1.0 Background

1.1 Historical Perspective

In 1915, the Government of Canada began building hospitals to treat injured and disabled Veterans of the First World War. As years went on, there was a growing number of Veterans with chronic service related injuries who needed more care as they got older. To respond to those needs, Veterans Affairs Canada (VAC) and its predecessors instituted programs and created Veterans’ facilities in response to the number of aging WW1 Veterans requiring long term care. VAC adapted its programs over time as the needs of Veterans changed and as the provinces began offering more services to their citizens.

In 1948, the federal government introduced a series of National Health Grants to directly provide funds to the provinces for hospital construction, professional training and public health.

In 1966, the Medical Care Act was introduced which established the formula by which the federal government transfers funds for hospital and health services provided by the provinces. This framework later evolved in 1977 and again in 1984 into what is now called the Canada Health Act.

In 1966, the Medical Care Act was introduced which established the formula by which the federal government transfers funds for hospital and health services provided by the provinces. This framework later evolved in 1977 and again in 1984 into what is now called the Canada Health Act.

Today, VAC works in cooperation with provinces, local health authorities, and long term care facilities to provide care to Veterans across the country. As of December 31, 2012, there were 8,727 Veterans in long term care being financially supported by VAC.

1.2 Sunnybrook Veterans Centre

The Sunnybrook Veterans Hospital was transferred to the University of Toronto in 1966. Over the years, the Sunnybrook Veterans Hospital has evolved to its current status as the Sunnybrook Health Sciences Centre, the largest single site hospital in Canada. Affiliated with the University of Toronto, it has become an internationally recognized acute care facility and research centre serving 1.2 million patients per year. In addition to Veterans, Sunnybrook offers specialized geriatric services to the community.

The Sunnybrook Veterans Centre (SBVC) provides care to 500 Veterans. Of the 500 beds, approximately half are dedicated for the care of Veterans with moderate to severe dementia which includes a specialized 10 bed unit for Veterans with severe dementia. The table below provides a summary of the profile.

Table 1 – SBVC Profile

Type of Beds	190 Nursing HomeFootnote1 310 Complex Continuing CareFootnote2
Type of Support	258 Physical Support 242 Cognitive Support
Annual Admissions	175 – 200
Gender	94% male, 6% female
Average Age	90 years

Source: Sunnybrook Veterans Centre

VAC provides funding in support of all 500 beds. For the 190 Nursing Home Care beds, VAC funds the full cost of care. For the 310 Complex Continuing Care beds, the province funds the care and VAC provides additional funding for “enhanced services”. Examples of enhanced services include: additional Registered Practical Nurses and Activity Aides, Recreation and Creative Arts Programs, Pastoral and Chaplaincy Services and an enhanced Dining Program.

1.3 Purpose of the Audit

In the fall 2012, some family members raised concerns related to: the quality of care provided, complaints being ignored, room changes without notice, and staffing levels. All areas of concern were investigated; however, family dissatisfaction persisted.

The Department’s expectation is that all Veterans will be treated with respect by any and all who serve them and will receive quality care in provincial long term care facilities. The seriousness of the concerns prompted the Minister to announce that VAC would conduct an audit of the SBVC. The purpose of this audit was to ensure that VAC, the Ontario Ministry of Health and Long Term Care and the SBVC were fulfilling their responsibilities as outlined in the terms of the agreements. Audit results identified some opportunities for improved service delivery; however, as presented in Section 3.1, the audit team does not have the authority to enforce recommendations involving provincial responsibilities. As a result, these opportunities for improvement have been discussed with SBVC and their responses are presented in this report.

Separate from the VAC audit, Sunnybrook Health Sciences Centre conducted an external review of the quality of care provided to Veterans. The results of this external review including recommendations for improvement were made public on February 20, 2013.

While this VAC audit is completely independent from SBVC’s external review, the two reports taken together provide useful information on the care being provided to Veterans.