We have provided below highlights of the AMA’s 2016 recommendations for the improvement of home and nursing-home care. Please reflect on these issues and indicate if you consider these to be fully or partially resolved, no longer relevant, or still unmet. In addition, please feel free to include other areas of concern. Responses will be compiled to inform our response to the Government’s request for feedback. 

To provide your feedback, you can download this form, enter your comments and attach the form in an email to president@albertadoctors.org by 9 a.m., February 16, 2021.

COORDINATED HOME CARE REGULATION

Issues identified:
•	Increasing complexity of Home Care patients
o	Home Care should provide for a range of services set out in regulation (e.g., homemaking, support services, etc.)

[Enter your answer here]

•	Staffing
o	Home Care should provide the level of support required for complex clients (i.e., provide for unexpected needs or visits after-hours) to allow them to remain at home with supports for a longer time
o	Add definition, scope and practice of case management

[Enter your answer here]

•	Recognize family caregivers
o	Formally recognize family caregiving support; identify and address family caregiver stress/burden.
o	Encompass respite care more explicitly
o	Include caregivers as partners in care; assess caregiver needs; assist with access to required supports; include in case management

[Enter your answer here]

•	Palliative care needs
o	The scope of Home Care should explicitly include palliative care

[Enter your answer here]

•	Integral linkages – Home Care and Primary Care
o	Align Home Care with the Medical Home model for chronic disease or palliative care, moving away from an acute care focus to providing more care in the community
o	Strengthen relationships between Home Care teams and PCNs/family physicians, recognizing that neither PCNs nor Home Care can take on this work without additional funding

[Enter your answer here]
•	Medical advisory oversight
o	Add physician advisory role to regulations
[Enter your answer here]

NURSING HOMES REGULATIONS

Issues identified:
•	Lack of regulation of Supportive Living (SL)
o	There are many more levels of care than there were at the time the Nursing Homes Act and regulations were enacted. SL settings now have to rely on the Nursing Homes regulations, not intended for SL, for some of what they do
o	More regulation is required beyond the domains of housing and accommodation
•	need to harmonize regulation overall (LTC/SL/Home Care)
•	health services and medical oversight, 
•	formularies, etc.
•	terminology

[Enter your answer here]

•	Staffing levels
o	Having only one RN per facility contributes to increased risks for hospital transfers
o	RNs in SL should have a clinical role and not purely an administrative function
o	Guidelines should exist to direct situations when an RN is not available to ensure safe situation management including transitions in care
o	Provide role clarity for unregulated and regulated staff – definitions, scopes of practice, reporting structures, skills, education and training, etc.

[Enter your answer here]

•	Address decision-making capacity
o	Need to define processes for surrogate decision-makers, next of kin or agents according to the Personal Directives Act (PDA) and the Adult Guardianship and Trusteeship Act (AGTA), etc.

[Enter your answer here]

•	Family caregivers
o	Address the role of family caregivers in nursing homes for caregiving and decision-making
o	Determine responsibility and processes for taking patients to off-site medical appointments

[Enter your answer here]

•	Drug formularies across the system
o	Identify formulary medications at points of transition to address safety, efficacy and cost implications for patients and families

[Enter your answer here]

•	Special or therapeutic diets
o	Ensure availability of special/therapeutic diets

[Enter your answer here]

•	Equipment
o	Address needs for ADL supports

[Enter your answer here]

•	Restraints and physician orders for secure settings
o	Ensure policies exist for use of restraints

[Enter your answer here]

•	Medical leadership structure
o	Advocate for more of a medical model, with more emphasis on medical leadership and medical oversight in regulations/legislation
o	Develop collaborative models for care, e.g., nurse practitioners
o	Address medical care provision:
•	Privileging
•	On-call responsibilities

[Enter your answer here]