RE: Canadian's perception of Medicare

[Joan Riches]

I think your ‘socialised medicine’ is organized on an insurance model while ours in Alberta, is on a service model. Our supervision is within our facility or service. The only people I may have to justify my service to are my immediate superior (who may not be an OT) and perhaps a clinical specialist (OT). Our statistical reporting is for tracking and planning not for payment in the micro sense. Overall budgets are impacted by what we demonstrate we do, of course. In the long term care setting where I do relief we have general referrals for everyone so the residents can walk or wheel into the department or stop us in the hall if they need us. Family can call or visit. Other staff can consult or give us a specific referral. Everyone is entitled to service based on our scope of practice. We just keep track of who we see and for what. We also serve the acute population in our rural hospital. Most of the referrals are to assess and treat. Sometimes physicials will ask for a specific assessment for discharge planning. In my other relief setting, Home Care in a regional health authority, we use a prime provider/case management model. The profession who is likely to see the client most is case coordinator and we consult and refer to each other within the team. I may have a referral for a cognitive assessment from a nurse who is seeing someone with high nursing needs, for instance. I may refer to a nurse for a medication review for a client of mine who is going through the lifestyle and environmental changes to deal with a progressive chronic condition. The same is true for PT and social work. Speech, dietician and physician are consult or referral only, no case coordination. We use a standardized functional assessment and risk of institutionalization screen. Based on these we can order support services for about 80% of our clients on our own authority based on service packages. We refer to other professionals based on our own judgment. For those who fall outside the parameters either more or less we consult with our manager for individualized care plans. All is not ideal, of course, because our case loads are based on geographic areas, whoever shows up, which can get pretty hairy. People only get the service we can manage to give.              Service models vary across the country, province to province and region to region within a province so I speak only from my individual experience.. Joan Riches 1109 4th St SE High River, AB T1V 1J2 403 652 7928 FAX 403 652 7970