Improving St. Boniface and St. Vital Seniors’ Access to French-Language Health Services Summary of Emerging Priority Issues

Danielle de MoissacMarch 2013

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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.

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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.

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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.

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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.

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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

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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.