Healthcare Quarterly, 5(4) June 2002: 88-91.doi:10.12927/hcq..16505
Profile
Camille Orridge
Abstract
In her first job in Canada after leaving Jamaica, working as a ward maid at Toronto General Hospital in the late 1960s, Camille Orridge was bitten by the healthcare career bug. She then became a Medical Records file clerk at Toronto Western Hospital. After taking a correspondence course through the Canadian Hospital Association, she received certification as a Health Record Technician. Now, as Executive Director of the Toronto Community Care Access Centre (www.torontoccac.com) since 1997, Camille has a staff of 308, service contracts with 33 organizations and oversees a budget of $73 million. She's been front and centre with media lately, in changing regulations in coordinating home, palliative and school community health services and placements in long-term care facilities. The TCCAC is the primary point of access and referral in health services provided by Canada's most populous city, and Camille is working amid massive shifts in healthcare delivery nationally and provincially to ensure community care is a key player.Prior to the TCCAC's organizational name change from the Home Care Program for Metropolitan Toronto, the largest single provider of home-care services in Canada, Camille was its Senior Vice-President. After graduating with a Master of Health Science from the University of Toronto in 1983, she joined North York General Hospital as a Manager, in two positions until her 1986 move to home care. She holds a BSc in Medical Record Administration from Viterbo College in Wisconsin, and is a Certified Health Executive, Canadian College of Health Service Executives. Camille has worked with many volunteer organizations and boards, most notably Regent Park Community Health Centre, and in 1999 was given the Leadership Achievement Award from the Society of Graduates in Health Administration at the University of Toronto.
Under Camille's leadership, the TCCAC instituted new regulations on May 1 so clients now have 24 hours to decide whether to accept a bed, with the bed held for five days, up from three under the previous policy. If clients decline or defer, they now must wait six months to reapply, a policy of concern to those working with seniors since deterioration can occur quickly. Given recommendations for national home-care services and long-term facilities are in Roy Romanow's Future of Healthcare report to be released later this year, this issue has national significance. We welcome Camille's thoughts on this and, of course, as with all our profiles, her unique personal reflections and insights.
Your career is largely in administering community health
services. Why is this aspect of health intriguing?
Working in the community sector is congruent with my own values and
politics. I'm one of those very fortunate people who love their
work. I've always felt a need and responsibility to be active in
the community and consider myself fortunate in being able to
contribute. It's very gratifying to feel you can make a difference.
As well, the TCCAC has cultivated staff dedicated to the community
and this enhances our shared commitment and enjoyment of our work.
Being active in my community is an essential part of who I am. My
volunteer activities reflect my commitment, and did not always
directly involve either healthcare or what's considered mainstream.
I was a founding member of the Canadian Home Care Association, the
Black Coalition of Aids Prevention and served on boards of Regent
Park Community Health Centre, Pedahbun Lodge and Immigrant Women's
Health Centre. When I first got involved in AIDS work, it was still
low profile in community activism; home care responded early to
providing services for the AIDS population.
Greater Toronto is served by six CCACs: Scarborough, North York, York, East York, Etobicoke and Toronto. Our community is defined by boundaries of the old City of Toronto. Ours is arguably the most diverse area of the city with clients representing a broad range of countries of origin, ethnic and cultural groups, languages, economic situations from very wealthy to those in poverty, and wide variations in health status. Providing services is interesting, challenging and, most of all, rewarding.
Since most don't actively choose to be consumers of
healthcare delivery, how do you choose whether to call people
clients, customers or patients?
The manner in which we communicate is a vitally important aspect of
our presence. Much of our work is conducted in the homes of people
whom we refer to as our clients. We're guests in their homes, and
the words we use must convey our recognition of this fact. We may
have knowledge, but the clients have the power in their own homes,
and we respect that they've chosen us as their provider of health
services.
You give information sessions and post 13 languages on your
website, but it's still difficult for many to understand how the
TCCAC operates. How do you connect with the silent and
hard-to-reach?
Since our community is so extensive and diverse, we're well aware
there are groups that may get overlooked. Attempting to reach
groups by encouraging representatives to serve on boards or
committees isn't really effective because you don't really get the
voice of the community, but rather one voice, generally that of a
well-educated, English-speaking activist. We don't want to limit
ourselves to these viewpoints. This is why we put so much effort
and energy into community outreach initiatives. We scan the
community and, each year, target specific areas on which to
concentrate outreach activities. We also invite representatives
from a wide range of our population to participate in focus groups.
These individuals represent specific target populations …
ethnic or cultural groups, senior clients and their families,
caregivers of all ages, health professionals in the community, etc.
We don't want to be limited to the views of articulate activists
only.
The goal of Regent Park's Community Succession Mentorship
Program (www.regentparkchc.org) is to
stimulate career development so children will become doctors,
nurses, health professionals and administrators. How's it
doing?
The Community Succession Mentorship Program for children grades 8
through 12 is part of Pathways to Education that provides
educational, social and financial supports to economically
disadvantaged at-risk young people in the Regent Park community.
The first cohort is now completing grade 9, and results to date
offer compelling reasons for optimism. Data gathered certainly
shows support provided is making an important difference to these
students. However, healthcare organizations could give this program
a huge boost by developing initiatives by offering volunteer
training and work opportunities. They could provide summer
employment for these students. Hospitals are always talking about
being part of the community, yet rarely can they point to a program
that directly benefits the community. Well, here's their chance! We
worry about recruitment … well, here we actively encourage
healthcare careers among these young people. These are kids who
reflect the diversity of our community and an employment pool for
the future. These are excellent programs that truly make a
difference and we in the healthcare sector should be giving them
our full support in whatever way we can. These are the long-term
initiatives that are so needed in today's healthcare system.
Another program is Parents for Better Beginnings, aimed at
parents and young children. How does this lead to better health -
perhaps also reduced health costs - illustrating that spending on
community services is good for the system?
One really frustrating aspect of our system is its continuing
emphasis on "sick care." There's little emphasis on changing the
flow downstream. The Regent Park Programs make a difference
upstream by focusing on the child when real health promotion can
truly make a difference. Social determinants of health are now well
known, yet little has been done to put this knowledge into action
for change. Parents for Better Beginnings is a primary prevention
program in partnership with community organizations and residents'
groups to promote positive development in children. It encompasses
a series of programs offering pre- and post-natal support, parent
education, language and communication courses, playgroups, parent
relief, outings/trips and workshops on life skills and other areas
recommended by the community. These help to minimize risk factors
that create serious social, emotional, behavioural, physical and
cognitive problems and introduce protective interactions and
activities that support development of healthy babies, healthy home
environments, positive child/adult interaction and increased
self-esteem in children. The end result is healthier children and a
first step in refocusing from "sick care" to health promotion.
With some 8,000 Torontonians waiting for a nursing-home bed
and situations that can deteriorate rapidly, how crucial is
coordination of home care in helping people to stay in their
homes?
Most people would prefer to stay out of institutions altogether.
The health continuum ranges from healthy, active and independent
through to illness, frailty and, ultimately, dependence. Healthcare
should reflect this complete continuum. However, there's a
fundamental weakness in the system that allows only two choices:
stay in your home or long-term care facility. Of course, there are
retirement homes, but these are limited to the small sector of the
populations able to afford them. The missing link is supportive
housing. Home care tries to support clients in the home as long as
possible, but there's a cap on services. Those with more bountiful
resources are able to stay in their homes longer than those with
only minimal reserves. There should be a policy to allow funding of
additional support in the home, up to what it would cost to support
the individual in a nursing home.
Is the hope that with increased coordination, the deferred
option will evaporate?
The deferred option for long-term care beds was not government
policy, but initiated by CCACs to help people who wanted to stay in
their homes as long as possible. However, with the advent of the
MDS standardized assessment, the new lists more accurately pinpoint
those who truly need long-term care facilities. And that, in
itself, should lead to shorter waiting lists.
If people turn down a bed, thinking it may be too soon for
institutionalized care, doesn't this actually penalize them for
attempting to stay or care for others at home?
The introduction of the new regulations and planned implementation
of MDS-HC as the common assessment tool for the province will
result in clients being deemed eligible when they are in immediate
need for a long-term care bed. What's missing from the system is
the ability to plan for one's future care. A couple can move into a
retirement home adjacent to an affiliated facility to accommodate
aging in place. They can no longer have themselves placed on the
LTC facility waiting list. If they are hospitalized with a stroke
and cannot return home, there is no guarantee where they will be
placed while waiting for their first-choice bed. On the other hand,
if individuals who can afford retirement homes get first choice and
preference for affiliated LTC facilities, then others and
particularly those from disadvantaged groups would not get in. One
possible solution may be that every third admission to these LTC
facilities be from the retirement home.
Is this policy change evolutionary? With the new system and
beds (increasing from 60,000 to 74,000 by the end of 2004), what do
you see in future for CCACs?
CCACs should become agencies whose key role is client assessment
and the development of service plans. They would be responsible for
determining client eligibility for the entire spectrum of services
including in-home care, adult day programs, supportive housing and
complex continuing care.
A 1999 TCCAC report predicted a disaster in community care,
based on a human resource shortage and increasing demand. Was this
addressed?
We're certainly experiencing a human resource shortage in
healthcare, and it will get worse over the next five years as
health personnel retire. The situation will be further exacerbated
as new long-term beds come into the system and personal support
workers are pulled from the community into institutions. The human
resource crisis will continue until we effectively deal with
disparity in wages and working conditions between community and
institutional sectors.
One website survey on the Future of Healthcare commission
solicits views on home-care funding. What's the best-case scenario
you foresee for national changes?
I hope the government develops a national home-care strategy. Such
a strategy would determine how we define healthcare, home care and
health maintenance. Many procedures previously done in hospitals
are done as day surgery procedures, with post-surgical care and
recuperation at home. Health should be funded universally, wherever
it's delivered. Health maintenance programs should be provided to
all Canadians, with cost-sharing as an integral factor. It would
involve such services as cleaning and laundry and would be based on
a sliding scale so people pay according to their means.
How does your organization assist with providing urban health
services?
We learned in treating the homeless and other marginal populations
that it's more effective to partner with agencies and organizations
in the community that have established a relationship. We then take
our services to those who need them in their own environment, thus
giving them a measure of control. We must recognize that equitable
access to care is distinctly different from equal access to care.
Services and educational materials must be designed to ensure
equitable access. For some populations, you must initiate specific
steps to bring them into the healthcare system. A prime example is
hospitals: they offer equal access, but if they offered equitable
access, they'd provide services on evenings and weekends for those
unable to go weekdays between 9 a.m. and 5 p.m. Wherever and
however we deliver services, equitable access requires we take that
extra step. One step forward in providing equitable service is to
ensure our workforce accurately reflects our community.
What's your favourite speech topic?
I most enjoy talking about how we can make a difference in the
lives of children and how we can truly practise health promotion in
a way that has huge payoffs for young people.
Do you have fun at work?
Yes, I do indeed! I consider myself fortunate because my work is so
in keeping with my values and beliefs. My work is very gratifying
because it often affords me the opportunity to make a knowledge
transfer, to pass on what I've learned to the next generation and
to help them define their places in the world. I am privileged to
work with a great bunch of dedicated individuals who share an
amazing, sometimes irreverent, sense of humour.
What would you do in a one-year sabbatical?
No question about it; I'd spend it in Africa! I'd first go to West
Africa for a few months, where I'd like to work with women on
development issues. This would allow me to fulfill my fierce desire
to learn African dance and indulge myself in the clothing. Next I'd
go to South Africa to enjoy the spectacular beauty of the land and
immerse myself in the music. The final months I'd spend in East
Africa on safari, going out in the day and returning to lovely
lodges with all the modern amenities. There is nothing whatsoever
in my genetic make-up that would tempt me to take part in any sort
of "roughing it" or camping experience.
What book(s) are you reading?
John le Carre's The Constant Gardener. My reading tastes
encompass black literature, spy and mystery novels and science
fiction.
What do you do for fun?
I love to visit cafes and restaurants, from very expensive to tiny
establishments, places little more than a hole in the wall.
Toronto's wonderful multiculturalism is reflected in the
availability of dishes from every corner of the world, and I love
to try them all.
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