Monday, September 17, 2018

Health system fails to provide quality care for seniors

It's clear the status quo isn't meeting the needs of our aging population. So what can be done?

By Ruta Valaitis
and Maureen Markle-Reid
EvidenceNetwork.ca
Despite having diabetes and arthritis, Verne was a thriving independent 72-year-old who lived at home with his wife when he had a stroke. He had excellent emergency care in the hospital and began his recovery there. But he didn't adjust well after arriving home. He started to show signs of depression and was at risk of re-hospitalization.
Verne feared he would have another stroke as he waited for follow-up appointments with neurology, physiotherapy and speech pathology. He had difficulty remembering to take his new medications and adapting to using a walker.
Ruta Valaitis
Ruta Valaitis
Transitioning home from hospital is challenging for older adults with multiple chronic conditions. Home-care services are often not available or inadequate. And followup care from doctors or specialists is too often infrequent or involves juggling multiple appointments over long wait periods.
Add to this the challenge of managing complex health conditions and the risks for depression and recurring poor health and hospitalization are high.
Unfortunately, Verne's experience is not uncommon.
The 2016 State of Seniors Health Care in Canada report from the Canadian Medical Association (CMA), highlights a key problem: our medicare system was established to deal largely with acute, episodic care for a relatively young population.
Today, our system struggles to care properly for patients managing multiple ongoing health issues. We know older adults with chronic conditions need more health services and have a higher risk of hospitalization compared to those with a single chronic condition.
Adults 65 years and older are the fastest growing age group in the country. In Ontario, 16.7 per cent, in British Columbia and Quebec 18.3 per cent, and in Nova Scotia 19.9 per cent of the population is 65 years or older.
Maureen Markle-Reid
Maureen Markle-Reid
Multiple chronic conditions among older adults are increasing. Approximately 75 to 80 per cent of Canadian seniors report having one or more chronic condition, such as diabetes, asthma, arthritis, high blood pressure, mood disorder and chronic obstructive pulmonary disease (COPD).
Like Verne, these patients face several challenges in managing their conditions. A lack of care co-ordination amongst health professionals combined with low health literacy gets in the way. Their care is piecemeal and fragmented, with little focus on the patient and family as a whole. Limited financial resources to cover the costs of supplies, additional care and transportation also create barriers to self-management.
These seniors often experience loneliness. Their family caregivers often lack support. Managing multiple, often interacting medications is also difficult.
So what can be done? We asked seniors to find the answers.
As researchers with the Aging, Community and Health Research Unit at McMaster University, we're working with older adults with multiple chronic conditions and their family caregivers to promote optimal aging at home.
Community Assets Supporting Transitions (CAST) is a new hospital-to-home transitional care program in Sudbury, Burlington and Hamilton that aims to reduce depressive symptoms, improve patients' quality of life and self-management ability, and support family caregivers. CAST is delivered by registered nurses who support patients transitioning from hospital to home over a six-month period through in-home visits, telephone follow-up and care co-ordination.
There's also a community-based diabetes self-management program in Ontario, Quebec and P.E.I. that was developed for older adults with diabetes and multiple chronic conditions. The program includes monthly wellness sessions, and a series of home visits with a registered nurse and a registered dietitian. They work as a team with staff and volunteers from seniors centres or YMCAs to deliver a health promotion program for participants.
We've also been creating a new way of providing outpatient stroke rehabilitation services for older adults with stroke and multiple chronic conditions living in the community. We provide regular in-home visits for the patient and monthly interprofessional care conferences for the providers. We also developed a new web-based app, MyST (My Stroke Team), to support communication and collaboration among the interprofessional stroke team.
Clearly, the status quo isn't meeting the needs of our aging population and fails to provide quality care for seniors. Creating innovative pilot projects to improve the transition from hospital to home will help us provide a better system that's both more efficient and cost-effective, and will improve the standard of care to seniors like Verne.
Dr. Ruta Valaitis is a professor McMaster University School of Nursing, the Dorothy C. Hall Chair in Primary Health Care Nursing and co-scientific director of the Aging, Community and Health Research Unit and a contributor with EvidenceNetwork.ca, which is based at the University of Winnipeg. Dr. Maureen Markle-Reid, is a professor McMaster University School of Nursing the Canada Research Chair in Person-Centred Interventions for Older Adults with Multimorbidity and their Caregivers and co-scientific director of the Aging, Community and Health Research Unit.


Thursday, September 13, 2018

Chicken Pot Pie

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Tuesday, September 11, 2018

One of the biggest offshore corporate tax-avoidance cases in Canada

Loblaws in $400M tax fight with CRA over claims it set up bogus offshore bank

Barbados transactions were designed to 'circumvent' the Income Tax Act, government alleges


A four-week-long Tax Court trial will weigh the government's claim that Loblaws took steps to have a Barbados-based subsidiary appear to be a foreign bank in order to avoid paying tax. (CBC)
A senior judge warned Loblaws and the federal government this morning that she would not look kindly on any further procedural delays in a $400-million battle the two sides are waging in Tax Court.
Loblaws and the government were in a Toronto courtroom in one of the biggest offshore corporate tax-avoidance cases in the country, with authorities alleging the grocery conglomerate set up a bogus foreign bank to avoid tax on hundreds of millions of dollars in investment income.
The case has been brewing since 2015 and is slated for a full trial in April — more than a year after the originally scheduled start date, due to a series of procedural squabbles.
"I do not want to have to adjourn this again," Associate Chief Justice Lucie Lamarre cautioned both sides on Wednesday. 
At stake for Loblaws is a huge potential tax bill: $404 million, including interest, penalties and provincial income tax, according to documents related to the case.
"These are all big numbers," said Peter Baek, a Toronto tax litigator and former senior CRA auditor experienced with offshore tax rules.  
Loblaws is facing scrutiny on other fronts as well, including its recent admission to a price-fixing scheme on the sale of bread in Canada, as well as revelations in the Paradise Papers exposing the company's use of offshore havens to shield profits.  

'Circumvent the rules'

The tax battle has its roots back in 1992, when Loblaws incorporated a regular offshore company in Barbados initially called just Loblaws Inc. A little over a year later, the subsidiary changed its name to Glenhuron Bank Ltd. and obtained a Barbados banking licence.
Loblaws funded Glenhuron Bank largely with money from other arms of its global grocery business. Glenhuron Bank then used the money to invest in financial derivatives including interest and currency swaps, earning hundreds of millions of dollars in income.
Normally, those profits could legally avoid income tax in Canada under an exemption for the investment earnings of Canadian-owned foreign banks.

The name of Glenhuron Bank Ltd., the Loblaws subsidiary at the centre of the trial, is listed on the directory at the CGI Tower in Warrens, St. Michael, Barbados, as seen on 13 December 2010. (CaribDigita/Wikimedia Commons)
But not so fast, auditors for the Canada Revenue Agency said as they reassessed the 2001 to 2010 tax filings of Glenhuron Bank's Canadian parent, another Loblaws subsidiary. They determined Glenhuron Bank, known as GBL, shouldn't qualify for the exception.
"GBL's activities did not constitute banking or a banking business," the government alleges in its court filings. "GBL was not in the business of providing financial services."
The filings claim Glenhuron Bank got its seed money from "the diversion" of more than $470 million US from other Loblaws entities, in the Netherlands and in Delaware. If that money had stayed in the hands of those entities, any earnings would have been taxed, the government claims.
What's more, the government alleges Loblaws deliberately swapped the name of its Barbados entity from Loblaws Inc. to Glenhuron Bank, and then applied for a banking licence, solely "to obtain tax benefits."
"The purposes of the series of transactions... were to have GBL appear to be a foreign bank in Barbados in order to circumvent" parts of the Income Tax Act, filings state.

CEO Galen Weston named

Loblaws denies all those claims, saying Glenhuron Bank legitimately qualifies as a regulated foreign bank under the Income Tax Act and the Bank Act.
"Glenhuron Bank was a regulated foreign bank that earned income outside of Canada. Canadian tax policy and law says that the income of regulated foreign banks is not taxable in Canada," the company said in a statement Tuesday evening. "Therefore, our position is that Glenhuron Bank's income was not taxable in Canada. The CRA disagrees."
The case is set for a three-week trial this spring, after more than a year of procedural wrangling.
The government at one point claimed that a vice-president at Loblaws parent company George Weston Ltd. "was unable or unwilling to answer many questions" during pre-trial discovery hearings. Later, a judge was brought in to referee during one of the discovery sessions — a rare but not entirely unusual step.
At another point, a judge "express[ed] alarm" during a pre-trial conference at the number of unresolved questions between the government and Loblaws, according to minutes in the court file.
Finally, in November, the government filed a motion demanding that Loblaws go to the top, to billionaire CEO Galen Weston Jr., to get answers to some of its pre-trial discovery questions about "the purpose for which GBL was established and the activities of GBL during the years at issue." The government ended up withdrawing its motion after Loblaws provided additional information.
Tax lawyer Baek said the back and forth is not surprising.
"I can see how, especially with the amount they're looking at here, there could be lots of procedural fighting."

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Monday, September 10, 2018

Why are consumers going meatless?

A strong economy gives us the time and money to think about the ethical, environmental and moral implications of our food choices

By Sylvain Charlebois
Senior Fellow
Atlantic Institute for Market Studies
Sylvain Charlebois
Sylvain Charlebois
It seems the pleasure of eating is being overpowered by values-based food consumption. And it's happening at an astonishing pace.
Vegetarianism and veganism are coming into their own, allowing more people to 'come out of the cupboard' to speak openly about and affirm their commitment to a self-imposed diet. They're doing it for animal welfare, the environment, health - whatever factor is deemed personally important.
But make no mistake, this trend is an indication that the economy is strong.
Human psychology shows us that consumers traditionally indulge, ironically perhaps, in times of uncertainty. Fear of food insecurity is very powerful. Consumers who lose their job, for example, often treat themselves to sweets and other unhealthy offerings, just to forget about their reality for a while.
But it appears that healthy eating habits are winning over indulgence.
And once long-term food security is achieved, even if it's based on pure optics, many things can change.
The food security concept recognizes the importance of food quality in a general sense, including food safety, nutrition and health, as well as the experiential aspects of food shopping and consumption. This is likely where our economic cycle is now.
Years ago, food conversations were about flavours, tastes and traditions. Today, we talk more about morals and values linked to how we consume food, simply because we can afford to.
Stock markets are on a tear and the unemployment rate is nearing an all-time low. Food is not just about survival; it's about making a socio-economic statement as much as a moral one. At some social gatherings, people can be made to feel as though eating meat is a crime.
In the past, consumers recognized that they had limited ability to influence the choices they were offered. They doubted that even collective action would work to change those choices. And they made little connection between threats to global food supply and their daily consumption practices.
That's all changed, thanks to the abundance of free time we now enjoy.
Most of our time is spent looking at a screen of some sort. Technological advances, coupled with our pursuit of convenience, have given us a lot more time to think differently about food. Grocery shopping and cooking take less time than the pre-industrial practices of hunting and harvesting. And ready-to-eat food means we save even more time, which we can spend on developing a philosophical attitude toward food consumption.
Technology makes our lives simple, and with simplicity comes greater coherent thought and enhanced self-awareness as a consumer, particularly as a food consumer.
In response, the industry is adapting quickly. McDonald's is offering Big Macs without the meat and, according to some sources, the Beyond Meat Burger campaign at A&W is a great success. We've also seen changes in packaging and labels to appeal to the increasing number of consumers who are rejecting the status quo.
But it all really comes down to the state of the economy.
The unemployment rate is incredibly low, and according to human resources giant Morneau Shepell, salaries should go up by an average of 2.6 per cent over the next 12 months.
More money in consumers' pockets will allow them to believe they can trade up, or perhaps sideways, when making food choices.
Also enticing to consumers is a weaker than expected food inflation rate across the country. Food inflation remains more than one per cent lower than the general inflation rate.
However, grocers are indicating that prices will increase due to U.S. tariffs. While the rationale of raising prices due to tariffs is highly disputable, when grocers use financial updates to let consumers know prices may go up, it's a sign. Loblaw and Metro have done it and it wouldn't be surprising if Sobeys follows suit. Food inflation should reach 2.0 to 2.5 per cent by year's end.
But even with higher food prices, the buoyant economy allows more of us to think about the ethical, environmental and moral implications of our food choices.
And we can afford to - for now.
Sylvain Charlebois is dean of the Faculty of Management and a professor in the Faculty of Agriculture at Dalhousie University, senior fellow with the Atlantic Institute for Market Studies, and author of Food Safety, Risk Intelligence and Benchmarking, published by Wiley-Blackwell (2017).