Canadian Health Care Systems Quiz

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition

• This book is a 3rd edition on gerontological nursing and healthy aging specifically in Canada
• Authors include Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, and Kathleen Jett.
• Copyright © 2023 Elsevier Inc.

Chapter 24: Economic and Legal Issues

Learning Objectives (1 of 2)

• Explain the reasons for differences in health insurance among Canadian provinces/territories for out-of-hospital care.
• Describe the financing of the Canadian healthcare system.
• Compare the Old Age Security program, the Canada Pension Plan, and the Quebec Pension Plan.

Learning Objectives (2 of 2)

• Compare and discuss the roles of a power of attorney and a guardian.
• Explain the process of assessing mental capacity.
• Detect and assess elder abuse.
• Describe strategies for preventing and detecting the abuse of older adults.

The Canada Health Act (1 of 2)

• The Canada Health Act of 1984 combines previous federal legislation.
• It outlines the national health insurance plan and the roles of federal, provincial, and territorial governments in the healthcare system.
• Healthcare is managed and provided by provinces and territories.

The Canada Health Act (2 of 2)

• Medically necessary services, like primary care, hospital care, and surgical/dental services are publicly insured under the Canada Health Act.
• Federal government responsibilities include:
  • Setting and administering national healthcare principles through the Canada Health Act.
  • Collaborating with provinces and territories on national health policies.
  • Contributing to healthcare funding through transfer payments to provinces and territories.
• Provincial and territorial variability exists in some services, including home care, long-term care, medications outside of hospitals, physiotherapy, and optometry.

Health Care Financing

• Total healthcare spending in Canada in 2019 was approximately $265.5 billion.
• Government spending consistently accounts for roughly 70% of total healthcare spending.
• The remaining 30% is private-sector spending (private insurance and out-of-pocket expenses).
• Health care spending for older adults (65+) was $11,599 per capita in 2019, the second highest after infants under 1 year ($12,678).
• Increased healthcare expenditures for older adults are partly due to increased service utilization by those in poor health.

Social Security Retirement Income Programs (1 of 4)

• Old Age Security (OAS) Program
  • Provides income support to older Canadians
  • Includes OAS pension, Guaranteed Income Supplement (GIS), Allowance, and Allowance for the Survivor.
  • Federally financed through general tax revenues.
  • Monthly payment for Canadian citizens/legal residents aged 65+ who have resided in Canada for at least 10 years after age 18.
  • Maximum 2017-2021 monthly OAS pension benefit was $615.37.
  • OAS is indexed and considered taxable income.

Social Security Retirement Income Programs (2 of 4)

• Guaranteed Income Supplement (GIS)
  • A monthly benefit for OAS recipients with limited or no other income.
  • Benefit amount depends on income, marital status, and whether a spouse receives OAS or GIS.
  • Maximum single person benefit (2021) was $919.12, and $553.28 for a spouse.
  • GIS is also indexed to the cost of living.

Social Security Retirement Income Programs (3 of 4)

• Allowance and Allowance for the Survivor
  • Paid to the survivor (widow/widower) of an OAS pensioner.
  • Income-tested based on the combined annual income of the couple or survivor.
  • Persons aged 60-64 who meet Canadian citizenship/residency requirements are eligible and must reapply annually.
  • Maximum monthly benefit (2021): $1168.65 (Allowance) and $1393.05 (Allowance for the Survivor)
  • Not taxable income and indexed to the cost of living.

Social Security Retirement Income Programs (4 of 4)

• Canada Pension Plan (CPP) and Quebec Pension Plan (QPP)
  • Provide retirement pensions and disability benefits for contributors.
  • Eligibility: older adults who contributed to the plan, are 65 years or older, or between 60 and 64 and meet additional requirements.
  • Maximum monthly income (2021): $1203.75, indexed to the cost of living.
  • Survivor benefits include CPP death benefit, CPP survivor's pension, and CPP children's benefit.

Implications for Gerontological Nursing and Healthy Aging

• OAS and CPP/QPP programs aim to prevent older Canadians from living in poverty.
• Health care services accessibility varies across Canada, sometimes dependent on income and location.
• Low income cut-offs (LICO) are a common measure of poverty in Canada.
• Nurse assessments should include total income, income sources, and knowledge of OAS and CPP/QPP benefits application.
• Gerontological nurses can encourage age-friendly attitudes by understanding the financing of healthcare and the pension system.

Health Care and Services for Veterans

• Federal government (through Veterans Affairs Canada) provides veteran and wartime civilian treatment, benefits, and services including:
  • Disability pensions
  • War veterans allowance
  • Home care services
  • Long-term care and treatment benefits
  • Counselling
  • Personalized care planning
  • Medical needs assessment
  • Advice
  • Information and referral
  • Legal help with pension/allowance matters and funeral/burial costs.

Implications for Gerontological Nursing and Healthy Aging (Veterans)

• Gerontological nurses should be aware of veteran services and support.
• Assessments should include questions about wartime military service or civilian service.

Legal Issues in Gerontological Nursing (1 of 2)

• Legal Capacity: A person's ability to make decisions.
• It's a legal concept, not a clinical diagnosis.
• To be considered capable involves understanding relevant information, evaluating data, and appreciating decision consequences.
• People are usually presumed capable until legally determined otherwise.
• This applies to financial decisions and decisions about daily routines, housing, personal care, medical decisions (including consent to treatment).

Legal Issues in Gerontological Nursing (2 of 2)

• Capacity is issue- or task-specific and exists on a spectrum.
• Mental capacity is assessed by various people (depending on the decision).
• Power of Attorney: legal document to designate another person to act on one's behalf (e.g., family member, friend). - can be continuing (ongoing) or enduring (incapacitated).
• Guardians: appointed by a court to manage finances, property, and/or personal care for someone deemed incapable.

Abuse, Mistreatment, and Neglect of Older Adults (1 of 2)

• Elder abuse: any action by someone in a trusted relationship resulting in harm or distress to an older person.
• Elder abuse occurs across all socioeconomic, racial, and ethnic groups in Canada.
• Neglect: a lack of action by someone in a trusted relationship resulting in harm or distress.
• Types of elder abuse: physical, psychological/emotional, sexual, economic/financial, spiritual abuse.

Abuse, Mistreatment, and Neglect of Older Adults (2 of 2)

• Common types of elder abuse are emotional and financial abuse.
• Estimates of elder abuse are likely underreported.
• Surveys may underestimate the prevalence of elder abuse due to reluctance to report and because vulnerable older adults are less likely to participate.

Institutional Abuse

• Inadequate care, nutrition, standards of nursing care, inappropriate/aggressive interactions, substandard/overcrowded/unsanitary environments.
• Risk factors include environment, organizational culture, staff characteristics, and resident characteristics.
• Two types:
  • Resident-resident abuse (1%-41%).
  • Staff-resident abuse. More likely reported from another resident than staff member. High risk residents: female, cognitive impairment, wandering behavior, limited mobility.

Signs of Elder Abuse

• Fear, anxiety, depression, or passiveness towards a family member, friend, or care provider.
• Unexplained physical injuries.
• Dehydration, poor nutrition, or poor hygiene.
• Improper use of medication.
• Confusion about new legal documents (e.g., wills, mortgages).
• Sudden drop in financial holdings.
• Reluctance to discuss the situation.

Implications for Gerontological Nursing and Healthy Aging (1 of 2)

• Nurses must be aware of potential for abuse, observing for signs/symptoms in interactions with vulnerable older adults.
• If abuse is suspected, a comprehensive assessment should be conducted, considering victim safety/desires. Assess the victim's capacity.
• See associated Box 24-3: Questions to Ask When Assessing Suspected Abuse.

Implications for Gerontological Nursing and Healthy Aging (2 of 2)

• Intervention strategies to stop mistreatment and neglect of older adults.
  • Provide care/treatment for consequences of abuse.
  • Protect the victim and the public from illegal/inappropriate acts.
  • Hold abusers accountable.
  • Support offender rehabilitation.
  • Order restitution for properties/expenses due to abuse.

Prevention of Abuse

• Gerontological nurses should recognize situations with risk of mistreatment and take preventive steps to avoid abuse or neglect.
• Educating potential victims of abuse/neglect about available support and options for leaving the situation.

Criminal Code and Reporting

• Provincial/territorial laws may require reporting abuse of incapable individuals to the police.
• Mandatory reporting of suspected abuse/neglect of residents in long-term care (LTC) and assisted living facilities.

Test your knowledge on the various aspects of Canadian health care systems, including the Canada Health Act, provinces' differences in health insurance, and elder care. This quiz covers public and private spending, as well as issues related to elder abuse and assessment. Prepare to explore important topics in Canadian health policy.