Peace Health Advisory Council (HAC)

Thursday, November 27, 2014 5:00 p.m. to 8:00 p.m.

Grande Prairie Provincial Building Grande Prairie, AB

MINUTES

Council Members: Ms. Lucille Partington (Chair), Ms. Donna Buchinski, Ms. Judy Brown, Ms. Theresa Sandul Alberta Health Services: Ms. Sandra Herritt, Ms. Marie Johnson, Ms. Janet Kaplan, Dr. Karen Lundgard, Mr. Douglas Norton, Dr. Jim Pope, Ms.

Susan Smith, Ms. Sara Warr, Mr. Terri Woytkiw Public: Mr. Bill Given, Mr. Kevin O’Toole, Mr. Dan Pearcy, Mr. Isak Skjaveland, Ms. Cheryl Stetsko-Mayne, Ms. Katherine

Stevenson, Mr. Rory Tarant

Regrets: Ms. Violet Dettling, Ms. Evelyn Bzowy, Ms. Connie Hansen, Ms. Leona Hanson, Ms. Michelle Margarit, Mr. Michael Ouellette (Vice Chair), Ms. Yvonne Rempel, Ms. Cheryl Van Eerden

Agenda Item Discussion Action

Welcome and Introductions

Council Quorum As per the Health Advisory Council Bylaw, Article 9, Section 9.4:

“A quorum shall consist of 50 percent plus one (1) of the members then in office. A resolution may be passed, or action taken on any matter, only where a duly consisted meeting has been called and a quorum is present at the time the resolution is put forward. In the event that a quorum is not present, the meeting may proceed; however, any action or resolution shall be deferred to the next meeting where a quorum is present.”

Chair, Ms. Partington noted that council quorum was not established. Council has agreed to continue with an informal meeting.

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1. Review of Agenda As the required quorum was not achieved at this meeting, the agenda could not be approved (see Bylaw Article 9, Section 9.4). The agenda was reviewed, moving item 5.1, the Advisory Council Officer (ACO) report, to item 5.4 to allow for guest comments first.

2. Review of Previous Minutes As the required quorum was not achieved at this meeting, the minutes from the previous meeting could not be approved (see Bylaw Article 9, Section 9.4).

Minutes from the September 17, 2014 meeting to be presented for approval at the next council meeting on January 14, 2015 when quorum is achieved.

3. Presentations

3.1. 3.1 Grande Prairie Chamber Health Action Committee – Mr. Dan Pearcy, CEO Grande Prairie and District Chamber of Commerce

3.2 Northern Obstetrical Review presentation – Ms. Sandra Herritt, AHS Senior Operating Officer – Acute Care, Allied and Seniors’ Health, North Zone

Mr. Pearcy provided an overview of the Grande Prairie Chamber of Commerce Health Action Committee, including the history of the group and some of its successes, including work with U of A to increase the number of medical school spaces in the province.

Question and response: Council and public members passed along concerns that Alberta universities/programs should give Alberta students priority. Mr. Pearcy mentioned encouraging schools to consider pressures on the healthcare system regarding rural and remote communities, when creating programming and accepting students. Dr. Pope questioned the process of how medical education programs are funded, and policies for how students are chosen. Ms. Herritt spoke about the Northern Obstetrical Review and services currently available in the north, including delivery stats for area communities in 2014, staffing, epidural services, c-section, patient preference and how it’s determined where those specific services are offered. She also mentioned the Healthy Beginnings Program and other community supports offered to new moms and babies.

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3.3 Seniors and Continuing Care –

Ms. Robyn Maddox – AHS

Question and response: Ms. Sandul asked for clarification about how patient preference is factored in for rural/remote patients.

Ms. Herritt confirmed that patients who know beforehand that they would like to have an epidural, would need to make prior arrangements to give birth in a community where those services are offered. She mentioned that staff and physicians need to be able to use those skills often to feel confident in their abilities.

Ms. Sandul summarized that AHS may not always be the reason why a service not being offered in smaller communities.

Ms. Herritt spoke about prenatal and primary care services also offered for moms who don’t have regular physicians. She mentioned increasing demands, young demographics, high risk pregnancies, and related long term planning for services. She also mentioned the popularity of midwifery services in areas where that is offered.

Ms. Partington asked why are c-sections are getting more popular.

Ms. Herritt mentioned that some c-sections are required if baby can’t be delivered safely, while some are determined beforehand for medical reasons, and others are performed as a patient’s personal choice if there were issues with previous deliveries.

Ms. Sandul mentioned that midwifery does seem popular but that the service isn’t available everywhere.

Ms. Herritt spoke about the possibility of additional midwifery services in the future.

The panel spoke about various seniors and continuing care concerns raised at previous meetings.

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Executive Director, Seniors’ Health, North Zone; Ms. Janet Kaplan - Manager - Continuing Care Access; Ms. Terri Woytkiw - Clinical Support Lead; Ms. Marie Johnson – Director Patient Care - ED, OR and Seniors, Grande Prairie Area

Ms. Marie Johnson spoke about the supportive living placement process. She mentioned that homecare is contacted first and a referral is made for assessment, which is then forwarded to placement office. The assessment is discussed with the client/family, along with the appropriate options in their community. Clients/families identify their top three choices of facilities. If those choices are appropriate and in the family’s community of choice, the client will get priority there. There is one wait list in the Peace area, based on the date a client is approved, and a breakdown based on community. Wait times are difficult to predict because they dependent on beds becoming vacant.

Question and response: Ms. Partington asked about planning among physicians and families for future placement.

Ms. Johnson mentioned that physicians and staff sometimes present proactive options to patients/families, and the responses can vary.

Ms. Robyn Maddox mentioned that the continuing care access team can help patients/families navigate the system. Ms. Janet Kaplan spoke further about the continuing care access line, which is staffed by RNs, with local homecare offices following up with callers to get services in place and discuss options. Referrals can be made to other community resources as well. Ms. Terri Woytkiw spoke about advanced care planning and the green sleeve initiative. She spoke about the differences between a personal directive and goals of care designation. She mentioned that the green sleeve program also includes other documentation.

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Question and response: Ms. Partington asked where the green sleeve should be kept.

Ms. Woytkiw mentioned that EMS staff typically look for documentation near a patient’s fridge. She went on to mention that planning can vary throughout life and includes considering your wishes, and goal of the care you’re receiving at that time. These topics should be discussed with your physician and put down on paper. It should be changed if there are significant changes in your life or living situation.

Ms. Sandul mentioned she found it complicated to fill out, and asked if the documents could be made available at physicians’ offices.

Ms. Woytkiw responded that materials are provided to Primary Care Networks to distribute to physicians.

Dr. Karen Lundgard spoke about difficulty in getting materials to her office.

Ms. Woytkiw said they would work with physicians to help provide materials and asked what may work better.

Dr. Lundgard suggested an electronic copy to print out, but that different physicians may have different preferences.

Ms. Woytkiw mentioned the documents can be found on the Conversations Matter website, and that AHS is working through PCNs to connect with physicians. Ms. Kaplan mentioned that the office of public guardian also has information about personal directives and how to create one.

Ms. Maddox spoke about a grant bid period open now for supportive living initiatives, where companies/groups can

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connect with Alberta Seniors to put together applications. AHS can help provide information through Alberta Seniors if needed.

Ms. Partington asked about the grant funding available.

Ms. Maddox replied that the grants can amount to up to 50% of the capital funding.

Ms. Partington mentioned that the community of Clairmont may be interested in a project and applying for a grant.

4. Old Business

4.1. 4.1 Business arising from the previous meeting’s minutes

1. Ms. Warr to follow up with Ms. Sue Cumming on Peace area specific Health Link stats. Complete - North Zone stats and community breakdown attached with meeting packages. 2. Ms. Warr to reach out to North Zone Seniors Health Director for information on LTC Oral Health and pilot project. Complete - Spoke with Oral Health Team Lead with AHS, who mentioned that the pilot project is taking part in a few LTC sites through the province, including the Hythe Continuing Care Centre. It involves training frontline nursing staff on different techniques to help residents with proper oral hygiene. Training is now finished and staff are using what they learned. 3. Ms. Warr to contact Ms. Sandra Herritt/Ms. Kate Butler for more information on the Northern Obstetrical Review. Complete - Sandra Herritt presentation complete. 4. Ms. Warr to continue emailing new doctor news releases to council members. Complete 5. Ms. Warr to look into getting EMS presence at future

meeting to address member questions. Outstanding –

Executive Director with EMS Operations in the North Zone

to follow up with specific HAC members with concerns.

Ms. Warr to coordinate EMS presence at future meeting.

1. Ms. Warr to look into getting EMS presence at future meeting to address member questions.

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6. Ms. Warr to inquire about single bed standards for new

facilities. Complete – New AHS Infection Prevention and

Control guidelines developed in 2013 recommend single

inpatient rooms with their own washroom.

7. Ms. Warr to send members information on non-urgent

patient transfer EMS and non-ambulance transport service

(NAT). Complete – Information sent to members with

meeting package.

8. Ms. Warr to look into having a North Zone Seniors

Health presence at future meeting to address recurring

council concerns. Complete - Presentation by Ms.

Maddox, Ms. Kaplan Ms. Woytkiw and Ms. Johnson

complete.

9. Ms. Warr to include future meeting dates, locations,

and website info on posters. Outstanding – to be

completed once new meeting schedule for 2015 is

decided.

2. Ms. Warr to include future meeting dates, locations, and website info on posters.

5. N New Business

5.1. 5.1 Physician Recruitment report, Ms. Susan Smith, Physician Resource Planner, North Zone

Ms. Smith provided a report about physician recruitment efforts in the council area, including the following highlights:

Beaverlodge – one vacancy, one physician hopeful.

Hythe – one vacancy, one physician hopeful.

Fairview – two vacancies, one hopeful, one incoming physician.

Fox Creek – two vacancies.

Grande Cache – three new physicians over the summer.

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Grande Prairie – nine family physician vacancies, four incoming, four hopefuls, six new physicians since the spring. One anesthesiology vacancy, one hopeful. One geriatrician vacancy. One internal medicine hopeful (2015). One OB/Gyn vacancy, one hopeful. One pediatrics vacancy, two hopefuls. One child/youth psychiatry vacancy, one incoming, one new in July. One general surgeon incoming (2015). Four new surgical assistants since the spring.

Manning – one vacancy with two long-term regular locum physicians providing coverage.

McLennan – one vacancy, one hopeful.

Peace River – three vacancies for physicians with special skills, two hopefuls, one incoming.

Sexsmith – one vacancy

Valleyview – one vacancy, one new physician since the spring.

So far in 2014, 33 family physicians and 7 specialists have been recruited to the North Zone. Questions and Comments from Council:

Dr. Lundgard noted the need for physicians in Peace River. Ms. Partington mentioned success from the South Peace Physician Attraction and Retention Committee (SPPARC) website. Ms. Smith said AHS has been in touch with the SPPARC group and the physician to determine next steps. Mr. Kevin O’Toole asked about potential concerns about filling physician and staff requirements for the new Grande Prairie Regional Hospital (GPRH). Ms. Smith mentioned that physicians are spreading the news amongst colleagues in the province and elsewhere, and excitement is

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building about the new hospital. She mentioned that the majority of new physicians in the north zone come after hearing positive feedback about the zone from other physicians. She noted that there is a physician shortage nationwide. Dr. Pope mentioned that the financial health of the province helps determine how many surgeons moving here. He noted that adequate support staff and patient numbers are also needed to keep a physician’s skills sharp and those factors also play a role in where physicians choose to practice. Mr. O’Toole mentioned hearing that applicants were slow to come in when the South Health Campus first opened. Ms. Smith noted that word is getting out now about the new GPRH, and excitement is building among potential new recruits.

5.2. 5.2 North Zone update, Ms. Marie Johnson, Grande Prairie Area

Ms. Johnson provided the North Zone update. Highlights of the report included:

GPRH – construction continues. Operational planning, including workforce planning, will begin soon, along with service planning for the QEII.

The QEII Hospital experienced some overcapacity in the fall. A grand opening was held for 24 new supportive living spaces.

The Grande Prairie Primary Care Network (PCN) After-Hours Clinic saw more than 7900 patients between April and October, with an average wait time of 37 minutes.

Alberta Health Living Supervised Exercise programming is now being offered in Grimshaw/Berwyn, in conjunction with the local PCN.

The long-term care facility in Hythe is participating

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in an oral health pilot project.

Eight week Well Child Clinics have been coordinated with physicians in Peace River, reducing duplications of services.

An AHS Aboriginal Health Liaison partnered with National Native Alcohol and Drug Abuse Program (NNADAP) to promote National Aboriginal Awareness Week in Sturgeon Lake.

The Grande Prairie PCN has a new Executive Director. The Peace River PCN is planning to expand mental health services for the area.

Question and response: Ms. Cheryl Stetsko-Mayne asked about plans to promote walking at the new GPRH, and the potential for walking areas in and around hospital to encourage activity amongst staff and patients.

Ms. Johnson mentioned work being done by the City of Grande Prairie to expand the park and trail system around the hospital site. Mayor Bill Given mentioned that the city plans to work with AHS, Alberta Infrastructure and Alberta Health to connect with trails on the hospital site.

Ms. Stetsko-Mayne inquired about walking options inside the facility.

Ms. Johnson explained that the hospital would be divided into front and back sections, with transporting of patients and staff occurring in the back, while the front would be for the general public. She mentioned that the facility will be half a kilometer in length, providing plenty of walking opportunities.

5.3. 5.3 Guest Comments Mayor Given mentioned that the City of Grande Prairie was happy to be invited to the HAC meeting and he enjoyed hearing the information that was shared. He

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mentioned that the City is also looking at mental health services in community and offered help to the HAC in advocating for the community’s healthcare needs, at a provincial level. Ms. Stetsko-Mayne mentioned that Alberta Cancer Prevention is looking to hear from communities and get residents to take ownership of their health in a proactive way. She said it was nice to see collaboration between municipalities and AHS as well as other health and wellness related groups. Ms. Smith mentioned that AHS is grateful for help from communities in helping to recruit physicians. Mr. Isak Skjaveland mentioned that it was good to be at the meeting to hear some good information. Ms. Partington thanked Mr. Skjaveland for coming and for his support of healthcare services in Sexsmith. Ms. Stetsko-Mayne mentioned Thrive on Wellness, and the Town of Sexsmith’s support for the project, which included the installation of outdoor fitness equipment in Sexsmith, with support from the Town and County of Grande Prairie. Mr. O’Toole thanked the HAC for the meeting invite, and information shared, adding that some of it was overwhelming. He spoke about his role as Chair of the local Combative Sports Commission, and the group’s difficulty in getting physicians to support the community in this way. He mentioned that the group uses physicians from other communities for various events. He also spoke about physicians in other communities encouraging physicians to practice in Grande Prairie and area. He mentioned that the City would help where they could as well. Mr. Rory Tarant thanked the HAC for the meeting invite. He mentioned that he learned a lot, and that he has heard from residents that the physician shortage is a big

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concern. He said it was good to hear about recruitment work underway. Dr. Pope asked about how the HAC interfaces with government.

Ms. Partington mentioned that the HAC chairs meet with the Health Minister or Deputy Health Minister several times a year, which has increased recently. She spoke about potential plans for a new AHS board, or something similar to gather public/stakeholder input. She mentioned the Rural Health Care Review work being led by MLA, Dr. Richard Starke. Ms. Partington mentioned talk by the Health Minister about more flexibility for local decision making. She spoke about local concerns related to capital project cost overruns and delays, saying that Alberta Infrastructure planning could have been better. She also noted that the HAC is not a board, but rather volunteer community members.

Ms. Stetsko-Mayne asked about the need for a new board when HACs exist to share feedback between communities and AHS.

Ms. Partington noted that the HAC members are not accountable to AHS and that members are not paid. Ms. Sandul mentioned that many of the HAC volunteers are too busy to take on such a large role with no compensation. Ms. Judy Brown mentioned that HACs were meant to be a liaison between communities and AHS, and not intended to solve problems, but rather increase awareness and exchange information.

Dr. Pope inquired about being added to the invite list for future Peace HAC meetings. He mentioned promotion of meetings could be clearer, with better access. He spoke

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about seniors’ care being an AHS priority, with hopes to open additional spaces in MacKenzie Place. He mentioned the quality of local palliative care. Dr. Pope spoke about the issue of seniors care patients taking up acute care medical care beds, and efforts being made to address the issue.

Ms. Johnson mentioned that several acute care beds are occupied by patients with approved supportive living placements, but often all the supportive living spaces are full.

Mayor Given asked about the need for more private supportive living facilities, and who would decide if a facility is built.

Ms. Johnson mentioned that AHS funds the care provided in designated spaces in private facilities, while the partner organization (ie: Points West, Chantelle Management, Good Samaratin, etc.) builds the facility. She mentioned that the AHS Executive Director with Seniors Health for the North Zone would have more insight into the process. Ms. Stetsko-Mayne asked if more community based seniors programming is also needed.

Dr .Pope mentioned that there is a need for seniors day programs. He also spoke about gaps in the social service network for those with mental health and addictions issues. He mentioned that funding stretches only so far. Ms. Partington expressed concern about the level of services and funding that northern Alberta receives, despite providing resources and driving the economy, which benefits everyone. Ms. Stetsko-Mayne asked how shadow populations can support communities and social programs if they don’t contribute tax dollars to the municipality.

Mayor Given mentioned that shadow populations

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are a difficult issue. He suggested the possibility of a progressive income tax or other solutions to ensure services are funded according to their actual usage. He mentioned that shadow populations have a detrimental effect on services like healthcare. He encouraged residents to lobby the provincial government for more consistent funding that is not based on resource revenue alone.

Ms. Partington mentioned that the federal government doesn’t fully appreciate the different circumstances faced by northern Albertans, and have hurt the situation through changes to the Temporary Foreign Worker program, which affects some caregivers and other staff. Mayor Given added that hiring temporary foreign workers is a good way to build staffing levels and encourage staff to move, stay, and seek permanent residency. Mr. Norton expressed appreciation for the emphasis that the HAC and community put’s on mental health and addictions issues. He mentioned that work is being done to improve services and he is glad that these services are important to the community. He spoke about fewer mental health bed numbers in the north, when compared to urban areas, and how this is not reflective of the population in those areas. He mentioned that housing for those with mental health issues is also an issue that AHS is connecting with the City of Grande Prairie on. Ms. Stetsko-Mayne expressed appreciation for the work done by HACs.

Ms. Partington mentioned that HACs are being asked to do more since the AHS board was dissolved. She mentioned that the Official Administrator and Health Minister had expressed interest in traveling to the region, and that she would pass along the specifics once they were

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available.

5.4. 5.4 Advisory Council Officer (ACO) update, Ms. Sara Warr, Peace ACO

Ms. Warr provided the ACO report with the following highlights:

No updates on the new reporting structure for HACs/PACs.

The Council of Chairs met on September 19, which included an update on Continuing Care waitlists.

The Alberta Clinical Pathways committee has requested that an HAC Chair participate in their committee.

The province-wide Advisory Council meeting was held in early November in Edmonton. Feedback is encouraged.

Ms. Warr mentioned documents included in HAC members’ full-meeting packages. She also spoke about the Beyond the Headlines link on the AHS website, which provides more background to health related stories appearing in the media.

5.5. 5.5 Council Roundtable/ Workplan Discussion

Ms. Sandul mentioned a lack of consistency, and that it seems as if the government has distanced itself from the HACs. She said that a new AHS board is needed and a firm commitment from the board to the HACs. Ms. Buchinski spoke about frustration both before and after the AHS board. She said she was impressed at how the board shared information with the provincial government, but felt there were too many members to be effective. Ms. Partington spoke about the possibility of a new AHS board, but suggested one wouldn’t be formed before the summer of 2015. She mentioned the need for a northern/remote representative on a new board, aboriginal representation, HAC presence, and a physician.

6. Date of Next Meeting

Date: Wednesday, January 14, 2015 Time: 5:00 p.m. to 8:00 p.m.

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Location: Grande Prairie Public Health Unit - Telehealth

7. Meeting Evaluation and Adjournment

Meeting adjourned at 8:20 p.m.