Veterans Affairs Committee on June 7th, 2012

[Ben Lobb, Conservative, Huron—Bruce, ON]

So you're speaking specifically from the May report—

[Ray Kokkonen]

I'm speaking more to the previous recommendations that were made.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's what I mean. This came from last year, the previous Parliament's recommendations.

[Ray Kokkonen]

Yes.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay. Good. So we're on the same page with what we're talking about.

[Ray Kokkonen]

I threw in the other 18, because after reading them, we decided they were pretty good recommendations.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Fair enough. It's just that, the way it read, I wanted to make sure we were clear on that.

Of those, have you had the chance or the time to prioritize those or put them in some semblance or fashion that the department may be able to take them on in bite-size chunks? Or have you had that opportunity yet?

[Ray Kokkonen]

In the previous incarnation of the stakeholders committee, the Veterans Affairs Canada advisory committee, there was an attempt to put priorities on those various recommendations, but it did not go through. It was decided that they're all equally important and must all be implemented. There was a lot of discussion. It would have been a decision in principle, if we had set a priority on some of them.

So the collective decision was no prioritization.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's fair enough.

To Ms. Murray, I appreciate your presentation. I'm just wondering, when we look at case management, obviously there have been some changes at Veterans Affairs in regard to, I guess, empowering case managers to make some proactive decisions that will create some great outcomes for veterans of all ages.

What else do you see coming down the pipeline in the future that will provide case managers even better opportunities for better outcomes?

[Nancy Murray]

Well, currently what is promoted are the assessment tools—the electronic tools that give you scores or outputs that are indicators of where the client is in terms of risk, need, and possible care issues. That could be a possibility.

Also, common electronic records that can be shared would be another helpful opportunity for Veterans Affairs, if they don't have them. It's very helpful if someone in one region or another can share records. That type of thing is very helpful.

Also very helpful are teams that think in the same way and work in an interdisciplinary fashion with common client-focused and client-centric goals.

So some of the five themes that you have outlined in your transformation initiatives really speak to the value of case managers, of face-to-face assessment, and of looking at supporting the clients from their point of view and within their context.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

Mr. Kokkonen, you've presented your paper here and have obviously had time to observe the pillars of transformation. You've seen this take shape over time as far as transformation goes.

Of everything you have seen in the past, maybe, of what you see in the present, and of what has already been laid out for future opportunities in regard to transformation, if you were going to critique it or provide more input to Veterans Affairs, what would you like to see? Is there anything? I know that you've mentioned long-term health, but beyond that, is there anything else you would like to see in this report that would be helpful to Veterans Affairs?

[Ray Kokkonen]

I think the addressing of the shortcomings and the flaws in the new Veterans Charter is an absolute. That has to be done. They talk about “sustaining the new Veterans Charter”. Now, I'm not exactly sure how that fits in with correcting the flaws, but if you're asking for a sort of priority statement on this, that would be it on my part.

[The Chair, Conservative, Greg Kerr]

Thank you very much for that.

Now we'll go to Mr. Storseth for five minutes, please.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

Thank you very much, honourable Chairman.

Thank you very much to the witnesses. I'd like to thank you for coming.

Once again, it's always good to talk to you and your organization, Mr. Kokkonen. I think you guys have some very valuable input for this transformation initiative study that we have going on.

Ms. Murray, I'd like to talk to you—and perhaps to Ms. Park as well—about where you see the future of case management going. It's a broad question, but it's one that I'll narrow down in a minute.

[Joan Park]

It's the future—it's what's required for the health care system across Canada as we all age, as we all live with chronic illness, and as we survive catastrophic injuries. That is not a health care situation that is solved in a period of time or an episode of time. So all of us, moving forward.... My screen saver sometimes says, “Not everybody needs case management, but they need their care managed”. More and more of the population will need case management because of mental illness coming on board, as well as physical illness.

I was at the Health Council of Canada on Monday for the announcement of their progress report on health care. I said that they should interview front-line case managers, because they would hear about where the system is a problem and where the health care provider is a problem.

Dr. Kitts, who chaired that report, said that he had just come back from the U.S., where they spend a lot of money on trying to find solutions for their system. He asked Massachusetts General and Brigham Young what they had done and what they had spent the most money on that was bringing in the most value for the future, and their answer was case management.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

That's excellent.

So can you explain to me, then, your vision of what the role would be for somebody who is not yet a veteran, but who is in the process of transferring out of the Department of National Defence and the Canadian Forces into the role of a veteran? What would you see the ideal role of the case manager being in that situation? Also, how many case managers should the individual have in such a situation?

[Joan Park]

I was talking to somebody in this room earlier about having too many case managers.

Case management starts with an assessment. It's a very holistic assessment of what that individual client's needs, wants, and even dreams are for living a fruitful and productive life. It's based on that critical assessment, which is different from a nursing assessment versus an OT assessment. It's an all-inclusive assessment of their health and social needs. I think that's where case management's strength lies, in pulling together the health care and the social service needs of an individual client.

How many case managers does somebody need? It does become problematic to have one, two, or three leading the parade. Sometimes I don't think that's the problem. It is a problem that the client and the case managers have, but it's a problem created by the system, not to help identify who is going to be the collaborative leader. You need a collaborative leader in that case.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

So it is possible that it could be overwhelming for somebody transferring into the role of a new veteran to have two, maybe even three case managers, plus a SISIP adviser, plus an adviser on some of his health matters, plus an adviser on his pension, to sit down with them all.

[Joan Park]

Case management is about coordinating care. That's exactly what you're talking about, so that is the expertise of a case manager, to coordinate that care. It's going to take those roles of heavy communication, heavy collaboration, navigation, and advocating the systems and the other individuals on the team.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

You might not be able to answer this, but what would a reasonable timeframe be for somebody dealing with all this, working with a case manager, to work through the processes?

[Joan Park]

In lots of cases you're not talking about an episode of care that has a start and a stop; you are talking about—I don't want to use the word continuum—a journey, for sure. I think, like any journey—that's what Nancy's referred to—there are times for intensive case management, and there are times when things are going along okay, but you're always on the ready for the next intensive period.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

With the plethora of these systemic case managers that can occur, is it beneficial to have one key point person they know they can go to if there is a situation?

[Joan Park]

Absolutely.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

Thank you for your time.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

That's the end of round one. We appreciate that.

We're only going to have time for two, and we're going to have to jam them in. Ms. Morin, we're going to have four minutes for you, please.