleanliness of the individual, which includes washing, rinsing, and drying of hair, face, trunk, extremities and perineum, and anything that touches the individual, which includes glasses, dentures, clothing, linens, hearing aids, prosthesis, and orthosis;

(g) the grooming of the individual, which includes cleaning of teeth and/or dentures, brushing, combing and maintenance of hair, application of therapeutic moisturizing cream/lotion, application of make-up, shaving, and clipping nails;

(h) the timely obtaining, donning and doffing of the individual’s indoor and outdoor clothing, and when applicable, prosthesis +/or orthosis,+/ or clean, properly fitting glasses in good repair and of the correct prescription, +/or clean, well-maintained, properly fitted dentures, +/or clean and fully-charged properly functioning hearing aids, +/or incontinence products/devices;

(i) the habitual ingestion of a variety of sufficient nutritious, familiar, culture-specific, prepared to the correct consistency, texture and temperature, foods and beverage to improve or to maintain the individual’s best health, including feeding the individual if necessary;

(j) the integration of the psychological and spiritual aspects of individual care;

(k) the exercise of empathetic social behaviours in order to support the emotional and mental health of the individual;

(l) enhancing the quality of life of the individual, and of their families/designated caregiver, facing the problems associated with the individual including bereavement counseling, if indicated;

(m) sufficient repositioning/rotation of the individual on a regular basis to prevent bedbound complications;

(n) the safety and stability of the individual when the individual mobilizes without assistance;

(o) a safe, comfortable, temperature- and humidity-controlled environment for the individual;

(p) engagement of the individual in programs that foster the physical, social, emotional, intellectual and spiritual maintenance or improvement of the individual, and demonstrate an appreciation of their inherent value;

(q) maintenance of good communication with the individual, including attentive listening, smiling, patience, and empathetic and calming actions;

(r) development of strong communications channels that ensure the individual and their families/designated caregiver receive timely, accurate and useful information;

(s) monitoring of the individual’s vital signs, as necessary;

(t) the maintenance of good sleep hygiene;

(u) provision of timely professional medical, dental and/or therapeutic intervention, especially if and as soon as something untoward or unusual is seen or detected;

(v) the timely delivery of medication, assessment of the effective outcome of medication, and periodic assessment by drug interaction professionals – i.e., pharmacists – to oversee administration of prescribed drugs and over-the-counter drugs and supplements using de-prescribing guidelines.