Picture Seniors Health Services

Presentation to Health Advisory Councils

October 13, 2012

Cheryl Knight, Seniors HealthPrimary & Community Carecheryl.knight@albertahealthservices.ca

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Overview

Who are we?

What do we do?

What do we see for the future?

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Who are we?

• We are the Provincial team responsible for developing health delivery strategy for continuing care services

• We are one of three parts of AHS:– Strategy– Operations– Strategic Clinical Networks

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What do we do? All ages and all diagnoses

Continuing care and short term care services to older individuals and those living with chronic illness requiring assistance with health care needs

– At home– In community day support and health programs – In congregate living spaces– In designated supportive living spaces– In long term care facilities– In community hospice spaces

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Philosophy Leads Strategy

• 90% of Albertans want to live in their own homes even when their needs require continuing care health services

• ASH Goal - support people to remain as healthy, active, and independent as their abilities allow

• Key foundational element of the AHS plan for continuing care

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The Continuing Care System Touching Albertans ALBERTA POPULATION -

ANY GIVEN DAY – Home Care serves almost 68,000 unique individuals– Designated Supportive Living sites house and provide

hospitality and health services to ~ 8,000 people– Long Term Care Facilities house and provide hospitality

and health services to ~14,500 people– Day Programs provide support to ~ 2100 people– Community Hospice Beds provide end of life care to ~200

people

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Continuing Care is About Relationships

No matter where provided, continuing care is a sensitive health service – it is intimate, personal, and longer standing than most health services

Continuing care is provided through relationships – • between Operators, AHS, and Government at all levels• between Communities and Operators• between Clients and Families and Friends and Management

and Staff, Physicians, Community Pharmacists, and Volunteers

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Who provides continuing care?

Continuing care services are provided by • AHS

– Directly– Fully owned subsidiaries (Capital Care Group and

Carewest)

• Contracted Providers – Not for profit– For profit

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What can we expect of continuing care providers?

All providers are:

• Partner with AHS to provide safe quality health care

• Accountable to the same Health Services and Accommodation Standards

• Audited in the same manner

• Funded under the same funding model for the service type

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Regulations & Standards • Alberta Hospitals Act• Alberta Nursing Home Act• Alberta Public Health Act• Regional Health Authorities Act• Protection of Persons in Care Act

• Alberta Health Services Standards• Alberta Accommodation Standards for Supportive Living and

Facility Living environments• Alberta Infection Control Standards• Building and Fire Codes

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How do you get continuing care?All continuing care clients move through a “single point of access”

process – one process across the province

• Any one can be referred to or refer themselves to a centralized point of contact – an intake office/offices in the Zone

• Home care staff member calls or visits and talks to the person about the need for health services

• When the right service is identified, the recommendation is discussed

• A CASE MANAGER may be assigned to someone to help during all the transitions through the health system

• Common assessment instruments – examine unique individual through a common set of questions – RAI tools

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Long Term Care Facilities

Supportive Livingwith 24/7 Professional Nursing

Supportive Living with 24/7 Health Care Aide help

Assistance in Home Environments

Living Options and Care

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Home Care Programs• Provide services in the home to maintain health and safety

– Personal care– Housekeeping– In-home respite for family caregivers

• Working toward standardizing what you can expect to receive from home care – hours of service; 24/7 access

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Home Care Programs• Innovations

– Paramedics are helping people connect to home care – 2000 referrals in one year

– Nurses in the emergency room specifically to help people get home again with support – 3000 referrals in one year

– Mobile x-ray machine – could prevent 1,300 ER visit– Taking the position of “home first” before any other living

option is considered – Increasing spaces in Day Programs and Day Hospitals to

serve an additional 500 people over the next 3 years – Increasing professional resources – case mangers

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Congregate Living SettingsDesignated Supportive Living

• To provide the appropriate care opportunity to individuals who require a congregate living setting but do not require a more intense care environment

Facility Based Long Term Care

• To provide the appropriate intensive care services within a congregate living environment

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Supportive Living and LTC

• Provide degrees of health support in congregate settings – Respectful of person wishes and health goals– Address unmet needs and support the person to support

themselves

• Working toward a standard service delivery model – types of care and hours of care

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Supportive Living and LTC

• Innovations– Creating supportive living environments –

providing choice – Improving HCA competency– Creating LPN leadership– Creating new relationships between home care

and congregate settings– More than 2000 spaces added to continuing care

capacity in two years – goal is 5300 spaces

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System Level Activities

Service Needs Determination

Case Management

Integrated Information Management

Information and Exit

AssessmentService

Recommendation and Referral

Negotiation of Individual Service

OptionsTransition Discharge

Negotiation of Individual Service OptionsProcess by which continuing care services, settings and providers are matched to the individual’s evaluated needs.

Single Point of Entry

Service Delivery, Monitoring,

Reassessment

Inquiry for Information

Intake and Screening

Waitlist Management

Information and Referral to

Non-Continuing

Care Services

AssessmentProcess by which the unmet needs of the individual are determined.

Service Needs DeterminationProcess by which the assessed needs of the individual are evaluated.

Service Delivery, Monitoring, ReassessmentProcess by which client’s care is provided, reviewed and the care plan updated.

Intake and ScreeningProcess by which an individual enters the continuing care system.

Service Recommendation and ReferralProcess by which an agreement is reached regarding the chosen services, services provider and setting.

TransitionProcess by which transitions between services, settings or providers occurs.

Waitlist ManagementProcess by which waitlists are collected and managed.

DischargeProcess by which clients are discharged from continuing care.

Inquiry for InformationProcess by which an individual makes an inquiry for information about continuing care services.

Case ManagementProcess to manage the provision and coordination of care across the continuum and to balance potential client outcomes with effective use of available resources.

Integrated Information ManagementProcess by which information is collected in a way that minimizes duplication and optimizes information sharing between service sectors.

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Challenges in Service Delivery

Proportion of Individuals over 65 years of age in last 50 years

Statistics Canada, 2012

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Challenges in Service Delivery

Supporting People to Live at Home

• People want to live close to home if not at home• Older homes may not be “safe” – Simon Fraser studies• Older communities or smaller communities may have

inadequate infrastructure• Building a community program of universal access/safety• Adequate transportation

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Challenges in Service Delivery

Enough of the Right Kinds of Spaces and Staff

• AHS expects by March 31, 2011, we’ll have added between 1,200 and 1,300 continuing care spaces

• Goal – 5300 spaces by 2015

Challenges: • Capacity of owner/operators to meet shifting and increased

service delivery demands• Construction delays and costs• Staffing availability and sustaining competency

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Staffing – Enough of the Right People • Challenges exist at all levels

– Registered Nurses– Licensed Practical Nurses – Health Care Aides

• AHS has a workforce planning group

• Initiative on Health Care Aide recruitment in continuing care continues; will expand to acute care

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Considering Care – Decision Challenges

Coming to agreement – care is required

• Understanding of the person’s values, expectations, capacity, autonomy

• Understanding the personal support system• Understanding the public support system

– Community– Health services– Social support

• Philosophy of partnership

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Experience of Care

We all do our best, challenges exist

• Attracting staff to this level of work• Scheduling care around multiple individuals’ preferences • Keeping everyone safe

– environments (room size, equipment needs, dogs etc)– competency (training, performance evaluation)

• Maintaining an equal balance of authority/power – shared responsibility

• Providing medical services for disease or chronic conditions within the context of home

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So let’s talk

• What do you want from a continuing care system?

• What can we tell you to increase your confidence in the system?

• How do we make a social shift from institution to home; from paternalistic to partner?

I am interested in your thoughts