3.0 Findings – Relevance

3.1 Profile of Clients Accessing Preferred Admission Beds

Analysis of a file review conducted on Veterans in preferred admission beds indicates that 211 Veterans accessed beds between June 2016 (when the initiative began) and June 1, 2018. The average age of Veterans in preferred admission beds is 86.3 years old (85.6 for men, 91.7 for women) with an age range from 51-102. This is mainly due to a higher percentage of CAF Veterans in preferred admission beds (63%) who are typically younger than war service Veterans (the average age of CAF Veterans receiving long-term care is 82 versus 94 for war service Veterans). For the entirety of the Program, the average age of Veterans in long-term care is approximately 91.

In line with VAC’s overall client demographics, Veterans accessing preferred admission beds are predominantly male (187 or 89% men vs. 24 or 11% women). See Table 4 for gender and service type breakdown.

Source: Audit and Evaluation Division file review analysis of data provided VAC Statistics Directorate.

As identified previously, there are 29 eligibility criteria through which Veterans can access the Program. The file review indicates Veterans have accessed preferred admission beds through 15 of these eligibility streams, however, the vast majority of Veterans (87%) entered the long-term care under the following criteria (see Table 5).

Source: Audit and Evaluation Division file review analysis of data provided by VAC Statistics Directorate.

CAF Veterans account for 98% of those who received preferred admission eligibility under VAC’s frail policy. Income qualified recipients are exclusively Allied Veterans (8 Korean War Allied Veterans and 12 World War II Allied Veterans).

3.2 Continued Need for the Program

VAC contributes to Veterans’ long-term care to ensure their physical, mental, and social needs are being met. The preferred admission beds initiative has allowed expedited access for Veterans at facilities such as Camp Hill Veterans Memorial Building or Sunnybrook Health Sciences Centre which were formerly reserved for World War II and Korean Veterans (100% of the beds in these facilities were contract beds). In addition, preferred admission beds provide Veterans with an alternative to community beds which are often fully occupied and have long waitlists. At locations where there are waitlists, wait times vary from weeks to several years.

Facilities offering preferred admission beds provide Veterans with access to enhanced programming. This enhanced programming stems from the arrangements for contract beds. The evaluation team visited five of the 10 facilities where VAC has agreements for preferred admission beds and observed enhanced programming such as music therapy, woodworking, and horticultural therapy. The team observed that these facilities incorporate a Veteran-friendly approach towards commemoration by providing an atmosphere that incorporates Veterans’ art, memorial walls, enhanced remembrance ceremonies, and interaction with current Canadian Armed Forces personnel.

The introduction of preferred admission beds allows a new group of Veterans to receive long-term care services in facilities with other Veterans that have similar shared experiences. Interviews indicate that co-locating Veterans fills a social need and that community is an important aspect of well-being. A Veteran’s cultural and social environment is included in VAC’s seven interdependent domains of well-being ^{Footnote 12}.

There are growing waitlists for preferred admission beds at facilities such as Camp Hill Veterans Memorial Building ^{Footnote 13}, Sunnybrook Health Sciences Centre, and the Perley and Rideau Veterans’ Health Centre. Interviews with VAC staff and officials at these facilities suggest that there is a growing demand for preferred admission beds that cannot be met under the current bed allocation. As stated in section 1.4 Preferred Admission Beds Initiative, Table 2, multiple facilities sought and received an increase in their preferred admission bed allocation.

Officials at the Perley and Rideau Veterans’ Health Centre indicated that the wait time for a preferred admission bed has grown to between 2 and 2.5 years (58 Veterans on the waitlist as of June 2018). Camp Hill Veterans Memorial Building had a waitlist of approximately 23-30 Veterans who have been deemed eligible for preferred admission beds.^{Footnote 14} At the same time, the facility has unused contract beds (see Appendix C).

VAC does not have a consistent approach for monitoring preferred admission bed waitlists. In some instances VAC controls and monitors the waitlist, while in other instances the waitlists are controlled by the provincial health authorities. This limits the Department’s ability to accurately gauge demand for preferred admission beds across the country and respond to inquiries from Veterans or their families.

Though preferred admission beds appear to be fulfilling a need in the areas they are located, the distribution of beds across the country is uneven, limited to former VAC hospitals located in select urban centres. There are three provinces (Newfoundland and Labrador, Prince Edward Island, and Manitoba) where no formal agreements are in place for preferred admission beds. In addition, Veterans in several large urban centres, such as Vancouver and Montreal, do not have access to preferred admission beds in their community. Negotiations continue in some of these locations for preferred admission beds (e.g., Vancouver). While Veterans always have the option of moving, long-term care facility staff indicated that it is rare that a Veteran will leave his or her province for the purposes of receiving long-term care (though in some cases Veterans will make the move to be closer to family members).

3.3 Alignment with government Priorities

The evaluation finds that the use of preferred admission beds appears to align with the government of Canada’s priorities as outlined in the 2015 Speech from the Throne which states that “…the government will do more to help them [Veterans] and their families”. Budget 2016 also reiterated the government’s commitment to Veterans, saying “Our veterans have dedicated their lives to the defence of their country. They deserve our gratitude, our respect and our support. We made a solemn promise that they will have it. And we will keep that promise.” In addition, a series of announcements were made related to the establishment of preferred admission beds by the then Minister of Veterans Affairs. The Minister stated the Department was “…changing the rules and regulations around this process, as we identified them as being too stringent and too inflexible, to have more veterans get beds in various locations”.^{Footnote 15} The preferred admission beds initiative has allowed expedited access to long-term care beds in former Veteran’s hospitals for a new cohort of Veterans, in line with the government’s pledge to do more to help and support Veterans.

3.4 Alignment with Federal Roles and Responsibilities

VAC’s mandate to deliver the Program is derived from s. 4 (a) (1) of the Department of Veterans Affairs Act which assigns the Minister of Veterans Affairs the powers, duties, and functions to provide for:

"…the care, treatment or re-establishment in civil life of any person who served in the Canadian Forces or merchant navy or in the naval, army or air forces or merchant navies of Her Majesty, of any person who has otherwise engaged in pursuits relating to war, and of any other person designated by the Governor in Council…"

VAC’s responsibility to deliver the Program is further cemented in Sections II, III, and IV of the VHCRs, which outline program eligibility, financial support, and appeal rights.

During World War I, the federal government began constructing a series of hospitals for the care of ill and injured Veterans returning from overseas. The care of military matters was considered a federal responsibility under s.91 of the Constitution Act, 1867. Over time, the Department has devolved its responsibility to provide direct care for Veterans to the provinces as the provinces assumed a greater role in providing Canadians health care (VAC has transferred ownership of all federal Veteran hospitals to the provinces). Although VAC no longer provides direct long-term care to Veterans, the evaluation finds that the Department continues to meet its responsibility through its financial contribution towards the cost of the Program.

While the evaluation finds that VAC has a mandate to deliver the Program, it is not clear whether authorities extend to the provision of preferred admission beds to those who do not otherwise have access to a contract bed. Current governing authorities (e.g., acts and regulations) do not reference preferred admission beds. Legal advice is currently being sought to determine what authority changes, if any, are required.