Typically--and I believe this is certainly true in Veterans Affairs and in provincial continuing care systems--there is usually a process by which someone who needs care would come to the attention of the health care system; that is, they themselves might call, or a physician or a family member might call. There would be a short screening to ask what the nature of the problem was, and if it appeared that the person did have a health care need, there typically would be a comprehensive assessment of the individual and also probably of the level of availability of family to support, and so on. That comprehensive assessment done by the assessor would provide a pretty good overview of the needs, circumstances, and environment of the individual. Based on that review and on discussions with the client and the family member, a care plan would be developed that would be matched to the kinds of needs that had been identified, so essentially it would be within the care plan that the determination would be made regarding appropriate types of services.
Certainly if professional services and nursing services and so on are required--and they are very important services--they would be part of the care plan, and those services would be provided. What we find is that often they also need these kinds of supportive services, and these services would also be part of the care plan.
Through this process one would determine what the needs are and develop a care plan. Then essentially the services would be authorized in some appropriate manner, whether by providing the services directly through the health staff in the health region or by purchasing them through third-party providers, and so on.