2014 Health Care Professional Conference...

healthprofessionalconference.com

10th Annual

Health Care Professional Conference

September 12, 2014 | Vancouver, B.C.

CBI Health Group is a values-based, results-oriented and collaborative group of companies that is focused on providing improved access and better health outcomes to clients and communities across Canada.

better health begins here.

PART OF THE CBI HEALTH GROUP

www.cbi.ca

CAREPOINT

HEALTHCENTRE

* Note: Only attendees who have given their consent are on the list.

Health Care Professional Conference 3

10th Annual Health Care Professional Conference Attendee List*

First name Last name Organization Address CityBrenda Adams Brenda Adams 200–321 Festubert Street DuncanMike Allegretto CBI Workplace

Solutions605 Discovery Street Victoria

Stephen Allen GWL 2nd Floor, 8700–200th Street

Langley

Manouch Amel Mountainview Kinesiology Ltd

1025 Robin Way Anmore

Nikki Anderson Drake Medox Health Solutions

13817 103rd Avenue Surrey

Kristan Ash CBI HealthJennifer Beck Progressive Rehab 401–3999 Henning Drive VancouverColleen Bell WorkSafeBC 157–3031 Williams Road RichmondDave Bernard Back In Motion Physio

and Active Rehab#201–3975 North Road Burnaby

Deepak Bhasin Centric/Lifemark Health

19073–68A Avenue Surrey

Nick Blackman MPA Society 122 Powell Street VancouverGerald Blomme Gerald Cyril Blomme

Psychology Services Professional Corp.

Box 2961 Prince George

Jeff Boniface Boniface |Consulting Occupational Therapy Services

2915 Panorama Drive North Vancouver

David Bruce Vocational Consulting Group

109–2059 Kaltasin Road Sooke

John Buchanan BC Public Service Agency

700–235 1st Avenue Kamloops

Pardeep Chatha Asha Counselling Services

#202–15388 24 Avenue Surrey

Ralph Cheesman Back in Motion Functional Assessments

Suite 110–6651 Elmbridge Way

Richmond

Health Care Professional Conference4

First name Last name Organization Address CityMinda Chittenden Meridian Rehabilitation 3007 28th Avenue VernonHazel Choy Back in Motion #140, 6651 Elmbridge

WayRichmond

Leanna Cousins RCMP 1208- 14200 Green Timbers Way

Surrey

Gordon Davidson 250-542-0660 114 3105 31 Street VernonPeter De Marchi Back in Motion 206–5500 152 Street SurreySuki Dhaliwal RCMP 6699 194st Street SurreyKimberley Dimayuga Progressive Rehab-

Orionhealth401-3999 Henning Drive Burnaby

Robert Douglas Private Hollyoaks #20 Haven Gardens, Crawley Down

West Sussex

Tricia Earl CBI Health Group 716 Rivers Edge Drive Nanoose BayDeb Edwards We Care Health

Services#1108–7330–137th Street Surrey

Philip Fahrni White Rock Orthopaedic & Sports Physio Clinic

#80–1959 152nd Street South Surrey

Roisin Flinn OT Consulting/Treatment Services Ltd.

210–3438 Lougheed Highway

Vancouver

Britney Foster Bayshore Home Health 1843 West Broadway VancouverNaomi Goffman Community Therapists 401–8750 Selkirk Street VancouverAlaina Guymer Burnaby Hospital

- Workplace Health3935 Kincaid Street Burnaby

Tamara Guzman Recabarren

Orion Health 210–555 Sixth Street New Westminster

Dr. Denise Hall Dragonfly Psychology Services

#215 1118 Homer Street Vancouver

Kris Hallenburg Back in Motion 1040 Parker Street #1 White RockMary Hamilton Able OT Consulting 185 Cambridge Road TrailSven Hartman VISTA Disability

Management#223–119 W. Pender Street

Vancouver

Paul Hatch 15081 86A Avenue SurreyKen Hemphill Back in Motion Rehab 300–5450 152 Street SurreyRobin Henery ATF Canada 150–625 Agnes Street New

WestminsterCarly Higgon

(Duggleby)Back in Motion Functional Assessments Inc.

6651 Elmbridge Way Richmond


First name Last name Organization Address CityBrenda Hogan Back in Motion 140–6651 Elmbridge

WayRichmond

Tracie Holland BIM 206–5500 152nd Street SurreySilvia Hua Drake Medox Health

Solutions13817 103rd Avenue Surrey

Cyrus Huang LifeMark Centric Health

230–181 Keefer Place Vancouver

Natalie Hull Progressive Rehab — OrionHealth

1518 33rd Ave East Vancouver

Janet Hunt Progressive Rehab OrionHealth

401–3999 Henning Drive Burnaby

Jeffrey Hwang Century Chiropractic Clinic

204–2786 W. 16th Avenue

Vancouver

Iveta Janickova Treloar Physiotherapy Clinic

595 West 8th Avenue Vancouver

Barry Judge Back in Motion Physio and Active Rehab

#201–3975 North Road Burnaby

Alan Kaplan Orion Health 16555 Fraser Highway SurreyChristy Keillor Kinsmen Lodge 9650 137A Street SurreyMonica Khosla Great West Life 900–1075 West Georgia VancouverDarren Kimura OT Consulting/

Treatment Services Ltd.210–3438 Lougheed Highway

Vancouver

Sarina Kot Dr. Sarina Kot Reg Psych Inc.

262–2025 W. 42nd Ave Vancouver

Cary Kruger Kruger Neuro-Rehabilitation Inc.

204–2365 Gordon Drive Kelowna

Sannie Lau WorkSafeBC 6951 Westminster Highway

Richmond

Danuta Lipien Drake Medox Health Solutions


Jennifer Llewellyn MPA Society 122 Powell Street VancouverJohn Loh Dr. John Loh

Chiropractic Corp.201–3377 Coast Meridian Road

Port Coquitlam

Rob Low Drake Medox Health Solutions



First name Last name Organization Address CityBill Lyons LifeMark

Physiotherapy — Centric Health

209–12080 Nordel Way Surrey

Margaret Mallam RCMP Health Services 14200 Green Timbers Way

Surrey

Yenna Mansfield Community Therapists Unit 201–3997 Henning Drive

Burnaby

David Maxwell CBI Health VictoriaKerry Maxwell Burrard Physiotherapy #702–1190 Hornby Street VancouverMary Anne McLennan OrionHealth 201–3150 East 54th

AvenueVancouver

Marisol McRae Centre for Compassionate Change Inc

10458 Glenmoor Place Surrey

Larissa Mead-Wescott

North Shore Neurpsychology

#212–545 Clyde Avenue West Vancouver

Damaris Medina Community Therapists 14881 103A Avenue SurreyAnita Melin Open Door

Communications415 Baker Street, Suite B

Nelson

Hafeez Mian Psychotherapy & Counseling Clinic

17246 Fourth Avenue Surrey

Dr. Lawrence Miller Dr. Lawrence Miller, Professional Psychology Corporation

405–3551 Foster Avenue Vancouver

Anthony Milonas CBI HealthDev Mitra Drake Medox Health

Solutions164 Oriole Road Kamloops

Derek Monkman Fraser Valley Physiotherapist & Rehabilitation Centre

#2, 9145 Corbould Street Chilliwack

David Morosan Mountain Counselling & Mediation

34334 Forrest Terrace Abbotsford

Vanja Mudrinic LifeMark Health 230–181 Keefer Place VancouverMary Jo Mulgrew Focus Rehabilitation

and Consulting Inc.#305–1890 Cooper Road Kelowna

Michelle Noel Progressive Rehab — OrionHealth

#401–3999 Henning Drive

Burnaby

Colleen North Progressive Rehab, OrionHealth

3999 Henning Drive Burnaby


First name Last name Organization Address CityKhalil Nourani Direct Solutions

Counselling301–545 Clyde Avenue West Vancouver

Sarah Nowosad Bayshore Home Health 1845 West Broadway VancouverTess O'Brien Dr. Tess O'Brien 3665 Kingsway, Suite

300Vancouver

Sacha Oddstad CP Rail 1670 Lougheed Hwy Port CoquitlamHugh O'Loughlin OT Consulting/

Treatment Services Ltd.210–3438 Lougheed Highway

Vancouver

Chiara Papile OrionHealth 201–3150 E. 54th Ave VancouverPatti Parker RCMP 14200 Green Timbers

WaySurrey

Jaclyn Penner OT Works! 1517 London St New Westminster

Tania Percy Progressive Rehab OrionHealth

#401–3999 Henning Drive

Burnaby

Julie Plummer WorkSafeBC PO Box 5350 Stn Terminal

Vancouver

Audrey Pons WorkSafeBC POBox 4700 Stn Terminal

Vancouver

Paula Portnoi 181 Keefer Place, Suite 228

Vancouver

Steve Powell ATF Canada 625 Agnes Street, Suite 150

New Westminster

Lorne Prupas 501–3292 Production Way

Burnaby

John Pullyblank The M. Jackson Group Inc.

210 Sixth Street New Westminster

Colleen Quee-Newell Vocational Pacific Ltd. 309–2901 West Broadway

Vancouver

Abdollah Rezazadeh AR OT Rehab P.O. Box 18119 Port MoodyDebra Richards Richards and Company 98 Easthom Road GabriolaDustin Robin Victoria Sports

Physiotherapy108–1669 victoria st Prince George

Joan Russell LifeMark Health Kelowna

104–1634 Harvey Avenue Kelowna

Pamela Russell OT Works! 1517 London Street New Westminster

Nirmal Sahota OrionHealth 15855 89A Avenue Surrey


First name Last name Organization Address CityDebbie Samsom Back in Motion Rehab

Inc.#110–6651 Elmbridge Way

Richmond

Patricia Samuhel Treloar Physiotherapy Clinic

595 West 8th Avenue Vancouver

Keith Saunders Dr. Keith Saunders #2300–2850 Shaughnessy Street

Port Coquitlam

Andrea Score Fraser Health 6052 165A Street SurreyJohn Sherwood Classic LifeCare /

Connect1550–1200 W 73rd Avenue

Vancouver

Cathy Skain PT Health Squamish Physio and Wellness Centre

38247 Cleveland Avenue, PO Box 1970

Squamish

Angela Spooner Lifemark Health #230–181 Keefer Place VancouverWalter Stasiuk BC Ferries 500–1400 Blanshard

StreetVictoria

Andrew Sumner Great-West Life #900–1075 West Georgia Street

Vancouver

Nicole Swisher Fraser Health 709–260 Sherbrooke Street

New Westminster

Diane Tam WorkSafeBC 6951 Westminster Highway

Richmond

Gillian Tews CBI Health Group — Surrey

202–7350 King George Boulevard

Surrey

Niraj Thakore WorkSafeBC 6951 Westminister Highway

Richmond

Cindy Thompson Maples Counselling Inc.

147 Butler Avenue Parksville

Aurora To RCMP #1208–14200 Green Timbers Way

Surrey

Rebecca Tunnacliffe PABC 402–1755 West Broadway

Vancouver

Etienne Venter HeadWise Rehabilitation

Suite 210–7525 King George Blvd

Surrey

Hendre Viljoen HeadWise Rehabilitation

4555 Mountain Highway North Vancouver

Jaye Wald Back in Motion Rehab 201–3975 North Road BurnabyPatrice Weibelzahl Northwest Change

Agents24168 63 Avenue Langley


First name Last name Organization Address CityWarren Weir LifeMark Health 230–181 Keefer Place VancouverTheresa Weltzin OrionHealth #120 16555 Fraser

HighwaySurrey

Charlene Wharton OT Consulting/Treatment Services Ltd.

210–3438 Lougheed Highway

Vancouver

Joesphine Wong VCH-Richmond Hospital

7000 Westminster Highway

Richmond

Yuk Shuen Wong Dr. Wong & Associates Professional Psychology Corporation

337–2184 West Broadway

Vancouver

Matthew Wright-Smith Healthx Physical Therapy

1906 West 43rd Avenue Vancouver

Tanya Yardley CBI HealthSharon Yen Golden Ears

Physiotherapy202-20395 Lougheed Highway

Maple Ridge


10th Annual Health Care Professional Conference Agenda — September 12

Time Topic Presenter(s)7:45–8:30 am Registration and breakfast

8:30–8:35 am Introduction by emcee Dr. Brian Worth Psychologist, Health Care Services, WorkSafeBC

8:35–8:45 am Opening remarks Andrew Montgomerie Director of Financial Services and Health Care Programs, WorkSafeBC

8:45–9:45 am Demographic Effects: What demographic changes on a global and local basis mean for healthcare professionals

Terry Bogyo Independent researcher, speaker, and consultant

9:45–10:45 am Taking Action to Improve Psychological Health and Safety in the Workplace

Dr. Merv Gilbert Adjunct Professor, Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University

10:45–11:15 am Refreshment break/visit exhibitor booths

11:15 am–12 pm Breakout Session 1a

What About the Neck?: Identification and management of potential cervical contribution to concussion symptoms

Carol Kennedy Physiotherapist

Breakout Session 1b

Psychologically and Occupationally Responsive Treatment (PORT)

Dr. Merv Gilbert Adjunct Professor, Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University

12–1 pm Lunch/visit exhibitor booths


Time Topic Presenter(s)12:20–1 pm Physiotherapy Agreement Q&A

Panel Informal Session (Optional)Gabi Jacobson Program Manager, Health Care Services, WorkSafeBC

Karen Takai Quality Assurance Supervisor, Health Care Services, WorkSafeBC

Jamie MacGregor Physiotherapist and Certified Hand Therapist PABC/WorkSafeBC Liaison

1–1:15 pm Sponsor afternoon introduction and draw

1:15–2 pm Breakout Session 2a

Mobile Apps for Quantifying Recovery: Current state and emerging opportunities

Dr. Kendall Ho Professor in Emergency Medicine, University of British Columbia

Breakout Session 2b

Life of a Claim — How Law and Policy Affects the Decision- Making Process in the Mental Health Claims Unit

WorkSafeBC Claims Panel: Scott Brent and Mental Health Claims Unit team

2–3 pm The Do’s and Don’ts of Engaging a Family Physician in a Return-to-Work Plan

Dr. Gurdeep Parhar Executive Associate Dean, Clinical Affairs, Faculty of Medicine, University of British Columbia

3–3:30 pm Refreshment break/visit exhibitor booths

3:30–4 pm Empowering Workers to Empower Themselves

Jessica Vliegenthart Paralympic injured worker

4–4:15 pm Closing and prize draws by emcee Dr. Brian Worth Psychologist, Health Care Services, WorkSafeBC


Exhibitor Floor Plan

25

24

23

22

21

2019

18 13

1417

16 15

Coffee/tea station

Coffee/tea station

8 7

69

10 5

4

1 2 3

1112

Booth Company

18 Clinicmaster

20 Edgewood

21, 22, and 23

WorkSafeBC

24 Quart Healthcare West

25Essential Medical Products

Booth Company

1 Connect

2Columbia Speech and Language Services Inc.

3 OT Works!

4 Community Therapists

5Angel Accessibility Solutions Ltd.

6 Chairlines

7Canadian Magnetic Imaging Inc.

8Centric Health (LifeMark)

9 Bayshore Home Health

10Canada Diagnostic Centres

11LifeLabs Medical Laboratory Services

12 and 19

CBI Health Centres/ We Care Home Health

13 CAOT-BC

14Advanced Health Care Products

15Back in Motion Rehab Inc.

16BC Medequip Home Health Care Ltd.

17 OrionHealth Services

http://www.clinicmaster.com

http://www.edgewood.ca

http://www.worksafebc.com

http://www.quarthealthcare.com

http://essentialmedicalproducts.com

http://www.connectcommunities.ca

http://www.columbiaspeech.com

http://www.ot-works.com

http://www.communitytherapists.com

http://www.angelsolutions.com

http://www.chairlines.com

http://www.canmagnetic.com

http://www.centrichealth.ca

http://www.bayshore.ca

http://www.canadadiagnostic.com

http://www.lifelabs.com

http://www.cbi.ca/web/cbi-health-group

http://www.caot-bc.blogspot.ca

http://www.advancedhealthcare.ca/en/

http://www.backinmotion.com

http://www.bcmedequip.com

https://www.orionhealth.net


Speakers Disclosure statements

All presenters participating in these programs are expected to disclose to the program audiences any real or apparent conflict of interest related to the content of their presentation.

Guest Speaker The following information discloses my relationship with WorkSafeBC (Workers’ Compensation Board), and/or other corporate sponsors that might relate in some way to the presentation of my subject at this conference

Terry Bogyo Nothing additional to biography

Dr. Merv Gilbert Nothing additional to biography

Dr. Kendall Ho In discussion with Telus re: possible study in the future.

Used Blipcare equipment in a research study and paid them for their equipment. They have no interest with research design. This is purely a purchase.

Carol Kennedy Nothing additional to biography

Andrew Montgomerie Nothing additional to biography

Dr. Gurdeep Parhar Nothing additional to biography

Jessica Vliegenthart Nothing additional to biography


Terry Bogyo

Terry is an independent researcher, speaker, and consultant who focuses on workers’ compensation and occupational safety and health.

Over his 30 year career at WorkSafeBC, he held a variety of positions including: executive assistant to the Chairman of the Board, director of Policy and Research, Vocational Rehabilitation, and Community Relations. He is a student of workers’ compensation systems and is frequently engaged in comparative performance analysis of workers’ compensation systems around the globe.

Terry’s academic interests include advanced studies in Occupational and Environmental Health, Health Care and Epidemiology, and Philosophy. He’s a Registered Rehabilitation Professional (RRP) and a Canadian Certified Rehabilitation Counselor (CCRC). He’s co-chaired the Research and Standards Committee for the International Association of Industrial Accident Boards and Commissions (IAIABC) and worked closely with the Association of Workers’ Compensation Boards of Canada (AWCBC) on emerging issues.

Terry also technically reviews papers on workers’ compensation issues and teaches online courses. He’s an avid writer and speaker, and conducts workshops on issues facing workers’ compensation systems and on future risks facing workplaces and society at events around the world.

Plenary session: Demographic Effects: What demographic changes on a global and local basis mean for healthcare professionals

The world is experiencing dramatic shifts in its population characteristics that are fundamentally changing our economies, labour force, and communities as never before. These “demographic effects” have profound implications for our society, healthcare system, and families. This plenary presentation connects demographic change and the impacts already reverberating through our professions and communities.

Learning objectives:

• Understanding a range of demographic changes and techniques

• Interpret demographic data on healthcare professions

• Identify the personal implications of changes in longevity

• Use demographic data to inform personal and family decisions

• Gain new perspectives on the pressures driving healthcare policy and practice

Health Care Professional Conference Vancouver Hyatt Regency– September 12, 2014

Terrance J. BogyoIndependent Researcher | Speaker | Consultant

Introduction: Who is this presenter? Terrance (Terry) J. Bogyo (BSc, MBA, CCRC, RRP) I n d epen d en t Researc h er | Speaker | C o n su l tan t 1665 58 A Street Delta, BC V4L 1X5 e-mail: [email protected] Blog: www.WorkersCompPerspectives.wordpress.com Phone: (604) 943-3545 Skype: terry.bogyo

Outline Demographic Effects: What we mean by demographics How workforce and population demographics are changing What demographic change means to you and me, our

families, our communities– and healthcare professionals in particular


Demographic Effects: What demographic changes on a global and local basis mean for

healthcare professionals Learning objectives: The world is experiencing dramatic shifts in its population

characteristics that are fundamentally changing our economies, labour force, and communities as never before. These “demographic effects” have profound implications for our society, healthcare system and families. This plenary presentation connects demographic change and the impacts already reverberating through our professions and communities. The Learning Objectives for this session include:

· Understanding a range of demographic changes and techniques · Interpret demographic data on healthcare professions · Identify the personal implications of changes in longevity · Use demographic data to inform personal and family decisions · Gain new perspectives on the pressures driving healthcare policy and practice.

Demographics dem·o·graph·ics (dĕm'ə-grăf'ĭks) noun

shortened term for ‘population characteristics’ including race, age, income, educational attainment, home ownership, employment status, location ...

Common “Demographic” terms WASP YUPPIE OINK(Y) DINK(Y) SNAG WOOF(P) PIPPIE

White, anglo-saxon, protestant Young, urban, professional One income, no kids (yet) Double income, no kids (yet) Sensitive, new-age guy Well off, older folk (person) Person inheriting parents property


Common “Demographic” terms WASP YUPPIE OINK(Y) DINK(Y) SNAG WOOF(P) PIPPIE

White, anglo-saxon, protestant Young, urban, professional One income, no kids (yet) Double income, no kids (yet) Sensitive, new-age guy Well off, older folk (person) Person inheriting parents property

Top 10 Countries by Population

8http://sasweb.ssd.census.gov/idb/ranks.htmlViewed August 31, 2014

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

1,600,000,000 201420242034

Top 10 Countries by Population

9http://sasweb.ssd.census.gov/idb/ranks.htmlViewed August 31, 2014

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

1,600,000,000 201420242034


Average Employment Income by Age Group & Education Level

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

20 to24

25 to29

30 to34

35 to39

40 to44

45 to49

50 to54

55 to59

60 to64

Less than high schoolHigh schoolTradesCollegeUniversity

Source: Statistics Canada, 2006 Census of Population.Note: data is 2005 dollars

Physician Demographics Number of physicians by specialty and age, Canada, 2010

Specialty < 35 35 - 44 45 - 54 55 - 64 65 + Age

unknown Total BC Family Physicians/General Practice 3,129 8,377 10,840 10,184 5,925 1436 39,891 5,974

Geriatric Medicine 19 57 83 76 19 11 265 48

Occupational Medicine 0 9 7 21 17 2 56 7

Source: extracted from https://www.cma.ca/Assets/assets-library/document/en/advocacy/01-physicians-by-Specialty-Province-2014-e.pdf as viewed August 31, 2014

Percentage Growth in the Supply of Regulated Nurses, Canada, 2003–2013

12

SourceHealth Workforce Database, CIHI, 2014.


Nurse Demographics

Canadian Nurses Association, 2010 Workforce Profile of Registered Nurses in Canada (November 2012)http://cna-aiic.ca/~/media/cna/page-content/pdf-en/2010_rn_snapshot_e.pdf Viewed Aug 13 2014.

287,344 registered nurses (RNs), including nurse practitioners (NPs),

93.4% (268,512) were employed in nursing; 1.8% (5,169) were employed outside of nursing; 2.7% (7,787) were not employed; and 2.0% (5,879) did not state their employment status. The ratio of RNs employed in nursing to the Canadian

population in 2010 was one RN for every 127 persons.

RN Demographics - Sex Men represented 6.4% (17,163)

of RNs employed in nursing in 2010,

Women represented 93.6% of RNs (251,349) employed in nursing in 2010.

RN Demographics - Age The average age of an RN

employed in nursing in 2010 was 45.4 years

In BC, the average age of an RN is 46.2

0 1,000 2,000 3,000 4,000 5,000

70+

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

<30

RN Workforce, by Age Group 2013 for B.C.


RN Demographics- Responsibilities

Canadian Nurses Association, 2010 Workforce Profile of Nurse Practitioners in Canada (November 2012)http://cna-aiic.ca/~/media/cna/page-content/pdf-en/2010_np_profiles_e.pdf Viewed Aug 13 2014.

16.6%

10.4%

3.7% 4.7%

0%2%4%6%8%

10%12%14%16%18%

2008 2009 2010 2011 2012

Perc

entag

e Gr

owth

Physiotherapists Health Care Labour Force Total Labour Force Population

17

Percentage Growth of Supply of Physiotherapists, Labour Force and Overall Population, Canada, 2008 to 2012

Since 2008, the supply of registered physiotherapists has grown by over 16%, more than four times the growth rate of the Canadian labour force.

Source: Modified from CIHI, Physiotherapist Workforce, 2012 highlights current trends in physiotherapist practice across a variety of demographic, education, mobility and employment characteristics as accessed August 31, 2014

Top 20 Health Occupations BC 2011 – Count, density, predominance of Females

Regulated Nurses 41,406 892

Physicians (Excluding Residents) 10,246 221

Paramedics 7,277 157

Dental Assistants§ 6,748 145

Pharmacists 4,361 94

Dental Hygienists 3,406 73

Dentists 3,118 67

Physiotherapists 2,931 63

Social Workers§ 2,914 63

Medical Radiation Technologists§ 1,955 42

Occupational Therapists 1,817 39Dietitians 1,175 25Psychologists 1,123 24Chiropractors 1,122 24Opticians 1,049 23Speech–Language Pathologists§ 1,011 22Respiratory Therapists§ 880 19Optometrists 606 13

Health Information Management Professionals** 512 11Audiologists§ 250 5

Source: adapted from CICHI, Canada's Health Care Providers: Provincial Profiles 2012, as accessed August 21, 2014

Count CountPer 100K

Per 100K

Greater than 60% FemalesLess than 40% Females40-60% Females


Let’s get personal On the top of the page write

The year you were born Your age on your birthday this year The age you expect to retire What do you think your life expectancy was at birth? If you were 65 today, how many more years do you think you might

live? Do you plan to work after you reach retirement age? If so, why?

Health expenditures by Governments increase with age…

Source: Extracted from CIHI, Table E 1.14 Estimate of Total Provincial/Territorial Government Health Expenditures by Age and Sex, National Health Expenditure Trends, 1975 to 2013 as accessed at https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2400 on Sept 2, 2014

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

<1 1-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

-89

90+

FemaleMale


New study ranks Alzheimer’s as third-leading cause of death, after heart disease and cancer Washington Post By Tara Bahrampour, Published:

March 5

Contribution of Alzheimer disease to mortality in the United States

Bryan D. James, PhD, Sue E. Leurgans, PhD, Liesi E. Hebert, ScD, Paul A. Scherr, PhD, ScD, Kristine Yaffe, MD and David A. Bennett, MD

Published online before print March 5, 2014, doi: 10.1212/WNL.0000000000000240

Neurology 10.1212/WNL.0000000000000240 Alzheimers

New study ranks Alzheimer’s as third-leading cause of death, after heart disease and cancer Washington Post By Tara Bahrampour, Published:

March 5, 2014

Contribution of Alzheimer disease to mortality in the United States

Bryan D. James, PhD, Sue E. Leurgans, PhD, Liesi E. Hebert, ScD, Paul A. Scherr, PhD, ScD, Kristine Yaffe, MD and David A. Bennett, MD

Published online before print March 5, 2014, doi: 10.1212/WNL.0000000000000240

Neurology 10.1212/WNL.0000000000000240

Alzheimer's

Alzheimer's


Headlines Health care worker shortage looms as staff retire Nova Scotia's health Minister, Leo Glavine, warned in briefing notes The Canadian Press Posted: Jan 02, 2014 7:25 AM AT Last Updated: Jan 02, 2014 10:51 AM AT

Nova Scotia's new health minister is being warned the province could face "alarming" shortages across a range of professions in the health-care system as workers approach retirement, which includes a shortage of 800 nurses within five years.

"Professions requiring close monitoring include physicians, registered nurses, licensed practical nurses, continuing care assistants and lab and diagnostic imaging staff to name a few."

Headlines Global health workforce shortage to reach 12.9 million in coming decades WHO News Release NOVEMBER 2013 | RECIFE, BRAZIL -

The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. A WHO report released today warns that the findings – if not addressed now – will have serious implications for the health of billions of people across all regions of the world.

Demand elsewhere GETHealth Summit- Leveraging ICTs to Close the Health Workforce Gap 14 August 14

The world is currently facing a global health worker shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. There are fifty-seven countries worldwide which are suffering from a severe shortage of health workers; of these, thirty-six are in Africa.


High Demand Occupations Healthcare occupations top the list in Canada Inspectors in public and

environmental health and occupational health and safety

Nursing co-coordinators and supervisors

Registered nurses and registered psychiatric nurses

Specialty physicians General practitioners and family

physicians Dietitians and nutritionists Audiologists and speech-language

pathologists

Physiotherapists Occupational therapists Respiratory therapists, clinical

perfusionists and cardiopulmonary technologists

Medical radiation technologists Medical sonographers Licensed practical nurses Paramedical occupations Psychologists

Headlines Crisis and Intervention Lessons From the Financial Meltdown and Recession Conference Board of Canada January 2011

Lesson 1: Sound Fiscal Policy Is Key to Keeping the Economy Afloat in Hard Times

Lesson 6: “Too Big to Fail” Means Too Big

Lesson 2: Recession Only Delayed the Inevitable Workplace Shortages

Lesson 7: Integrative Trade Can Pull Us Down and Up

Lesson 3: The Financial Sector is Unique and Needs New Standards

Lesson 8: Local Governments Can’t Provide the Solution

Lesson 4: Public Sector Financial Institutions Prove Their Worth

Lesson 9: Psychology Matters to How a Recession Unfolds

Lesson 5: Global Coordination Was Critical to a Speedy Recovery

Lesson 10: The Fiscal Bills Will Eventually Have to Be Paid

Unemployment Rates rose but remained low for high-demand occupations (percent)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Management Contractors & supervisors in trade &transport

Natural applied sciences & relatedoccupations

Health, nurse supervisor, registerednurses

Art, culture, recreation & sport

2006200720082009

Source: Statistic Canada as quoted in Crisis and Intervention: Lessons from the Financial Meltdown and Recession,Conference Board of Canada 2010, page 52 Chart 7


Headlines… Starting in April 2023, the age of eligibility for the Old Age Security

(OAS) pension and the Guaranteed Income Supplement (GIS) will gradually increase from 65 to 67. This change will affect people born in 1958 and later.

Canada Pension Plan changes provide incentives to work longer:

Age 60 Age 65 Age 70 Prior to 2011 $900-(30% of 900) = $630 $900 $900+(30% of 900) = $1170 $900-(36% of 900) = $576 $900 $900+(42% of 900) = $1278

(by 2016) (by 2013)

Headlines… BC announces end to Mandatory Retirement (Feb 13, 2007) Ontario moves to end mandatory retirement

Mandatory retirement already eliminated in US, Australia, New Zealand

Tony Blair proposes raising the retirement age to 70 for high-income earners

“White-collar professionals [should] retire later then lower-paid workers because they have more cash and a longer life expectancy.” Adair Turner, head of the UK Pensions Commission

German experts fuel debate about retirement at 70 By VERENA SCHMITT-ROSCHMANN (AP) August 11, 2010 BERLIN

Germans are famous for being hard workers — but retirement at 70? That's the prescription of two think tanks, which say years more toil are inevitable due to stubbornly low birthrates and the ballooning costs of the cradle-to-grave welfare system in a country that already has decided to bump up the retirement age from 65 to 67.

32

“Sweden considers raising retirement age to 75” Published 27 February 2013

http://www.euractiv.com/health/sweden-prime-minister-considers-news-518068

Swedes should be prepared to work until they are 75 and to change careers in the middle of their work life if they are to keep the welfare standards they expect, Swedish Prime Minister Fredrik Reinfeldt said.

Reinfeldt, who leads a centre-right government, also said half of today's children in Sweden can expect to become 100 years old and there has to be a change in the way the Swedes view their work life.

33


So, What’s Happening With Life Expectancy?

0 5 10 15 20 25 30 35 40 45 50

Prehistoric timesAncient Greece

Medieval EnglandRenaissance England

Canada 18311841185118611871188118911901

Life Expectancy at Birth

Source: attributed to The Urban Futures Institute as published in “Planning for Retirement, Canadian Bankers Association.

So, What’s Happening With Life Expectancy?

0 5 10 15 20 25 30 35 40 45 50

Prehistoric timesAncient Greece

Medieval EnglandRenaissance England

Canada 18311841185118611871188118911901

Life Expectancy at Birth

Source: attributed to The Urban Futures Institute as published in “Planning for Retirement, Canadian Bankers Association.


In 1900… Life expectancy at birth was:

In the US As recently as 1900, 48.3 years for men and 51.1 years for women

In Austria, Czechoslovakia, Greece, Hungary and Spain less than 40 years

Belgium, France, Great Britain, Italy, Japan Under 50

Australia 53.2 years at birth and a female would have 56.8 years.

-Source: Bruce Bartlett, “ Setting a realistic retirement age”,

Washington Times, May 25, 2005

And Today… If you retire at age 55 having worked for 30 years…

As a female, you will live nearly as many years longer as you worked.

If you are married at age 60… There is a 50% probability that at least one of you will be

alive at age 90 At age 65, having 35 years of work, your savings, SS

(CP/OAS), and pension will have to support yourself for another 20 years

If you are 65 today, how many more years will you live?

15.0

16.9

16.917.3

18.6

18.618.7

18.9

18.9

19.0

19.1

19.419.6

19.6

19.9

20.020.0

20.0

20.120.3

20.4

20.620.7

20.7

20.721.0

21.0

21.1

21.4

21.4

23.2

0 5 10 15 20 25

1970 2005

13.113.113.2

13.914.4

15.517.1

15.715.615.5

16.117.2

16.116.257

15.816.316.4

17.116.717

17.517.4

16.816.7

1817.5

17.717

18.117.1

18.1

0510152025

TurkeyHungarySlovak RepublicCzech RepublicPolandDenmarkMexicoIrelandPortugalLuxembourgUnited KingdomGreeceGermanyOECDKoreaBelgiumNetherlandsUnited StatesNorwayAustriaNew ZealandSwedenSpainItalyIcelandSwitzerlandCanadaFinlandAustraliaFranceJapan

Years

1970 2005Males Females

Source: Based on Health at a glance 2007: Focus on Quality of Care - OECD © 2007 - ISBN 9789264027329


Estimated median age in selected countries 2010 -2050

Japan

South Korea

Germany

China

Brazil

Mexico

United States37.9 43.8 Canada

Canada from Statistics Canada, Population Projections for Canada, Provinces and Territories, Catalogue no. 91-520-X

Estimated median age in selected countries 2010 -2050

Japan

South Korea

Germany

China

Brazil

Mexico

United States37.9 43.8 Canada

Canada from Statistics Canada, Population Projections for Canada, Provinces and Territories, Catalogue no. 91-520-X

Fact It is astonishing to realize that more than half of all the

human beings who have ever lived beyond the age of 65 are alive today. [prologue xxix]

Aging: Concepts and Controversies 5th Edition By Harry R. Moody

Published by Pine Forge Press [2006]

ISBN 1412915201, 9781412915205


The Truth — An Inconvenient Inevitability The developed world – not just BC or Canada—is facing

an “Age Tsunami” a “Demographic Discontinuity” A “Population Predicament”

Chose your catch phrase… the truth is the same: A million people worldwide turn 60 every month over the next 25 years, around 70 million people will retire

in developed countries… …and will be replaced by just five million

Your “Demographic” baby boomer - People born between (and including)

1946 and 1964. generation X - a.k.a. GenX (pronounced: jen-X) 1963

and 1978 (or 1961 to 1981). generation Y - a.k.a. Gen M -or- millennials -or-

digital natives -or- echo boomers -or- millennial students -or- 21st century learners -or- Net Generation 1980 and 1995.

“70 or bust! Current plans to raise the retirement age are not bold enough”

PUT aside the cruise brochures and let the garden retain that natural look for a few more years. Demography and declining investment returns are conspiring to keep you at your desk far longer than you ever expected.

This painful truth is no longer news in the rich world, and many governments have started to deal with the ageing problem. They have announced increases in the official retirement age that attempt to hold down the costs of state pensions while encouraging workers to stay in their jobs or get on their bikes and look for new ones.

Unfortunately, the boldest plans look inadequate. Older people are going to have to stay economically active longer than governments currently envisage; and that is going to require not just governments, but also employers and workers, to behave differently.

Economist: April 7, 2011 print edition


So, what will your future hold? When will you Retire? Labour Force Exits vs. Life Expectancy and Official Retirement

75.067.966.565.565.364.964.364.163.963.963.263.162.962.362.261.961.961.361.361.061.060.960.860.359.558.558.358.257.957.754.5

50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86

Labour force exit rate Life expectancy at 65 Official

73.071.269.566.668.965.663.565.264.666.564.261.465.763.564.463.263.361.663.560.262.162.460.859.258.762.259.659.758.961.459.3

50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86

Labour force exit rate Life expectancy at 65 Official

MexicoKoreaJapan

PortugalIcelandIrelandTurkey

SwitzerlandUnited StatesNew Zealand

NorwaySpain

SwedenOECDAustralia

United KingdomCanada

NetherlandsDenmarkFinland

GermanyGreece

Italy

LuxembourgFrance

Czech RepublicBelgiumHungaryAustriaPoland

Slovak Republic

MexicoKoreaJapan

PortugalIcelandIrelandTurkey

SwitzerlandUnited StatesNew Zealand

NorwaySpain

SwedenOECDAustralia

United Kingdom

CanadaNetherlands

DenmarkFinland

GermanyGreece

Italy

LuxembourgFrance

Czech RepublicBelgiumHungaryAustriaPoland

Slovak Republic

Society at a Glance 2009: OECD Social Indicators - OECDChapter 5. Self-sufficiency Indicators.Version 1 - Last updated: 29-Apr-2009

Males Females

Business Week’s Cover Story… “The logical conclusion:

raise Social Security's normal retirement age incrementally to 70.”

“Old. Smart. Productive” BusinessWeek: JUNE 27, 2005

Only 16% of Canadians and 17% of Americans plan on never working again after retirement

The Future of Retirement


Why will you work?

•Money (30% US 24% CDN)

•Mental Stimulation (15% US 18% CDN)

•Keep Physically active (22%US 21% CDN)

•Connect with others (7%US 11% CDN)

•Have something meaningful / valuable to with your time (21% US 23% CDN)

How individuals think governments should finance ageing populations (in percent)

14%

34%

17%

10%

22%

14%

34%

14%

6%

28%

0%

5%

10%

15%

20%

25%

30%

35%Increase Taxes

Enforced Additional PrivateSavings

Not Sure

Reduce Pensions

Increase Retirement Age

Source: HSBC Future of Retirement Research 2006US Canada

Gordon Waddell and A Kim Burton. Published by The Stationery Office, 2006.

ISBN 0-11-703694-3.

From the book by Gordon Waddell, A Kim Burton


M Frese & G Mohr 1987, “Prolonged Unemployment And Depression In Older Workers: A Longitudinal Study Of Intervening Variables.” Soc Sci Med 25: 173-178

Re-employment in older workers can improve physical functioning and mental health.

Haynes SG, McMichael AJ, Tyroler HA. 1978. “Survival After Early And Normal Retirement.” Journal of Gerontology 33: 269-278.

Mortality after early retirement is higher than would be

expected in a corresponding working group: the only significant predictor is pre-retirement health status (i.e. a health selection effect). Taking all the data, no excess mortality was observed after normal retirement.

Morris JK, Cook DG, Shaper AG. 1992. “Non-employment And Changes In Smoking, Drinking, And Body-weight.” BMJ304: 536-541

Men who remained continuously employed had the lowest mortality, even after adjusting for socio-economic variables, manual/non-manual work and health-related behaviour. Even men who retired for reasons other than illness and who appeared to be relatively advantaged and healthy had a significantly increased risk (RR 1.87). The effect was non-specific: the increased risk of mortality from cancer was similar to that from cardiovascular disease.

Continue…


Tsai SP, Wendt JK, Donnelly RP, de Jong G, Ahmed FS. 2005. “Age At Retirement And Long Term Survival Of An Industrial Population: Prospective Cohort Study.”

BMJ doi: 10.1136/bmj.38586.448704.EO. After adjusting for socioeconomic status, employees who

retired early at 55 had greater mortality than those who retired at 65 — the mortality was about twice as high in the first 10 years after retirement. Early retirees who survived to 65 had higher post-65 mortality than those who had continued working. Mortality was similar in those who retired at 60 and 65. Mortality did not differ for the first 5 years after retirement at 60 compared with continuing work.

What does this mean? It looks like we will see more older people in our society, in

our organizations and in our labour force What are we going to do to accommodate them? And with more older workers, what are the costs likely to be? Would it be fair to hire older workers but limit their rights to

health benefits, pension benefits…?

How many “Years of Potential Life” do I have?

1. Determine current age

2.Select Gender

3. ReadTotal life

Expectancy

Total Life expectancy at age 30Female: 82.8 (52.8 YPL)Male: 77.6 (47.6 YPL)


How long was my life expectancy when I was born?

Sources: Adapted from BC Stats, Ministry of Technology, Innovation and Citizens' Services 1921-1946:Longevity and Historical Life Tables, Dhruva Nagnur, Statistics Canada1950-2013: BC Stats, Ministry of Technology, Innovation and Citizens' Serviceshttp://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/VitalStatistics.aspxas accessed Set 2, 2014

50

55

60

65

70

75

80

85

90

1921

1936

1950

1953

1956

1959

1962

1965

1968 1971

1974

1977

1980

1983

1986

1989

1992

1995

1998

2001

2004

2007

2010

2013

Male

Female

Note: Population data after 1970 adjusted for non-permanent residents and undercount.Figures prepared through the use of single year of age life table.using deaths provided by Vital Statistics, Ministry of Health, and theaverage of consecutive years of population provided by Statistics Canada.Deaths are on a Census Year period basis (July 1, year 1, to June 30, year 2).Source population is date referenced July 1.

If I were 65 today, how long could I expect live?

1012141618202224

1950

1953

1956

1959

1962

1965

1968 1971

1974

1977

1980

1983

1986

1989

1992

1995

1998

2001

2004

2007

2010

2013

MaleFemale

Source: Data from BC Stats, Ministry of Technology, Innovation and Citizens' Serviceshttp://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/VitalStatistics.aspx

as accessed Set 2, 2014Note: Population data after 1970 adjusted for non-permanent residents and undercount.

Figures prepared through the use of single year of age life table.using deaths provided by Vital Statistics, Ministry of Health, and theaverage of consecutive years of population provided by Statistics Canada.Deaths are on a Census Year period basis (July 1, year 1, to June 30, year 2).Source population is date referenced July 1.

Life Tables Canadian Life BC Life Public Service

Pension Plan Age Male Female Male Female Male Female

55 80.01 84.11 81.20 84.84 83.22 86.62

60 80.84 84.72 81.98 85.41 83.80 86.99

65 81.98 85.52 83.01 86.16 84.96 87.61 Source: PensionsBC BC Pension Corp.


6050403020100

Population Pyramid From pre-history to pre-modern times

…and in some modern-day tribes…

Some Modern Pyramids

One child policy starts 1979

Cultural Revolution/Gang of Four 1966-76

How are projections done? Cohort Component methods are commonly used (among

others) Start with the male/female population by age (usually five year

groups) Look at the age-specific survival rates by gender and age category Apply the fertility rates for the women and the gender ratios at

birth to get the number of new males and females to add Add the expected births for each gender to the top of the list, move

the survivors down one age category and repeat Variations include ethnicity, religion, region, adjustments

for immigration, emigration, (and in-migration, out-migration) on a state or provincial basis), parity rates…


95 -99 90 - 94 85 - 89 80 - 84 75 - 79 70 - 74 65 - 69 60 - 64 55 - 59 50 - 54 45 - 49 40 - 44 35 - 39 30 - 34 25 - 29 20 - 24 15 - 19 10 - 14 5 - 9 0 - 4

From 2010 to 2015 •Subtract deaths•Subtract Emigration•Add Immigration•Then shift categories up one age grouping

????????????????????????????????????????????????????????????????????????????????????

95 -99 90 - 94 85 - 89 80 - 84 75 - 79 70 - 74 65 - 69 60 - 64 55 - 59 50 - 54 45 - 49 40 - 44 35 - 39 30 - 34 25 - 29 20 - 24 15 - 19 10 - 14 5 - 9 0 - 4

•Apply live birth rateto each age group•Then apply the Gender Ratio

0 - 4

Males Females

Live Births per 1000 15<20 Year Old Girls /Women all date 2012 UN Demographic Yearbook Table 10 except Canada and BC 2010 Statistics Canada CANSIM Table 102-4503 Washington State Dept. of Health-Center for Health Statistics 2012 table A10

3.44.54.64.85.97.17.78.18.2

11.415.9

21.822.9

24.941.5

54.686

0 10 20 30 40 50 60 70 80 90 100

Switzerland

JapanDenmark

Netherlands

Sweden

NorwayFinland

British Columbia

Germany

Canada

AustraliaUnited Kingdom

Washington state

New Zealand

United StatesPuerto Rico

Panama

How many Males to Females? Roughly 105 to 107 males for

every 100 females at birth is normal males have higher mortality in

childhood Women have higher mortality

in child birth but live longer One would expect the same

ratio regardless of birth order

Country M/F ratio at birth

Canada 106

United States 105

Hong Kong 113

China 111

India 112

Viet Nam 112Source: CIA World Factbook athttps://www.cia.gov/library/publications/the-world-factbook/fields/2018.html

as accessed Sept 3, 2014


The war on baby girls

Gendercide Killed, aborted or neglected, at least 100m girls have disappeared—and the number is rising Mar 4th 2010 | The Economist

China - Sex Ratio at Birth by birth order (parity), 1982-2005

108.4

143.2

156.4

141.8

109.9109.4105.2105.6

161.4160.3

151.9

107.1

100

110

120

130

140

150

160

170

1 2 3 4

198220002005

http://www.unfpa.org/gender/docs/studies/china.pdf

After: Shuzhuo Li, “Imbalanced Sex Ratio at Birth and ComprehensiveIntervention in China”, 4th Asia Pacific Conference on Reproductive and Sexual Health and Rights, 29-31 October 2007; HYDERABAD, INDIA

What do you do with 33 million extra males age 15-34?

Authors: Andrea Den Boer, Valerie M. Hudson, "A Surplus of Men, A Deficit of Peace: Security and Sex Ratios in Asia's Largest States"Journal Article, International Security, volume 26, issue 4, pages 5-39 Spring 2002


Canada Population Projection

BC Population 2015 and 2035

Source: Based on extract from BC Stats http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx as accessed Sept 2, 2014

BC Population 2015 and 2035


Population Pyramid Points to Ponder Are the rights and needs of older people being

addressed in our organizations, institutions and tribunals?

How are we going to address the rights and needs of women, particularly older women, as they increase in numbers?

Who will fill the roles in the economy as the population pyramids in western countries shift?

Workplaces

Demographics:The Growth and

Structure of Population

Key commoditiesand services

required

Employment opportunities

available to workers

Demandfor

Workers

Occupationsrequired

Rates of Immigration

Work ForceParticipation Rates

Birth Rate

Supply ofWorkers

Demand for private

consumption

Demand/Need forpublic expenditures

(especially Health careand Education)

Unemployedworkers

Employedworkers

[Undocumented]Illegal immigrant workers[Documented] Temporary Foreign workers


Immigration? Possible source but…

We are competing with every other industrialized nations for the same skilled immigrants

New immigrants bring new challenges and may be more vulnerable to workplace injury, stress and adjustment

Canada Source: "Citizenship and Immigration Canada, Facts and Figures". Citizenship and Immigration Canada. 2013. Retrieved Dec 7, 2013.

Canada

Canadian Immigration

China 13%

Philippines 13%India 11%

Pakistan 4%USA 4%

USA

US ImmigrationMexico 14%

China 7%India 7%Philippines 5%Dominican Rep 4%

US Source: U.S. Lawful Permanent Residents: 2013" (PDF). Annual Flow Report, May 2014

Australian ImmigrationNew Zealand 18%India 12%China 12%UK 4%Philippines 4%

Australia Sourcehttps://www.immi.gov.au/media/fact-sheets/02key.htm /

Australia

UK

UK Source: https://www.gov.uk/government/publications/immigration-statistics-april-to-june-2014/immigration-statistics-april-to-june-2014#settlement-1

UK ImmigrationIndia 17%Pakistan 12%Nigeria 5%China 5%South Africa 4%

Immigration Trends: Canada(2012), US(2013), Australia(2012/13), UK(Q2 2014)

Temporary Foreign Workers? A growing source but…

We are competing with every other industrialized nations for the same skilled immigrants

Temporary foreign workers bring new challenges and may be more vulnerable to workplace injury, stress and adjustment


0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

BC

Stock of Temporary Foreign Workers on December 1st

Source: 1997-2008 http://www.cic.gc.ca/english/resources/statistics/facts2009/temporary/02.asp2009-2012 http://www.cic.gc.ca/english/resources/statistics/facts2012/temporary/10.asp

Increasing Participation Rates? Possible sources

Retaining people (particularly younger people) in our jurisdiction and labour force

Increasing participation rates of women Accommodating injured workers and disabled people who

would otherwise leave or be outside the labour force Older workers who would otherwise retire

JurisdictionallabourForce

Births 15+years ago

Retired, disabled, students and others Not In labour Force Deaths while

in labour force

Immigration of Workers

Emigration of Workers

Immigration -Emigration = Net Gain or Loss.


Source: CANSIM data from Labour Force Survey (LFS)

0

50

100

150

200

250

300

350

400

450

Mar

-76

Sep-

77M

ar-7

9Se

p-80

Mar

-82

Sep-

83M

ar-8

5Se

p-86

Mar

-88

Sep-

89M

ar-9

1Se

p-92

Mar

-94

Sep-

95M

ar-9

7Se

p-98

Mar

-00

Sep-

01M

ar-0

3Se

p-04

Mar

-06

Sep-

07M

ar-0

9Se

p-10

Mar

-12

Sep-

13

Thou

sand

s

Full and Part-time employment Persons Aged 65 and Older Canada March 1976 to July 2014

Full-time employment (4) Part-time employment (5)

Back to Workers’ Compensation And why all of this is important to WorkSafeBC How Demographic change has impacted our system

already

15

20

25

30

35

40

45

50

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Average age (2013):

Males 41

Females 43

Average Age of Injured Worker in B.C. (Time-loss injuries only)


Average Days Paid by Age Groups

0

20

40

60

80

100

15-19

20-24

24-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

Age Groups

Aver

age D

ays P

aid

n= 500k time-loss claims Method: 1) claims divided into buckets by age at injury2) Days paid per claim totaled and divided by

number of claims in bucket

Axioms Older [male] workers are less likely to have work-related

time-loss injuries than younger workers…BUT Older workers [males and females] take a lot longer to

recover than younger workers…


You’ve seen the truth… (and just some of the questions)…

What will these demographic changes mean in our lives, our society, our businesses and tribunals?

How does Demographic Change impact health care?

Now the consequences

Canadian society is getting older The evolving demographic picture will mean

More older workers in the workforce More workers with age-related conditions, impairments and

disabilities will be present in our communities and workplaces

Designing and delivering services for a more diverse population

And… Dementia, Alzheimer's, depression will

Become more prevalent Require direct and indirect departures from the labour force Increase demands for health care services

Normal aging for an increasing proportion of the population will Increase demand for physiotherapy, medication, home care,

and hospital services Drive up costs for wages, recruitment, retention Result in increased competition for scarce resources


Further… We will see more people from outside Canada come to live

permanently and temporarily to fill many occupations Older workers will become more prevalent in the labour

force More workers will be vulnerable due to

Age “newness” to the job Language and culture Economics Precariousness of employment

Some final thoughts Be sensitive… Take care of your health… Be very nice to your children… Be very generous to your retirement savings…

Health Care Professional Conference Vancouver Hyatt Regency– September 12, 2014

Terrance J. BogyoIndependent Researcher | Speaker | Consultant



Dr. Merv Gilbert, PhD, R Psych

Dr. Merv Gilbert is a psychologist with over thirty years experience in direct clinical and leadership roles at regional, provincial, and international levels. He has published and presented in a diverse array of forums on the importance of workplace psychological health and safety for individuals and organizations. Dr. Gilbert has also served on a number of professional and non-profit organizations and currently serves on the steering committee of the American Psychological Association’s Psychologically Healthy Workplace Network.

Dr. Gilbert is currently a principal partner with Psych Health + Safety, a consulting partnership, providing planning, training, implementation and evaluation services that enable organizations to foster psychologically healthy employees and workplace climates. He is an Adjunct Professor with the Centre for Applied Research in Mental Health and Addiction (CARMHA), a research centre within the Faculty of Health Sciences at Simon Fraser University. Dr. Gilbert is a primary participant in the development, evaluation and dissemination of resources for workplace mental health. His most recent work has been creating resources for the Mental Health Commission of Canada.

Plenary session: Taking Action to Improve Psychological Health and Safety in the Workplace

More and more employers recognize the legal, financial, and practical need to effectively address workplace psychological health and safety but are unsure where to start. Is their organization ready to change? What resources will they need? How will they know if their actions are effective? This session will provide an overview of Psychological health and safety: An action guide for employers. The guide is one of the key resources identified in the National Standard of Canada for Psychological Health and Safety in the Workplace. The session will take participants through a strategic, sequential planning process that will include identification of practical, evidence –informed actions that are readily accessible to all employers, regardless of size or sector. It will be of interest to health professionals, human resource practitioners, health and safety experts, employers, organized labour and employee representatives. Key learning objectives include:

• Introduction to Psychological Health and Safety: An Action Guide for Employers

• Determining the business case for your organization

• Selection the best actions for your organization

• Creating an action plan for your organization


Breakout session: Psychologically and Occupationally Responsive Treatment (PORT)

PORT is a training program that enhances the treatment and rehabilitation of workers with psychological conditions by presenting an approach that integrates psychological and work-related issues, focusing on barriers to successful coping with the work situation and recovery of occupational function.


• Improve understanding of the various factors that are critical to return-to-work (RTW) planning for clients with mental health disorders including preparation, planning, implementation and relapse prevention

• Become familiar with a workforce problem-solving model, and how it can be applied to improve communication and understanding between employers, healthcare providers, employees in order to achieve successful RTW

• Enhance awareness of effective interventions for sustained work return

• Learn about various tools that can facilitate RTW planning for individuals with mental health issues

Taking Action to improve Psychological Health & Safety in

the Workplace 10th Annual Health Care Professional Conference

Vancouver, September 12th, 2014

Merv Gilbert, PhD, RPsych

Partner, Psych Health + Safety Consulting Adjunct Professor, CARMHA, Simon Fraser University Chair, BCPA Psychologically Healthy Workplace Committee Steering Committee, APA Centre for Organizational Excellence

Love and work are the

cornerstones of our

humanness

But for too many adults, their work is experienced as compromising their

psychological (mental) health


Impact of poor psychological health • Estimated to cost the Canadian economy $50

billion dollars/year (+) • Fastest rising cause of long term disability,

main cause in some (e.g. health care) • Longer periods of absence than most other

disorders (e.g. diabetes, back pain, cardiac disease)

• Raises the risk for other psychological and physical disorders

• Contributes to accidents, injuries and incidents

Why is this happening now? • The worker? • The workplace?

• The nature of work?

•OH&S movement triggered improvement in physical domain •PH&S aims to trigger action in psychological domain

Occupational Health & Safety

Psychological H&S

Physical H&S

Evolution of Health and Safety


FINANCIAL Big impact on productivity

LEGAL Regulators & courts demand it

PRAGMATIC It’s hard to solve problems with distressed workers

ETHICAL It’s the right thing to do …

The business case for addressing PH&S?

The Standard focuses on mental illness prevention and mental health promotion in the workplace. It is intended to help prevent harm to all people in the workplace, whether or not they have had a lived experience with mental illness.

“(A workplace) in which every practical effort is made to avoid

foreseeable injury to the mental health of employees.”

The National Standard for Canada: Psychological health and safety in the

workplace — Prevention, promotion, and guidance to staged implementation

Goal: Create psychologically healthy and safe workplaces that meet the needs of employers and employees


The APA Psychologically Healthy Workplace Model

The choice for employers: • Do nothing: Outcome is increased

costs, decreased productivity/morale, loss of skilled workforce

• Act: Outcome is decreased costs, increased productivity/morale, recruitment/retention of skilled workers

But where do we start?

Introducing: Psychological Health & Safety: An Action Guide for Employers

Available at www.carmha.ca


POLICY

PLANNING

PROMOTION

PREVENTION

PROCESS

PERSISTENCE

The P6 Model

24 employer actions to enhance and protect PH&S. Actions are:

• Evidence-consistent • Practical • Stand-alone Includes stories, resources, references and topics of special interest (e.g. PH&S

for small business)

Some key actions to improve workplace PH&S

1. Take a strategic approach 2. Assess and address risks to PH&S 3. Train Managers in engaged performance

management 4. Train employees in psychological safety skills 5. Provide timely support to staff who are

struggling


Take a Strategic Approach

Integrated into the organizational plan, vision & values

Meaningful leadership & employee involvement Based on a clear business case

E.g. Measure of Organizational Readiness for Psychological Health (MORPH)

Assess and address PH&S hazards &

risks

Workplace variables that impact employee

psychological health

Employee input (surveys, focus groups,…) Key indicators (absence, STD/LTD, benefits utilization, grievances…)

e.g. Guarding Minds @ Work

Train and support

managers

Appropriate skills to respond to staff with possible MH issues

Training may be are in-person, online, written materials

E.g. WorkSafeBC Bullying and Harassment Prevention toolkit


Train employees in PH&S skills

Adapted to fit the needs of the worker,

the workplace and the organization

E.g. Resiliency training, conflict resolution, active problem-solving,

stress management

E.g. Coaching Antidepressant Self-care Skills (CASS)

Support employees

who are struggling

Early intervention to prevent functional

impairment & disability

Support access to effective on-line

resources, psychological

treatment, SAW/RTW

E.g. Psychologically & Occupationally Responsive Treatment (PORT)

The BCPA Psychologically Healthy Workplace Program

• Mission: to enhance and ensure the health, productivity and sustainability of Canadian workers and workplaces

• Members: psychologists, business leaders, academics and informed professionals volunteering their time and expertise

• Actions: Provide education and recognition for British Columbia organizations to enhance psychologically healthy and safe workplaces

For more information: http://www.phwa.ca/


An Example: Brookhaven Extended Care Facility

Questions? Comments?

Merv Gilbert [email protected]


Psychologically & Occupationally Responsive Treatment

PORT

10th Annual Health Care Professional Conference Vancouver, September 12th, 2014

1

Merv Gilbert, PhD, RPsych Partner, Psych Health + Safety Consulting Adjunct Professor, CARMHA, Simon Fraser University

Objectives • Understand key principles critical to providing treatment and

rehabilitation for employed clients with psychological issues • Understand an alternative to the medical model, a problem-focused

approach to occupational disability • Integrate into intervention planning a cognitive behavioral approach,

focused on enhancement of the individuals capacity for effective personal and interpersonal coping

• Learn strategies to enhance appropriate and timely participation and engagement by key participants (employers, employees, unions, healthcare providers)

• Learn about practical tools, resources and programs to facilitate efficient, effective and sustainable recovery and work return

2

What is PORT? PORT is designed to enhance provider effectiveness in treating working

adults with psychological conditions by integrating occupational and psychological perspectives. Treatment incorporates primary, secondary and tertiary actions to address employee psychological health and safety.

3

Occupational Perspective

Psychological Perspective

Effective & Efficient Treatment


Individual Factors

Organizational Factors Crisis

Absence RTW RTD?

How a psychological disability develops

4

Key Principles • Treatment simultaneously addresses symptom reduction

and functional recovery • The effectiveness of interventions are measured and

demonstrated • Workplace problems are identified and addressed in a

timely manner • Key players, especially the client, are actively engaged in

the treatment and rehabilitation process

5

Principle: Treatment simultaneously address symptom reduction and functional recovery


FINANCIAL Big impact on productivity

LEGAL Regulators & courts demand it

PRAGMATIC It’s hard to solve problems with distressed workers

ETHICAL It’s the right thing to do …

The business case for addressing PH&S?

The Standard focuses on mental illness prevention and mental health promotion in the workplace. It is intended to help prevent harm to all people in the workplace, whether or not they have had a lived experience with mental illness.

“(A workplace) in which every practical effort is made to avoid

foreseeable injury to the mental health of employees.”

The National Standard for Canada: Psychological health and safety in the

workplace — Prevention, promotion, and guidance to staged implementation

Goal: Create psychologically healthy and safe workplaces that meet the needs of employers and employees


Principle: The goals of interventions are clear, agreed and measured

10

Set quality goals

Collaboratively set Operationally defined Focus on function Identify barriers

Not on broad improvement or

(necessarily) enhanced life satisfaction

Barrier Intervention Goal

Track Goal Progress

Ask about progress in each goal area

Session 3-4: engaged Session 7-8 significant progress Mean #of sessions 8-12

Use measurement Tools, e.g. PHQ, GAI


Principle: Workplace factors are identified and addressed in a timely manner

13

What workplace factors influence psychological health?

Individual variables

Organizational Variables

Workplace Worker

Poor psychological job fit Poor meta-job skills Poor stress management

(work & home)

High demand/low control Lack of

support/recognition (coworker & supervisor)

Dramatic change (positive

or negative)


Principle: Key players, especially the client, are actively engaged in the treatment and

rehabilitation process

16

HR Healthcare System

Union

EFAP

Frontline Manager

Employee

Insurer

What does the collective

agreement say?

Any involvement we might have is

confidential

We’re not allowed to ask

much

Get her back to work- 8 sessions Nobody tells

me nothin’

Standard Care

Therapist

What is my role exactly?

I feel confused and scared

We’re busy & we don’t have time to

deal with workplace issues

• neglects organizational factors • promotion of inactivity and isolation • provision of less-effective treatment focusing on

symptoms not functions • leaves a gap between the individual treatment of the

disorder and the return to the workplace

Standard care can make things worse


Insurer

Healthcare System

public /private

Union

Therapist

Employer Employee

Coordinator SAW/RTW

The Coordinated Approach

Positive Outcomes of a coordinated approach

• helps to keep people at work where they have routine, social contact, sense of identity and purpose

• enhances involvement of employer • prevents escalation of small matters • addresses causes, thereby arriving at real solutions

Support •some tx sessions after work return

Monitor • for conflict, distress, absence

Plan • agreed emergency plan

Prevent RTD (Return to Disability)


Thank you Questions?

Merv Gilbert: [email protected]



Dr. Kendall Ho, MD FRCPC

Dr. Kendall Ho, professor in Emergency Medicine at the University of British Columbia, practices clinically at the Vancouver General Hospital. Before this role, he was the founding director of the UBC Faculty of Medicine eHealth Strategy Office in 2008, and the associate dean of continuing professional development and knowledge translation.

Dr. Ho’s area of academic interest is in eHealth — the innovative application and evaluation of modern information and communication technologies in health research, education, and health practice. Examples of his research include: the use of apps, social media, and biosensors to support patient self-management with health professional support; telehealth using technology-enabled academic detailing to connect pharmacists and physicians for evidence-based prescribing; multicultural patient and care provider engagement for chronic disease management through the inter-Cultural Online health Network (iCON); public education to raise eHealth literacy.

He’s a member of the Association of Faculties of Medicine eHealth Education Committee and the Royal College of Physicians and Surgeons of Canada Professional Development Committee, chairs the Royal College’s eHealth Expert Working Group in CanMEDS 2015 Renewal, and co-chairs the Universitas 21 Health Sciences Social Media for Health Education Committee. He is also a collaborator with the World Health Organization global eHealth Observatory and the Pan American Health Organization Knowledge Management and Communications unit.

Breakout session: Mobile Apps for Quantifying Recovery: Current state and emerging opportunities


• To understand the current trends in mobile apps and sensors developments, and how they apply to injured patients and their recovery

• To consider using these sensors in your patient population

• To follow the emerging trends and contributing to their evolution over time

e H e a l t h S t r a t e g y O f f i c e

Mobile Apps for Quantifying Recovery:Current state and emerging opportunities

WorkSafe BC10th Annual Healthcare Professional Conference

September 12th, 2014

Kendall Ho, MD FRCPCProfessor, Emergency Medicine

Director, eHealth Strategy Office


•

•

•

•

•


mHealthGlobal Market

$9 million in 2014

>50% annual growth

$10 Billion in 2018




• Motivate

• Activate

• Calibrate


http://mraalert.blogspot.ca/2014/09/playing-for-prevention-innovative.html

Gaming


Biosensors Text Messaging Social Media

2013-2014Diabetic patients & caregiversLawson Foundation GrantCanada Health Infoway Grant


MoodFx mobile web app (www.MoodFx.ca) Computers, tablets, smartphones

Work functioning & depression

Scales to Assess/track outcomes

Text/email appointment reminders

Subscribe to text/email tips



Carol Kennedy, BScPT, MClSc(manip), FCAMPT

Carol graduated from Queen’s University in 1979, completed her Advanced Diploma of Orthopaedic and Manipulative Therapy in 1984, and her Clinical Masters of Science in Manipulative Therapy from UWO in 2010. She has been at Treloar since 1984 and became a partner in 1989. She’s taught extensively in the Canadian Manual Therapy Course System, as well as internationally, and is a chief examiner for the national exams. In 2005 Carol received an Award of Excellence for Clinical Contribution from the Physiotherapy Association of British Columbia for her work and teaching in the area of the cervical spine.

Carol treats neck pain patients almost exclusively, utilizing the evidence-based practice of manual therapy and specific exercise. She has written chapters on neck exercise in two textbooks. Carol was honoured to be involved in the Olympics as a speaker at the Medical Symposium and as a Clinical Specialist for the Athlete Physiotherapy Clinic. In 2012, Carol was one of the first physiotherapists to successfully complete the Specialization Program through the Canadian Physiotherapy Association in the field of musculoskeletal physiotherapy and also certified as an assessor for that process.

Breakout session: What About the Neck?: Identification and management of potential cervical contribution to concussion symptoms


• To be aware of the evidence supporting cervical spine involvement in concussion syndromes

• To be able to identify the features suggestive of cervicogenic headache and dizziness

• To have an awareness of management strategies for the treatment of the cervical spine for headache and dizziness

• Exposure to examples of manual therapy and exercise interventions to improve symptoms arising from the cervical spine

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Andrew Montgomerie

Andrew Montgomerie has been with Health Care Services at WorkSafeBC since 2004. Prior to that, Andrew worked in Vancouver as a kinesiologist, focused primarily on occupational rehabilitation and functional assessment. Andrew is currently the Director of Financial Services and Health Care Programs at WorkSafeBC. In his spare time, Andrew enjoys playing with his four children, and is working on achieving an accounting designation (CMA).

Plenary session: Opening remarks

Notes



Dr. Gurdeep Parhar

Dr. Gurdeep Parhar is Executive Associate Dean — Clinical Affairs for UBC’s Faculty of Medicine. He has also served as Associate Dean, Equity and Professionalism, for UBC’s Faculty of Medicine and as Acting Associate Vice-President, for UBC’s Equity and Inclusion Office. Previously, he was Co-Acting Head and Associate Head of the UBC Department of Family Practice.

Dr. Parhar is Medical Director of CORE Occupational Health Centre providing Independent Medical Examinations (IME) in the field of Disability Medicine, Functional Capacity Evaluations (FCE), and Cost of Future Care (CFC) assessments. He provides consultation services to assist in the rehabilitation of injured or ill workers. In this capacity, he serves as the Medical Director of numerous corporations in British Columbia.

Dr. Parhar was a Medical Advisor at WorkSafeBC for five years and was the first Medical Coordinator for the BC Workers Compensation Appeal Tribunal (WCAT) for nine years, before retiring from this position in February 2014.

He teaches extensively in the areas of impairment, disability, occupational medicine, and the management of motor vehicle collision injuries at the Faculty of Medicine at UBC. He also created and teaches a course on Physical Aspects of Medical Disability at Simon Fraser University in a diploma program for case managers and disability managers. At the University of British Columbia, he created and taught a course entitled “Medical Aspects of Disability”, a mandatory course in the Masters of Vocational Rehabilitation Counseling Program.

He was the Occupational Physician for the City of Vancouver where he was responsible for reviewing the health of injured and ill workers in the various departments of the City of Vancouver including the City of Vancouver Fire Department, Parks and Recreation, and Engineering Department.

Dr. Parhar has served as the Occupational Physician for the Workplace Health and Safety (WHS) Program at the University of British Columbia. He is also a Marine Medical Examiner certified by Transport Canada and determined fitness to work for all seafarers who work in the marine industry. In addition, Dr. Parhar is currently the Chairperson of the Royal Canadian Mounted Police (RCMP) Medical Review Board.

He also co-hosts a weekly television program entitled “Pearls for Success”, targeting the well-being of new Canadians.

In 2010, Dr. Parhar was awarded the Trial Lawyers Association of British Columbia (TLABC) President’s Award and the BC College of Family Physicians’ Teacher of the Year Award. In 2011, Dr. Parhar was awarded a UBC Killam Teaching Prize and the University of Calgary’s, Faculty of Medicine Alumnus of Distinction Award. In 2012, Dr. Parhar made the key note address to the Medical University of Vienna entitled “Diversity — Recruiting, Supporting and Promoting Excellence”. In July 2013, Dr. Parhar was invited as a visiting professor to teach Professionalism in Saigon Medical School Vietnam.

Breakout session: The Do’s and Don’ts of Engaging a Family Physician in a Return-to-Work Plan



• To understand the role of the family physician in managing injured workers’ situations

• To understand the advantages of the longitudinal and contextual family physician-patient relationship to the injured worker

• To be aware of common errors made by the case managers and rehabilitation communities when attempting to engage family physicians

• To learn strategies on how best to communicate and thereby engage family physicians

Dr. Gurdeep ParharExecutive Associate Dean

Clinical Affairs Faculty of Medicine [email protected]

CORE Occupational Medical CentreIndependent Medical Examinations (IME)Functional Capacity Evaluations (FCE)Cost of Future Care (CFC)604.525.8604coremedicalcentre.com

The Do’s and Don’ts of Engaging a

Family Physician in a

Return-To-Work Plan

Top Difficult Family Doctor Situations(as reported to me by Health Professional Colleagues in the past 20 years)

1. The family doctor is not approving my rehabilitation plan.2. The family doctor is not approving my gradual return to

work plan.3. The family doctor is not sending my client for the

appropriate investigation –MRI4. The family doctor is not referring my patient to the

appropriate specialist5. The family doctor is missing the real diagnosis

Top 10 Difficult Family Doctor Situations(as reported to me by Health Professional Colleagues in the past 20 years)

6. The family doctor is not initiating the correct medication/treatment.

7. The family doctor will not meet with me or speak to me on the telephone.

8. I cannot find a family physician willing to accept my client into their practice.

9. The family doctor is refusing/delayed in responding to requests for copy of clinical records or form.


10. The family doctor is not willing to offer an opinion as to future treatment and need for assistive devices and aids.

11. The family doctor is not appreciating or documenting the extent of my client’s injuries.

Top 10 Difficult Family Doctor Situations(as reported to me by Health Professional Colleagues in the past 20 years)

Learning objectives

• To understand the role of the family physician in managing injured workers’ situations

• To understand the advantages of the longitudinal and contextual family physician-patient relationship to the injured worker

• To be aware of common errors made by the case managers and rehabilitation communities when attempting to engage family physicians

• To learn strategies on how best to communicate and thereby engage family physicians

Outline

Family Practice Opportunities in Work Injuries

Family Practice Challenges in Work Injuries

Pearls for Dealing with the Family Physician


Family Practice Opportunities in Injured Worker Situations

• The Canadian College of Family Physicians of Canada has defined the following four principles of Family Medicine:

① The family physician is a skilled clinician.② Family medicine is a community-based discipline.③ The family physician is a resource to a defined

practice population.④ The patient-physician relationship is central to the

role of the family physician.

http://www.cfpc.ca/English/cfpc/about%20us/principles/default.asp?s=1

① The family physician is a skilled clinician

• demonstrate competence in the patient-centred clinical method

• develop a comprehensive approach to the management of disease and illness in patients and their families.

• are adept at working with patients to reach common ground on the definition of problems, goals of treatment, and roles of physician and patient in management.

• have an expert knowledge of the wide range of common problems of patients in the community, and of less common, but life threatening and treatable emergencies in patients in all age groups.

Family Physicians...

② Family medicine is a community-based discipline

• Family practice is based in the community

• Clinical problems presenting to a community-based family physician are not pre-selected and are commonly encountered at an undifferentiated stage.

• The family physician may care for patients in the office, the hospital, other health care facilities, or the home.


③ The family physician is a resource to a defined practice population

• view their practice as a “population at risk”, and organize the practice to ensure that patients’ health is maintained whether or not they are visiting the office.

• have effective strategies for self-directed, lifelong learning.

• have the responsibility to advocate public policy that promotes their patients’ health.

• accept their responsibility in the health care system for wise stewardship of scarce resources.

• consider the needs of both the individual and the community.


④ The patient-physician relationship is central to the role of the family physician

• have an understanding and appreciation of the human condition, especially the nature of suffering and patients’ response to sickness.

• respect the privacy of the person.

• provide continuing care to their patients.


• Rather than intermittent “snap shots” from which specialist colleagues are forced to understand the patient, the family physician has the luxury of frequent visits over a greater length of time.

• The very scope of family practice – focusing on breadth and not depth – compels the family physician to recruit the assistance of other health professionals in managing the patient’s complete care.

• Thus the family physician is perfectly poised to provide the comprehensive, longitudinal, multidisciplinary and community based care that these patients require.

Family Practice Opportunities in Work Injury Situations:


Family Practice Challenges in Work Injury Situations:

• Despite the potential opportunities that family physicians have in dealing with patients with complex injuries, very often these opportunities are not taken advantage of due to significant challenges.

• Perhaps the main impediment faced by family physicians is that of time.

It is very difficult interviewing, examining, diagnosing and managing a patient within a family practice appointment time allotment.

Many family physicians either rush or outright refuse to manage patients with complex injuries.

Many family physicians resent the time required to complete forms, write reports, attend conferences, interact with other health professionals, and communicate with case managers/legal representatives.

• Some family physicians feel frustration at not being able to access the appropriate resources needed to properly manage complicated patients.

• There are family physicians that feel animosity towards the Work Safe BC and some are even cynical of their own patients’ motivation with respect to work injuries.

• This notion is supported by various negative experiences: Patients whose recovery course does not follow the expected

trajectory Advocates/Case Managers that ask for additional details The “system” provides independent medical examination reports

challenging the patients’ disability and credibility.

Family Practice Challenges in Work Injury Situations:

Pearls for Health Professionals on Dealing with the Family Physician in Injured

Worker Situations

DO NOT:1) Show up at my office unexpectedly2) Show up in the examination room with my patient, without my

prior approval3) Ask me for medical information when you have not attached or

pre-forwarded a signed consent from the patient4) Ask me for medical diagnoses when you do not need them5) Ask me for medical diagnoses repeatedly6) Ask me to complete unnecessary lengthy forms7) Ask me for medical limitations when you really want restrictions

or vice versa8) Send the same form 3 times –via patient, via fax, via mail9) Ask for forms to be completed without a mechanism for payment10) Ask me to arrange a medical service that is not

covered/approved or the patient has no way of covering



Worker Situations

DO:1) Send simple/short forms2) Use, for doctors that do not respond, consider “silence means

approval” strategy forms3) Offer suggestions when you think we need to go in a different

direction4) Tell me what you can provide for the patient5) Tell me what you will lobby/advocate for, pending my

approval6) Send subsequent referral forms/authorizations for treatment

with the patient –eg. Active Rehab Program


Worker Situations

• Enhancing Communication is the single most important strategy in dealing with family physicians in complex medical legal cases. Some specific suggestions include:

1) Communicate Conveniently 2) Communicate Early3) Communicate Helpingly4) Communicate Exploringly5) Communicate Clearly

1) Communicate Conveniently

• The biggest challenge with busy family physicians is finding time to address administrative/paper work.

• When having to communicate volumes of material, it is best to send it in hard copy format by courier or mail.

• Ask the medical office assistant if the physician uses any form of encrypted electronic communication method

• When a written letter or report is not necessary, try to obtain medical information verbally.

• For a telephone consultation, pre-arrange an appropriate time with the medical office assistant


2) Communicate Early

• When you first become involved it is important that a letter be sent to the family physician as soon as possible.

• When requesting a report, meeting or attendance at ameeting, giving ample advanced notice respects the physician’s time and office resources required to complete the report and to alter scheduled patients.

• An early informal “fireside chat” with the family physician is often very valuable

• If the family physician does not understand the full array and severity of the patient’s symptoms you should remind your client to be very careful and detailed when visiting the family physician.

3) Communicate Helpingly

• One of the best methods to improve and solidify the relationship with the family physician is to offer them assistance with their management of the patient.

• If you can advocate for medical imaging, psychological assessments, medical assessments, or expedited surgery, offer it to the family physician.

• Communicate this offer of assistance verbally, by telephone or fax and ask the family physician to have the appropriate referral form faxed.

4) Communicate Exploringly

• Animosity between health professionals and family physicians usually arises from misunderstandings.

• The easiest method to avoid this disastrous situation is to have a telephone conversation with the family physician to explore how well their client’s injuries are understood to ensure that important pathology is not being overlooked.


5) Communicate Clearly

• When requesting medical clearance, approval of programs or approval of a return to work plan, ensure that your documents are as concise and clear as possible.

• As noted, the family physician has extensive knowledge of the patient’s biological-psychological-social context. If this is important to your case, ask.

Conclusion

There are few more terrifying things in life than having to recover from complex and serious injuries.

Patients struggling with long rehabilitation programs, multiple health professionals, insurance companies, financial stresses, family turmoil, and social isolation reach out to the two people they feel will get them through this difficult time: all of the clinicians need to work together. manage the treatment plan.

It is crucial that communication between the patient’s therapists andphysician be ideal.

Learning objectives

To understand the role of the family physician in managing injured workers’ situations

To understand the advantages of the longitudinal and contextual family physician-patient relationship to the injured worker

To be aware of common errors made by the case managers and rehabilitation communities when attempting to engage family physicians

To learn strategies on how best to communicate and thereby engage family physicians


It is all about accurate communication…

[email protected]

• I would be happy to discuss or assist you with any challenging situation –at no cost to you or your client.

• Thank you for being such an important part of the recovery of injured workers.


Notes



Jessica Vliegenthart

In 2004, five days before her 21st birthday, Jessica Vliegenthart broke her back while working as a forest firefighter in the Northwest Territories, leaving her a paraplegic.

Following the accident, Jessica completed her undergraduate degree in communications from Simon Fraser University in 2008 and her law degree from the University of Victoria in 2011.

Always an athlete, Jessica competed for Canada in wheelchair basketball from 2007 to 2012, retiring after competing at the London 2012 Paralympics. Jessica is now a lawyer specializing in personal injury (plaintiff) law and is happiest when she is in the role of advocate. She’s also passionate about adapted sport and helping those with mobility impairments get playing again. Jessica is the president and co-founder, along with her husband Jon, of the Kamloops Adapted Sports Association which offers wheelchair basketball, wheelchair tennis, and handcycling to residents of the Thompson Okanagan.

Plenary session: Empowering Workers to Empower Themselves

Notes



WorkSafeBC Mental Health Claims Unit Panel

The Mental Health Claims Unit (MHCU) is a 30 member team, comprised of adjudicative, support, and clinical staff. It is responsible for adjudicating and managing WorkSafeBC claims where the sole injury is psychological. The MHCU was created in response to expanded coverage for mental disorder claims following the passage of Bill 14 into law on July 1, 2012. Members of the MHCU include Dr. David Eveleigh, Damian Gorman, Abha Sharma McDonell, Jason Jang, and Scott Brent.

Scott Brent, Client Services ManagerScott joined the MHCU as a client services manager in February 2014. He previously worked as a review officer in the Review Division and with the Fair Practices Office at WorkSafeBC. He holds a law degree from UBC.

Dr. David Eveleigh, Senior Psychology AdvisorDr. Eveleigh is one of the MHCU’s senior psychology advisors. He obtained his doctoral degree from SFU and has worked as a psychologist at WorkSafeBC since 1995, initially in the Rehabilitation Centre before moving to Clinical Services. He has been with the MHCU since its inception in 2012.

Damian Gorman, Case ManagerDamian is an occupational therapist and past WorkSafeBC service provider for multiple health care services including FCE, RTWSS, COT, OR2, HIATS, MARP and CMPA. He recently joined the MHCU as a case manager.

Jason Jang, Vocational Rehabilitation ConsultantJason has been a vocational rehabilitation consultant with WorkSafeBC since 2006 and joined the MHCU two years ago. Jason holds a degree in Human Kinetics in addition to his RRP.

Abha McDonell, Return-to-Work Specialist NurseAbha is a RTW specialist-nurse that currently supports the MHCU. She has been with WorkSafeBC for over eight years and brings with her over 11 years of experience working in acute psychiatric care and public health care teaching.

Breakout session: Life of a Claim — How Law and Policy Affects the Decision-Making Process in the Mental Health Claims Unit

From left back row: Scott Brent, Dr. David Eveleigh, Damian Gorman, Jason Jang; Front row: Abha McDonell


• To improve the understanding of the collaborative process between the various members of the mental health claims unit to effect early, durable and safe return to work.

• To explore and understand the life of a claim including the various paths that can be taken and the impact on the injured worker

• To increase awareness of the impact that the new legislation and policy has had on the decision-making process


WorkSafeBC Mental Health Claims Unit Panel Discussion 10th Annual Health Care Professional Conference

September 12, 2014

Life of a Claim

How Law & Policy Affects the Decision-Making Process

Introduction to the Team

A Brief History – Mental Health Claims Unit (MHCU)

•  MHCU took effect on July 1, 2012.

•  On July 3, 2012, a Centralized Richmond Team began to adjudicate and manage mental disorder claims.

•  6 Case Managers initially (now expanded to 15), with case loads aligned by major employer versus geography.

•  Clinical support includes psychologists, physicians, nurse advisors and mental health specialists.

3


Changes to the Legislation Section 5.1 of the Workers Compensation Act

•  Under Bill 14, a worker may be entitled to compensation only if the mental disorder:

•  is a reaction to one or more traumatic events arising out of and in the course of the worker’s employment; or

•  is predominantly caused by a significant work-related stressor, or a cumulative series of significant work-related stressors, arising out of and in the course of the worker’s employment.

4

Additional Amendments Section 5.1 of the Workers Compensation Act

•  Other key changes: •  Replaced mental stress with mental disorder

•  Replaced references to physician with psychiatrist or psychologist

•  Included a definition of psychiatrist and psychologist

•  Included bullying or harassment as an example of a significant work-related stressor

5

Section 5.1(1)(c) Exclusion Decisions of the Employer Examples in Legislation and WorkSafeBC’s policy: •  a decision to change the work to be performed or the working

conditions

•  to discipline the worker

•  to terminate the worker’s employment

•  decisions of the employer relating to workload and deadlines, work evaluation, performance management, transfers, changes in job duties, lay-offs, demotions and reorganizations

6


A collaborative and team based approach to adjudication and claim

management

Adjudication and Case Management Model •  Only basic information taken when claim first registered.

•  CM completes a comprehensive worker history interview.

•  RTW Nurse Advisor is engaged to explore return to work opportunities even before claim is accepted.

•  Early use of RTW NA and VRC allows CM to focus on claims management issues.

Taking a Proactive Approach

8

Adjudication and Case Management Model •  New psych assessment contract stipulates 10 days turn-around

time (from date assessment is booked to report received)

•  This assessment is reviewed by the CM with the assistance of a Senior PA in a team meeting setting.

•  Both the Sr. PA and Board MA will provide guidance on the appropriateness of any treatment recommendations made, including medication or therapy.

Clinical Support

9


Regular Team Meetings Charting a Recovery and RTW Strategy •  Team meetings are held twice weekly. In attendance are:

•  Case Manager

•  Vocational Rehabilitation Consultant

•  Return to Work Nurse Advisor

•  Mental Health Specialist

•  Sr. Psychology Advisor and Board Medical Advisor

•  Case Manager Supervisor and Client Services Manager

•  Recovery and RTW are explored simultaneously. All individuals present bring their specific skills and role to the table.

10

Regular Team Meetings Monitoring Progress & Supporting the Worker •  Early Vocational Rehabilitation Consultant (VRC) involvement:

•  No expectation that worker RTW where workplace or duties are unsafe or deemed unsuitable

•  Early intervention to improve successful & durable RTW.

•  Encourages the worker to start thinking about a RTW as part of their recovery, and not a separate phase or stage.

•  MHS evaluates workers that self-identify as being fragile or express suicidal ideation. Completes a risk assessment and, where necessary, refers for CIR or to community resources.

11

Adjudication Process Map

12


Benefits of Team Based Approach Improved Troubleshooting Capacity

•  Improves chances of identifying barriers, either in treatment or in a RTW, early and removing them in a timely manner.

•  The MHCU works closely with Prevention to address safety concerns that workers raise in their workplaces.

•  Work closely with Health Care Services to provide feedback about what treatment interventions are proving effective.

•  Management presence in meetings allows for early identification of systemic issues that need to be raised in different forums.

13

The Numbers

Mental Disorder Claims Summary

Psychological Injury Only Claims by Registration Month

15

• • 

• • 

0

40

80

120

160

200

240

280

2009-05

2009-07

2009-09

2009-11

2010-01

2010-03

2010-05

2010-07

2010-09

2010-11

2011-01

2011-03

2011-05

2011-07

2011-09

2011-11

2012-01

2012-03

2012-05

2012-07

2012-09

2012-11

2013-01

2013-03

2013-05

2013-07

2013-09

2013-11

2014-01

2014-03

2014-05

2014-07

Psychological Injury Only Claims by Registration Month


Health Care and Social Services (7660) 1,336 26.68%

Transportation and Related Services (7320) 559 11.16%

Retail (7410) 445 8.89%

Accommodation, Food, and Leisure Service (7610) 406 8.11%

Public Administration (7530) 297 5.93%

Education (7650) 289 5.77%

Business Services (7620) 246 4.91%

Other Services (not elsewhere specified) (7640) 225 4.49%

Deposit Sector 11 (formerly Class 13) (8411) 165 3.30%

General Construction (7210) 140 2.80%

Wood and Paper Products (7140) 106 2.12%

Metal and Non-Metallic Mineral Products (7120) 94 1.88%

Professional, Scientific, & Tech Service (7630) 75 1.50%

Wholesale (7420) 53 1.06%

Food and Beverage Products (7110) 44 0.88%

Road Construction or Maintenance (7230) 44 0.88%

Other 259 5.17%

Not Specified (9999) 224 4.47%

MHCU Claims – Top Subsectors Claims registered July 1, 2012 – July 31, 2014 Subsector Count Percent

16

Acute Care (766001) 410 30.69%

Long-Term Care (766011) 226 16.92%

Ambulance or First Aid Services (766004) 151 11.30%

Counselling or Social Services (766007) 147 11.00%

Community Health Support Services (766006) 145 10.85%

Residential Social Service Facility (766017) 92 6.89%

Short-Term Care (766019) 30 2.25%

Life and Job Skills Training (766010) 27 2.02%

Medical Clinic or Medical Practice (766015) 22 1.65%

Retirement or Seniors' Home (accom only) (766018) 21 1.57%

Dentistry or Ancillary Dental Services (766008) 18 1.35%

Alcohol or Drug Treatment Centre (766002) 15 1.12%

Religious Organization (766016) 11 0.82%

Physiotherapy or Occupational Therapy (766014) 6 0.45%

Optometry (766013) 5 0.37%

Other 10 0.75%

MHCU Claims – Health Care Subsector

17

Claims registered July 1, 2012 – July 31, 2014 CU Count Percent

Allowed 747 14.92%

Disallowed 2,263 45.20%

No adjudication required 373 7.45%

Pending 307 6.13%

Rejected 27 0.54%

Suspended 1,290 25.76%

MHCU Claims – Eligibility Decisions

18

Claims registered July 1, 2012 – July 31, 2014

Claim Eligibility Decision Count Percent


Claim Scenarios

Scenario

•  A manager in a retail store reports what she describes as a campaign of harassment by the new district manager (DM) since the latter’s appointment six months earlier.

•  A detailed history is taken by the CM. The worker does not report any abusive or threatening behaviour, but indicates that she is having trouble sleeping and focusing because her continued employment is under review by the DM for the next 3 months.

•  The manager describes feeling singled out and targeted by her DM for bi-weekly meetings. The meetings are tense and unfriendly, but there is no yelling or swearing or other abusive conduct.

20

Scenario Continued

•  Both the worker and the employer agree that the subject-matter of the meetings is limited to the manager’s team’s sales, salary and overtime costs, its absenteeism and its contribution to corporate profits.

•  The employer denies the manager has been singled out and says that she is one of three managers who receive “regular performance coaching” because their teams are performing below expectations.

•  The DM acknowledges that the worker is exhibiting signs of being under intense pressure, but says the “coaching” sessions are necessary to ensure the success of the manager’s team.

21


Questions & Answers



WorkSafeBC PABC Physiotherapy Agreement Q & A panel

Gabi Jacobson, BSc, MSc.PT

Gabi Jacobson has been with WorkSafeBC since 2011, first as a Quality Assurance Supervisor and currently as a Program Manager with Financial Services and Health Care Programs. Gabi completed her Bachelor of Science degree at UBC in 2002 and then went on to complete her Master of Science degree in Physiotherapy at the University of Toronto in 2006. Prior to joining WorkSafeBC, Gabi worked as a physiotherapist in occupational rehabilitation programs with a focus on head injury and vestibular rehabilitation.

Karen Takai, BSc (Biochem), BSc (PT), MSc (Rehab Sciences)

Karen began working with WorkSafeBC in 2013, after practicing as a physiotherapist for 13 years in the community. She is a Quality Assurance Supervisor for the Physiotherapy Program with Financial Services and Health Care Programs (along with other programs including the Pain Management Program and the Recovery and Return to Work Pilot Program).

Karen’s clinical experience includes orthopedics and occupational rehabilitation programs, neurological and vestibular conditions, as well as rehabilitation program development and management, and implementation of outcome measures and evidence-based practice in the clinic. Karen completed her Bachelor of Science degree in Biochemistry in 1997, her Bachelor of Science degree in Physiotherapy in 2000, and went on to complete a Master of Science degree in Rehabilitation Sciences in 2006.

Jamie MacGregor BSc (PT), BSc (kin), CHT

Jamie MacGregor is a Physiotherapist and Certified Hand Therapist, and the Physiotherapy Association of British Columbia’s WorkSafeBC Liaison. A partner in Priest Valley Manual Therapy Centre, and owner of Okanagan Hand Therapy in Vernon, BC, Jamie has been working in private practice orthopaedics for the past 16 years with an emphasis on hand and upper extremity rehabilitation over the past 10 years.

Jamie has been a member of the PABC Business Affairs Committee, and WorkSafeBC liaison for the past 6 years. As


PABC-WorkSafeBC liaison Jamie works with physiotherapists and WorkSafeBC officers in addressing treatment model concerns, developing stronger relationships between physiotherapists and WorkSafeBC, and developing new treatment models for injured workers. Jamie has been very involved in the development, negotiations, and roll-out of the new Physiotherapy Treatment Services model with PABC and WorkSafeBC, and continues in his role as liaison to work on helping the model evolve.

Breakout session: Physiotherapy Agreement Q&A Panel Informal Session (Optional)

Notes


Thank you to all conference sponsors, exhibitors, and attendees for your support of the conference.


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