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Improving St. Boniface and St. Vital Seniors’ Access to French-Language Health Services Summary of Emerging Priority Issues
Danielle de MoissacMarch 2013
2
Table of contents
Background 1
Profile of Francophone seniors in Manitoba 1
Main medical conditions and care needs of Francophone adults in St. Boniface and St. Vital, compared to those of non-Francophone adults in the same communities 2
Home care for frail Francophone seniors living in Winnipeg 2
Francophone clients who use long-term care 3
Experiences of frail seniors living in the community 3
Health and social services available in French and how to access them 4
Bilingual human resources in the Winnipeg Region 4
Forecasts of future needs for Manitoba 5
Best practice in health services for seniors 6
In conclusion 6
Santé en français400 - 400 Taché AvenueWinnipeg, Manitoba R2H 3C3santeenfrancais.com
This summary is an initiative of Santé en français (formerly the Conseil communauté en santé du Manitoba),
which has been made possible by funding granted by Société Santé en français through Health Canada.
Written: March 2013
Printed: May 2014
1
Summary of Emerging Priority Issues
Background Manitoba’s population is aging and its Francophone
population is aging even more rapidly. Because seniors
are more likely to experience health problems and suffer
from concomitant chronic conditions, the complexity
and increasing frequency of care is driving health services
planners and health care managers and professionals
to optimize French-language services for seniors with
existing health system resources.
It is in this context that Santé en français has led the
“Improving St. Boniface and St. Vital Seniors’ Access
to French-Language Health Services” project under the
Société Santé en français’s national HR initiative,
funded by Health Canada. Under the Manitoba project,
the services of the Université de Saint-Boniface were
retained to provide a snapshot of the current situation.
Five research reports were produced.
This summary deals with the results of the following five
research deliverables:
1. Overview of St. Boniface and St. Vital seniors’
health, access to services, and health needs;
2. Description of individual experiences with
French-language health care for seniors living
in the community;
3. Inventory of French-language health services available
in St. Boniface and St. Vital and identification of
gaps in services;
4. Identification of bilingual human resources and
current human resource practices in Winnipeg
Regional Health Authority (WRHA) facilities;
5. Review of best practices in providing health
services for seniors.
Profile of Francophone seniors in ManitobaManitoba’s Francophone population is 4% of the total
population, of which 55% live in Winnipeg. People aged
65 and over account for 21% of the Francophone
population, whereas this age group accounts for only
13% of the general population. The senior Francophone
population is aging at a faster rate than the Anglophone
population and Francophone seniors report being in
poorer physical and mental health than Anglophones.
They are more strongly represented by seniors aged
80 and over as well as women. Women are more likely to
live alone, have limited income, experience health and
mobility problems, have a greater need for assistance
with daily tasks and have a higher rate of chronic use of
drugs potentially contraindicated for the elderly and of
psychotropic drugs (antidepressants and antipsychotics).
A high percentage of seniors have low levels of education
and health literacy. These seniors indicated that they would
find it easier to understand if health professionals spoke
French during consultations.
The senior Francophone population is aging at a faster rate than the Anglophone population and Francophone seniors report being in poorer physical and mental health than Anglophones.
2
Main medical conditions and care needs of Francophone adults in St. Boniface and St. Vital, compared to those of non-Francophone adults in the same communitiesThe main medical conditions affecting Francophone
adults in St. Boniface and St. Vital are diabetes and heart
disease, and among Francophones aged 55 and over,
dementia. In terms of pharmacotherapy, there is a greater
quantity of prescribed drugs among Francophones, a
higher rate of prescriptions for antidepressants, and a
lack of monitoring in this regard, as well as a higher rate
of potentially inappropriate prescriptions for sedatives
(benzodiazepines) for Francophones, especially residents
living in the community. With respect to hospital care,
adult Francophones have a higher hospitalization rate for
injuries, which are primarily attributable to accidental
falls, as well as a higher hospital discharge rate. The rate
of admission to long-term care facilities is higher among
Francophones. Also, a higher percentage of Francophone
residents in these facilities are aged 75 and over, and their
admission waiting times are long. In St. Boniface, waiting
times can be 16 weeks compared to 8 weeks for non-
Francophones in the same community.
Home care for frail Francophone seniors living in WinnipegFrancophone clients who apply for home care are most
often women whose average age is 85. These clients are
more likely to live alone because only 36% live with their
caregiver who is usually one of their children. These seniors
suffer from hypertension, arthritis, osteoporosis, cataracts,
thyroid disease, diabetes and cerebral vascular conditions
that may reduce their mobility and increase their loss of
autonomy. They have less dementia other than dementia
due to Alzheimer’s disease or a medical condition causing
difficulties in terms of cognition, emotions, activities of
daily living or unstable behaviour.
With regard to their health needs, these seniors primarily
require personal care, i.e. hygiene or basic health care as
well as assistance with housekeeping. They have greater
difficulty with more complex activities such as preparing
meals, performing general house maintenance and
cleaning, managing personal finances, transportation,
shopping and using the telephone. Half of the clients use
nine or more different drugs while a third uses between
five and eight. A higher percentage of these seniors request
medical alert bracelets or safety alert systems.
On average, Francophone clients receive fewer days of
home care services. They also have fewer appointments
with physicians or at medical clinics, as well as fewer
hospital stays.
Half of the Francophone clients receiving home care use nine or more different drugs while a third uses between five and eight.
In St. Boniface, waiting times to admit Francophones to a long-term care facility can be 16 weeks compared to 8 weeks for non-Francophones in the same community.
3
Summary of Emerging Priority Issues
Francophone clients who use long-term care Francophone clients who receive long-term care in
Francophone and bilingual Actionmarguerite facilities
suffer from neurological diseases such as dementia
associated with Alzheimer’s disease, cardiovascular
disease, musculoskeletal disease, hypertension, mental
health diseases such as dementia other than dementia
associated with Alzheimer’s disease, psychiatric disorders
and depression. They suffer from more severe loss of
autonomy so they require more care. There is greater use
of physical restraint devices, but there are fewer falls. A
higher percentage of Francophone clients use nine or more
different drugs, which increases the risk of side effects.
Experiences of frail seniors living in the community Six seniors, whose average age was 71, and four caregivers
shared their experiences with French-language health
services. Forty percent of the participants considered
themselves in poor or very poor health, with a prevalence
of diabetes and mobility problems and concomitant
health problems. The services most commonly used were
hospitals, laboratory and diagnostic services and the
services of a family doctor and specialists. Most of these
services were received in English. Participants said that
they were generally dissatisfied with a health system that
was not primarily focused on patient needs, but based
on the specific interests of the facilities, in terms of both
French- and English-language services. However, they
were very satisfied with the services of the Centre de
santé Saint-Boniface, the only bilingual primary health
centre in St. Boniface.
Seniors reported that their priority was to have quick access
to quality services, close to home, offered by a competent,
trustworthy professional. This was more important than
the language in which the service was provided. Seniors
identified some challenges with respect to requesting
and receiving French-language services:
1. An ambiguous relationship with the French language,
in the sense that they had fought to preserve it and
loved it, but thought that they did not speak it well
or often enough. They would like French-language
services without having to know which ones are
available and without always having to ask for them;
2. The paradox of supply and demand, which highlights the
fact that making the supply of French-language services
more visible will result in increased demand, while the
current supply already fails to meet the demand.
Seniors reported that the main obstacles to accessing
French-language health services were staff shortages, the
lack of resources (rooms in residences), the lack of political
will to serve Francophones in their own language, the
lack of awareness of some Francophones who do not
ask for services in French, travel distances to access
French-language services and the lack of information on
French-language services. Certain factors could facilitate
access and use of services, including:
1. Modifying the service delivery infrastructure and
housing a larger number of professionals in a single
location, thereby increasing visibility and access;
2. Encouraging seniors or caregivers to acquire the
particular skills needed to access services (request, insist,
demand, persist, be patient, start over and be present);
3. Disseminate information regarding services
available in French;
4. Recruit and train more bilingual professionals.
A higher percentage of Francophone clients who are in long-term care use nine or more different drugs, which increases the risk of side effects.
4
Health and social services available in French and how to access themThe inventory indicates that there are about 106 public,
private for-profit, private non-profit and community
organizations that provide French-language services in
St. Boniface and St. Vital. A large number and a wide
variety of services are available, particularly in terms of
supportive and non-supportive housing, mental health
services, information and counselling services by telephone,
chiropractic care, physical training, dentistry and massage
therapy. There is a shortage of French-language primary
care services, particularly in terms of general practitioners,
laboratory and diagnostic services, pharmacy, audiology,
speech therapy, orthodontics, occupational therapy,
physiotherapy and optometry services in St. Boniface,
services for frail seniors such as meal and transportation
programs as well as foot care for seniors living in the
community and finally, support for caregivers such
as respite services or sharing and support groups.
Winnipeg Francophone seniors who participated in a
Manitoba study on the availability and accessibility of
French-language services in Manitoba said that they dealt
with professionals who could provide French-language
services at a higher rate than the general Francophone
population but reported having less access to medical
specialists, pharmacists, optometrists, speech pathologists
and audiologists.
Bilingual human resources in the Winnipeg RegionThe following table (see page 5) describes the current
human resource situation throughout the Winnipeg
Regional Health Authority (WRHA) and the two largest
health care facilities in St. Boniface and St. Vital.
i.e. the St. Boniface Hospital (St. B. Hospital) and
Actionmarguerite, a long-term care facility.
Managers indicate that French-language services are
visible through signage, service at the reception and
bilingual documents, but clients are not always sure to
receive services from a bilingual professional. Identifying
Francophone clients or professionals is difficult and
services are not always actively offered. The greatest
challenge in human resources is recruiting and retaining
bilingual professionals. Although new training programs
are offered locally in French, there are few bilingual
professionals, and designated facilities are competing to
hire them. Few recruitment and retention strategies that
focus specifically on bilingual professionals have been
reported. Valuing efforts are limited due to the lack of a
valuing strategy and financial resources. Although language
training seems to be available to all employees who wish
to enhance their skills, there is a lack of standardization,
attendance and follow-up after the training.
Without a high percentage of bilingual professionals, it is
difficult to match bilingual professionals with Francophone
clients in a largely English-speaking environment. This
is done informally in small facilities, but requires the
willingness and commitment of many stakeholders.
To facilitate access to French-language services by seniors
who do not necessarily know the services are available or
how to access them, a service referral process should be
developed. In addition, active offer should be promoted
and practiced more extensively.
Managers indicate that French-language services are visible through signage, service at the reception and bilingual documents, but clients are not always sure to receive services from a bilingual professional.
5
Summary of Emerging Priority Issues
Forecasts of future needs for Manitoba A study conducted by the Manitoba Centre on Aging
suggested that a modest increase in the use of long-term
care facilities in Manitoba by 2021 will be followed by
a larger increase as baby boomers reach 85 years of age
between 2031 and 2036. There is already a lack of sufficient
housing options for seniors, such as support for seniors
living in groups, supportive housing and long-term care
facilities. In addition, the new family structure provides
seniors with less family support than they had in the past.
Also, once admitted to long-term care facilities, seniors
require more care and their lifespan is reduced. The
authors suggest two options: 1) increase and specialize the
care provided in supportive housing, which would allow a
greater number of seniors to live there despite their more
complex health needs, and 2) increase the number of beds
or long-term care facilities. Although supportive housing
can be an alternative to long-term care facilities, the
study points out that this type of service can only meet
12–20% of needs and so the number of beds in long-term
care facilities will eventually have to be increased.
Organization # DesignatedBilingualPositions
% Designated Bilingual Positions Filled
% Health Professional Positions
% Support Staff Positions1
%Administrative andAdministrative Support Positions3
WRHA 524.08 59% 67% 15% 18%St. B. Hospital 98.00 14% 59% 0 41%
Actionmarguerite 397.78 67% 71% 20% 9%
1. Support staff includes kitchen, laundry and housekeeping services.
2. Administrative staff includes client admission and registration positions, ward clerks, administrative assistants and reception staff.
3. Management includes managers and department heads.
4. Home care services are transitioning to full-time positions so it is currently difficult to estimate the number of bilingual human resources. Direct service positions are not currently designated bilingual.
Bilingual human resources in the Winnipeg Region
6
Best practice in health services for seniorsThe most cited best practice focuses on integrated
health services, which coordinate care for patients with
multiple health problems and chronic diseases rather than
treating each disease separately. Each senior, assigned
to a case manager responsible for implementing and
monitoring the action plan, is received at a day centre
by a multidisciplinary team.
This service model reduces the use and cost of institutional
services, particularly for people with concomitant chronic
diseases and various disabilities and those living alone,
without increasing the overall cost of health care, reducing
the quality of care and increasing the burden on seniors
and their loved ones.
This model includes six components:
1. Inter-facility coordination;
2. A single gateway;
3. A case management system;
4. A single assessment tool and a needs
classification system;
5. Development of individualized service plans;
6. A continuous information system.
Common work tools are critical to integrating services.
They include:
1. A needs assessment form that integrates the senior’s
functional autonomy evaluation and information
on managing the necessary services and resources;
2. An individualized service plan, which is used to
establish an action plan with objectives and document
the extent to which they are reached;
3. Computerized clinical records accessible to
practitioners of the organizations involved to facilitate
information exchange.
In conclusionThis summary provides an overview of Francophone
seniors’ current situation. It identifies the needs of an
aging population, the achievements of the current health
care system and gaps in French-language health and
social services in St. Boniface and St. Vital. To improve the
provision of French-language services for seniors, a best
practice is proposed, which promotes Francophone clients’
ability to navigate in an integrated health services system.
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The most cited best practice focuses on integrated health services, which coordinate care for patients with multiple health problems and chronic diseases rather than treating each disease separately.