Veterans Affairs committee  We define health care broadly to include various aspects of a client's well-being. Health care is defined generally, consistent with good models of care for the elderly. It focuses more broadly on a person's capacity to function in a home and in the community, and not narrowly on what might have been considered, traditionally, medical-type health care concerns.

Veterans Affairs committee  Maybe I'll ask Marcus if he would be kind enough just to give a very high level of what some of the themes are in the preliminary or early findings, to help to support the work of the committee.

Veterans Affairs committee  One thing that had been briefly discussed earlier was that we do have an expert who is a member of our Gerontological Advisory Council, Norah Keating, who has done a study that we financed and worked on with the University of Alberta and the Royal Canadian Legion. The committee may want to hear about that study in more detail, and we'd be delighted to share that information with you so that you can look at the results of this work and discuss how it could better inform veteran care.

Veterans Affairs committee  I'll answer that question with a few points. I think the “Keeping the Promise” document gave us a good template, and while it can't be done immediately, some of the key points included making a single integrated health care program. That can't be done overnight, but it can be done probably in a relatively quick period of time if the decisions are made to support that.

Veterans Affairs committee  I don't have a direct answer to that question either. There are different ways that we use medical professionals. Medical professionals may be involved in pension medical exams, which is one way we may work with physicians. Another would be that we do have medical advisers involved in our care delivery teams who work with the veterans independence program at our district offices.

Veterans Affairs committee  I agree that we should continue to focus on this issue. It's a challenge, and I think you've made a good point by underlining it as something we should continue to focus on. I appreciate that focus. In terms of how risk is defined, I think that's more or less what I was saying.

Veterans Affairs committee  I talked earlier about the concept of comprehensiveness. That means you need a range of options to address the wide range of needs that veterans present with. Where veterans require higher-intensity care that could involve health care and more professional care, we want to make sure that's available to them.

Veterans Affairs committee  Unfortunately I don't have the direct answer to that question. I can get it for you. I don't work on the data in day-to-day program delivery. I know a large number of clients came on, over the last few years, with the extension of services to primary caregivers, but I'm not exactly sure what the breakdown of new clients would be.

Veterans Affairs committee  Again, I don't have that kind of detailed information. However, caseload is complicated. It wouldn't simply be the number of cases divided by the number of case managers. It would be based on the number of clients who we think require different levels of intensity of service. The kinds of clients who would require the most intensive service would be ones who have high health care needs.

Veterans Affairs committee  I don't have the direct answer to your question.

Veterans Affairs committee  The data collection started a year and half ago. Marcus, is that correct?

Veterans Affairs committee  The data collection started in 2006.

Veterans Affairs committee  I agree with Marcus' comments. In a nutshell, the goals of the study were really twofold. One was to take a really sophisticated look at the veterans independence program, one that hadn't been taken to date, in order to assist us with formulating our policy, especially in the context of the veterans health services review, which is a very serious undertaking.

Veterans Affairs committee  Actually, a small-scale evaluation was done during the first two phases, but it wasn't as thorough an evaluation as we thought was necessary. Part of the interest in doing a more sophisticated study came in part from the Gerontological Advisory Council, because they felt that not only was it important for Veterans Affairs, but it was also very helpful information that might have a greater impact outside Veterans Affairs in the broader health care community.

Veterans Affairs committee  We've collected different levels of evidence over time. Currently, though, the evidence is being used in the context of the health care review. The OSV program is part of the bigger picture of the health care review. The kind of evidence that we're generating would be to enter different kinds of questions, such as whether the VIP program should be more comprehensive than it is now.