Veterans Affairs committee  There are quality of life scales that we've used in the past. There are strengths and weaknesses to each of them. But certainly if we look at the outcomes in studies, some of the things one typically looks at are the satisfaction people have with services—both the clients and the caregivers—and the quality of life of the individual.

Veterans Affairs committee  Thank you very much.

Veterans Affairs committee  I am happy to do that. Here are some of the key findings, which are similar to what we found in other studies. If you standardize the care need and you have a classification system that allows you to group people into similar categories of needs so that you can make apples-to-apples comparisons, it does seem to be less costly to provide care in the home.

Veterans Affairs committee  No. I think it's an important area and it's one that would in fact be good to study. I think that to do that more broadly you would want to be looking at making some connections between the primary care system and the continuing care system, really to see what options there might be for physicians to be encouraged to make these kinds of house calls or to work perhaps within the home care organization.

Veterans Affairs committee  Yes. I think it started in 2006.

Veterans Affairs committee  First of all, it was basically a study that was done in British Columbia, so it would have related to the British Columbia continuing care system at that time. These would have been dollars within the provincial ministry of health. Obviously, with federal transfers, some of that money would be federal as well.

Veterans Affairs committee  I think typically what would happen is that one would do studies on issues of relevance for future decision-making. They would be an input into policy formulation, so you may not be fully aware of a particular circumstance. If you do good targeted research, you can get relevant information about that, and depending on what that is, it may point out certain policy choices.

Veterans Affairs committee  Right.

Veterans Affairs committee  That is correct, and I think the difference was about $3,500 in the third year after the start of the study. There was really a natural experiment in British Columbia, where there was a policy of no longer providing housekeeping services to people who were at the lower level of care.

Veterans Affairs committee  It would have been very modest. I can't remember the exact number of hours, but typically for a low-level care needs person, they might get something in the order of four to six hours a month. That is, somebody may come in, perhaps twice a month, to provide some basic care and home maintenance.

Veterans Affairs committee  Yes, we're talking about the same thing.

Veterans Affairs committee  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.

Veterans Affairs committee  My first response is, in terms of the study we're undertaking, that what you point out is correct. We're not undertaking the study in Quebec. But I want to emphasize that we have not forgotten Quebec. If you look at the broader work that we're doing in the context of the health care review and if you look, for example, at the “Keeping the Promise” document and the work I've done myself over the last decade or so; in fact, the “Keeping the Promise” document relies heavily, in a lot of the service innovations that it talks about, both in the areas of screening and in some of the concepts around the single-entry model, on current cutting-edge practices in Quebec.

Veterans Affairs committee  Thank you. If I could just add something to what David was saying, in the research we're doing and in the work nationally and in this study and other studies, the issue of family members, particularly the spouse, who may remain either after the person dies or certainly if the person goes into a long-term care facility, is an important aspect and one that needs to be addressed perhaps more actively.

Veterans Affairs committee  We actually did a study a few years ago with the Royal Canadian Legion and the University of Alberta that looked at issues facing rural seniors. This study focused not necessarily on our clients but on a group of veterans as a whole. The research study involved surveys, analysis of Statistics Canada information, and also some community case studies.