I think that broadening the eligibility criteria would be the thing to focus on. But if you do that, there would be more people coming into the system. Now, most of these people would be coming in at very low levels of contact with the system.
When you have time to read the report more slowly—not speed-reading it—you'll know we're advocating a single point of entry to the system. In many cases, a first screening would lead to referral to an early intervention specialist. This is for someone who doesn't really have heavy care needs but who could probably benefit from health promotion interventions. The interventions themselves would most likely be delivered not by Veterans Affairs Canada personnel but by programs that are already existing in communities. You still need some training of Veterans Affairs Canada personnel within the health promotion area in order to capture people in that area.
So I think the first thing I'd say is about eligibility. You should go to a needs-based system right away. That does require some in-house training of the what we call the early intervention specialist, the care coordinator, and the high-needs-care manager. They don't need training, but they need organization.
In terms of the costs, we were actually asked to make our recommendations without having cost considerations explicitly in mind. In the sense that if you're going to recommend A you have to take away B in order to remain cost-neutral, explicit cost projections were not part of our job. That's something we'd turn over to the department to struggle with.
However, let me say what would probably happen if our recommendations were fully implemented. There would be some modest increases in cost, but because, as has been pointed out earlier, the older veterans are dying off at a few thousand a month, these costs will curve down. So initially there are higher program costs, but it's like a bubble: they're going to pass through the system as the traditional veterans die. That is also the reason we'd like to see the thing implemented as quickly as possible, so we can get benefits to them before they die. But we do see it as an up-and-then-down phenomenon.
We also think that the health promotion aspects of our program should actually lead to enhanced life expectancy. We do know that most health care costs of older people are actually incurred, you might say, in the dying process, in the two or three months before death. But the older you are when that period of terminal decline occurs, the lower the costs that are incurred. So there are further savings. By keeping people living healthier into their older years, you will also have savings.
I can't put a number on it, but I would anticipate a rise and then a fairly quick and stready drop-off, as the clients die.