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Innovators’ Challenge:
Going Beyond the Conversation
Summary Report Mar. 1, 2019
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The Covenant Health Network of Excellence in Seniors’ Health and Wellness was launched in 2013 to create capacity and expertise focused on enhanced and more sustainable models of seniors care. Since that time, the Network has connected with seniors, caregivers, health professionals and researchers province-wide and engaged them in partnering to design, test and spread ideas that help seniors live fully as active and connected members of their communities.
This report summarizes the possibilities ahead as the Network continues to strive for excellence in seniors’ health and wellness.
Our sincere thanks to the dozens of committed professionals and researchers that participated in the Oct. 2018 Innovators’ Challenge. It is through your inspiration that we continue to believe in a new future for seniors care.
Our gratitude is also extended to Zayna Khayat, our keynote future strategist, and to Leah Lechelt, lead Innovators’ Challenge facilitator and author of this report.
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Innovators’ Challenge – Beyond Conversation
Over the last six years, Covenant’s Network of Excellence in Seniors’ Health and Wellness (the Network) has invested in over 18 Innovation Fund research projects and several strategic initiatives. These Innovation Fund research projects and strategic initiatives aimed to generate new knowledge and enable high impact changes in the seniors’ health and wellness system.
As these projects have concluded the knowledge gained and shared from these pragmatic research projects gave us an excellent start, however the challenges in seniors’ health and wellness domain continue to emerge. Our aging population increases daily and our already strained healthcare system struggles to meet the growing needs of our seniors. In addition, the next generation of seniors, the baby boomers, intend to live healthier and longer lives and will demand services and care options that will better fit their wants and needs.
In order to confront these challenges the Network planned and supported a day of conversation and engagement with the goal of creating new energy and fresh thinking towards tackling these grand challenges through partnerships and collaboration. By inviting the Innovation Fund research project teams alongside a wide range of stakeholders within the seniors’ health and wellness realm, the day generated rich discussion and collaborative thinking.
We strongly believe that the expertise, the energy and willingness to make an impact made this day very exciting and purposeful for everyone. This brief report summarizes the outcomes of the day and the possibilities ahead of us all. As the Network of Excellence in Seniors’ Health and Wellness we will continue to strive for excellence in seniors health and wellness beyond conversation.
Dr. Anwar Haq Dr. Jasneet Parmar Executive Director Medical Director The Network The Network
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Background Covenant Health’s Network of Excellence in Seniors’ Health and Wellness (NESHW or the Network) brought together 61 thought leaders and senior executives in seniors’ health and wellness on Oct. 1, 2018 for a one-day symposium, Innovators’ Challenge: Going Beyond the Conversation. Through moderated sessions and breakout groups, participants were invited to address this question:
What are the Grand Challenges in seniors’ health and wellness? How do we create a new energy and fresh thinking toward tackling these challenges through partnerships and collaboration?
The aim of the symposium was to identify the most important challenges in supporting the province’s growing population of seniors and the increasing pressures in meeting the need for services.
Methodology Participants were invited from among Alberta’s community of health providers, researchers, administrators and advocates. Following a review of international literature on priorities within seniors’ care and an inspirational keynote address by a future strategist, participants were invited to describe up to three grand challenge in seniors’ care based on their professional and personal experience.
Participants identified 58 challenges and grouped them initially into 12 themes and then into seven categories. Each of the seven topics was assigned to a breakout table; participants joined the table/topic of their choice and were guided by a table facilitator through detailed exploration of the Grand Challenge topic, followed by potential Grand Solutions.
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The Seven Grand Challenges
The Seven Grand Challenges identified by participants are summarized below.
1. Structural Ageism □ Harmful generalizations regarding homogeneity of aging leads to viewing all seniors
the same. □ Low social capital of seniors leads to structural and systemic ageism and
devaluation. □ Medicalization of aging leads to care systems that are paternalistic and hierarchical.
□ Low health provider preparedness regarding aging leads to biases and stereotypes.
2. Social determinants of health
□ Health services do not address social determinants of health (SDH) and social/economic inequities.
□ Multi-generational interactions are needed to sustain and leverage seniors’ social capital.
□ Community-based organizations, not-for-profit organizations, and municipalities deliver social care better than health systems.
3. Social isolation
□ Social isolation is multi-faceted (emotional, spiritual) and is defined by the individual.
□ Isolation is socially constructed and reinforced by segregating seniors for service delivery purposes.
□ Services to mitigate isolation must address the individual’s subjective perception of loneliness rather than the system’s objective metrics.
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4. Risk tolerance: Outdated Policies/Regulations □ The health system’s culture of low trust and risk aversion has led to over-regulation.
□ Poor accountability distinctions and boundaries across public sector silos have led to misalignment and overlapping jurisdictions
□ Performance metrics have been inappropriately reduced to tracking inputs, outputs and compliance measures at the service delivery level rather than assessing macro-level population health outcomes.
□ Individual quality of life cannot be measured by quality control measures or risk metrics.
5. Technology-augmented health care □ The power and potential of technology is untapped as an enabler of system
transformation. □ Excessive legal concerns are preventing the democratization of data, which results in
data continuing to be tied to the site, sector or provider rather than the individual. □ Data integration is imperative to transitioning from a health/sickness care model
to one of self-care and self-efficacy. □ We must unleash the power of predictive analytics to link health and social data, and
reduce the reliance on retrospective reporting and funding models. 6. Community-based approaches to care
□ Care in the home, accompanied by robust caregiver supports, needs to become the norm for all care streams and provider groups.
□ We must manage longevity and complexity in community settings through innovation and reduced reliance on institutional care.
□ Fluid, flexible and recurring transitions between home, community and institutional care must be driven by new funding and care models.
□ Urban planning and community development are critical factors in promoting community living and outreach to seniors.
□ Intergenerational living and transportation are prerequisites to strong community-based care.
7. Inspire for change: System transformation □ Courage, innovation and change leadership are imperative to transform seniors’
care. □ We must embrace prudent risk-taking, innovation, and intentional change using
predictive and proactive approaches. □ Equity, not equality, should be the driver in meeting individual needs.
□ Seniors’ care needs to invest in ‘small’ – families, housing, neighborhoods, communities and zones – to drive innovation, break down silos, and create flexible pods within the larger system.
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Discussion and interpretation In addition to the seven main challenge topics, there were also three common over-arching themes that emerged across the seven breakout group discussions – all considered foundational to system transformation.
Wellness-illness dichotomy Traditional medical models and systems for seniors’ services are based on a historical narrative that becoming old is marked by a defined shift from being well to being unwell. The wellness-illness dichotomy has led to aging being managed as a diseased state, resulting in a seniors’ care system that is structured around episodic care, prevention of harm, and risk avoidance.
This contributes to chronic over-regulation as a means of anticipating and mitigating potential adverse events. The health system is therefore predisposed to counting, funding and rewarding inputs (staffing, dollars) and outputs (tasks, services) while punishing adverse events – rather than evaluating holistic outcomes such as quality of life and other person- reported outcomes.
Longevity is the new normal A focus on longevity – a sustained, 25-year period of gradual or cyclical changes in health and capacity – is the new path forward. Aging and the arrival of each new normal necessitates adjustments in expectations, supports and services.
The focus must be on sustaining health, autonomy and function within a continually evolving state of what is normal for the individual.
With this progression comes abundant opportunities to anticipate change, mitigate and manage the impact on the individual, and enhance their ability to adapt and respond to the changes.
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Seniors’ care can no longer focus on the intensity, constancy or permanency of interventions to rapidly restore health, but rather it must focus on building capacity, resiliency, and the ability to adapt to changing circumstances and health. We must strive for fluidity, responsiveness and flexibility of supports to address a full range of micro and macro changes in an individual’s health, social needs and function over time.
We are ill-prepared for the new era of seniors’ health and wellness
Every facet of our seniors’ health and wellness system – legislation, regulations, policies, infrastructure, care models and provider education – are structured around the traditional, disease-based model of aging and the wellness/illness dichotomy. While the health system responds well to sudden and catastrophic changes in health, it is poorly designed to respond to and support slower, progressive and cyclical shifts in health.
Today’s up and coming seniors will compel us to deconstruct the pervasive ageism that is inherent in every part of the current seniors’ care system.
Most supports and services for seniors are centered around deficits and losses rather than on individual capabilities, strengths and preferences. Seniors are increasingly segregated into housing, programs and facilities for efficiency and ease of service provision, leading to structural ageism, marginalization, isolation, medicalization, paternalism, provider biases, devaluation, and disrespect of older adults.
Under the current system, innovation is not rewarded and indeed poses a liability and funding risk to organizations and workforces. Current models also promote competition for resources, contributing to territorialism – and serving as a barrier to collaboration and system integration. Exacerbating this problem is the degree of overlap, duplication and conflicting priorities among bodies that regulate, fund, audit, own and operate within the seniors’ system.
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A new vision for seniors’ health and wellness Participants imagined an entirely new vision for seniors’ health and wellness – one that is articulated and shared jointly by seniors, government, service providers, communities and the public. It will be founded on the values that we cherish for seniors and will represent a bold, forward-thinking vision.
The new vision will recognize that caring and caregiving are the backbone of seniors’ social care and health services, and therefore our system must be structured and funded to support flexibility, responsiveness, and innovation.
In our re-imagined system, any and every door will be a reasonable door to access services – even if it’s your neighbor’s door.
Large institutions will be divested of extensive control so that smaller care environments can be fully accountable and nimble in all aspects of service provision and innovation. In turn, seniors, families, communities, providers, and regulators will be inspired to learn, trust, understand, and collaborate in ways that truly meet local needs.
In a re-imagined system, hidden and single access points will be replaced with an every-door-is-open principle as the medical system relinquishes its exclusive role as gatekeeper and point of entry. Care will be organized within community hubs. Funding will be decentralized and unbundled – following the senior/family rather than tied to the provider or care site. Emergency departments and hospital admissions will be a last rather than a first resort, and premature presentation to hospital will be interpreted as a failure of the community system.
Finally, our legal environment will change to accept some degree of risk as an acceptable trade-off to achieve senior, resident and family autonomy. We will no longer assume seniors need protection from all possible harms and risks – or that every senior needs or wants the same services and outcomes. Instead, we will have progressed from a paternalistic model to a partnership model; from doing to seniors to doing with seniors and their caregiving team.
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Where to from here? At the Grand Challenge conclusion, participants coalesced around four broad courses of action.
1. Emerging seniors are the change leaders Today’s generation of pre- and early seniors (55 – 75) will be the driving force behind transformational change. They are educated, mobile, healthy and motivated – and they will become essential partners in developing a new manifesto for seniors’ health and wellness. Their first step is to help officials recognize that pervasive ageism is inherent in every part of the current seniors’ care system – and that it must be tackled with great vengeance and with decades of concerted effort if true change is to occur.
2. Outdated policies Rewriting outdated regulations and policies – many of which are predicated on risk management principles and medical-illness models of care – is central to paving the way for system change. Otherwise, providers and organizations will continue to be legally and ethically bound by restrictive clinical practices, funding and operational procedures; prudent risk-taking and responsible innovation will never occur to the extent required for system transformation. Work should begin in targeted areas of focus and expand more broadly as partnerships and solutions are developed.
3. System bottlenecks With a forward-thinking seniors’ manifesto and an innovation-friendly regulatory environment in place, targeted bottlenecks in the system can be methodically addressed using evidence, best practice, and knowledge gleaned from other jurisdictions nationally and internationally. The work to break-down bottlenecks will force and inspire collaboration across sectors, sites, and provider groups in targeted and productive ways.
4. Client-facing drivers As the regulatory and service delivery environment shifts in favour of a more modern and responsive seniors’ care system, it will be easier for local communities to address client-facing drivers of wellness, such as social determinants of health, social isolation, community services and technology integration.
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Should you require more information about the Network, please contact us:
www.Seniorsnetworkcovenant.ca
