We asked 14 learned Chiefs from hospitals, health regions, LHINS, CCAC, and a Medical School to tell us what issues Jeff Lozon and Christina Bisanz should address at Breakfast with the Chiefs on Wednesday March 2, 2011.

Here, unedited and in alphabetical order are their responses:

1. Any interest in virtual ward type projects?
2. Are CCACs making system integration better or worse?  And, from the patient’s perspective, is system navigation better or worse?
3. Are we putting too many frail elderly into LTC homes rather than using other community options?
4. Closures for "infectious outbreaks"
5. Do they feel their clients are well served by physicians in LTC?
6. For Jeff - given your previous role as a Deputy Minister and your current role as CEO of Revera what are thoughts about the regulatory framework for long term care and residential care?
7. Holding beds for clients returning to hospital
8. How are the elderly managed through the primary, hospital, home, and long term care network and can this management be improved.  Who is responsible for the elderly person and could this be better coordinated.
9. How can the long term care sector help to reduce referrals to Emergency Departments – and further, reduce admissions to acute care hospitals?
10. How can the long term care sector take a leadership role and help reduce ALC (alternative level of care) in the acute care hospital sector?
11. How can we achieve a better system for aging in place?
12. How could LTC be better integrated with the primary care system?
13. How should we address the [real or perceived] shortage of community-based long term care services / capacity in the wake of the growing proportion of ALC patients in Ontario hospitals?
14. I would suggest something perhaps about how hospitals and long term care organizations might better work together to keep people in their own homes.
15. Key issue of Flow and intake.
16. Maximizing levels of care.
17. Medication review.
18. Mmm! I think that the big issues are that LTC is not part of the public insurance system; we don't have a clear policy and vision for its role and function; capacity is an issue...  and LTC is a crucial part of the continuum of care...a key enabler for patient flow from hospitals etc. So what I would like them to address is:
19. Setting priorities…who gets access…i.e. from the community vs. from the hospital
20. Should there be changes to the funding / reimbursement models in the system to support your vision of system transformation?
21. Supporting end of life care and minimizing use of ER's.
22. The difficult patient…e.g. smokers, behavioural disorders
23. Thoughts about partnerships
24. Week end acceptance
25. What is appetite for expansion of ER/LTC collaboration in preventing transfers to ER from LTC (a la TWH project)?
26. What is the long term view and vision from the LTC industry as to the optimal role for LTC in the system and changes need to be made to enable that...at a system and policy level. What is the industry doing to effect those changes, what can we do?"
27. What is the private / public mix that can best develop and sustain the needs of aging and seniors in Canada?  [I recall a statistic that indicated that Canada “puts” more seniors in institutional settings sooner and longer than many jurisdictions]
28. What strategies might P3 relationships play within the healthcare system as we seek to provide better care for seniors and/ or chronic disease management?
29. Who does the evaluation and are admissions to beds controlled by a central agency with uniform protocols of evaluation.
30. You could ask the speakers to look at the continuum of care for the elderly and how the patient moves from the hospital to the home or long term bed when needed. 

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