Eldercare: Planning your Geriatric Future

For the Rotary Club of North Scarborough July 11 2012Presented by: Tabatha Bowers RN (EC) MN GNC(c) CMSN (C),

Nurse Practitioner Geriatrics

The Scarborough Hospital• Who we are:

– Two general hospital campuses and seven community based sites– 3,700 staff, more than 700 physicians and

800 volunteers– A diverse range of services across eight

patient care areas:• Cardio-Respiratory & Critical Care• Medicine & Specialized Geriatrics• Emergency & Urgent Care• Family Medicine & Community Services• Maternal Newborn & Pediatrics• Mental Health• Nephrology & Dialysis• Surgery, Orthopedics & Rehabilitation

The Scarborough Hospital

Some key figures (2010/2011 fiscal year)

General Birchmount Total

Beds 324 226 550

Emergency Visits 59,029 44,831103,860

Admissions 18,042 13,187 31,229

Births 2,683 2,204 4,887

Square footage 574,388 435,000 1,009,388

Geriatric Emergency Management Work with ED team and patient/family to try to maximize

independence, and maintain living at home for as long as possible. Geriatric Emergency Management (GEM) Nurse provides a

comprehensive, focused nursing assessment for frail, elderly clients that present to the Emergency Department.

Emergency department visits are often sentinel events for seniors, threatening loss of independence, health and well-being. Through provision of a GEM nurse assessment, decline and loss of independence can often be prevented or postponed.

Available at both campuses Monday to Friday from 0800-1600 hrs. Saw over 400 patients last year

GAIN Geriatric Clinic Geriatric Assessment and Intervention Network (GAIN) Geriatric clinic

opened in January 2011 Proactively delivers specialized geriatric care to frail seniors, allowing them

to stay in the community and avoid unnecessary visits to the ER Interprofessional clinic that is led by nurse practitioners and consists of

geriatricians, gero-psychiatrist, physiotherapy, occupational therapy, social work, pharmacist and CCAC

Goals are to improve outcomes for frail seniors and provide linkages to community resources

Since opening, we have seen over 932 seniors for a comprehensive initial assessment and have had 611 follow up visits

Based on current patient satisfaction surveys, 100% of patients who come to the clinic would recommend it to family and friends who may need similar services (33% response rate)

Acute Care for the Elderly Acute Care for the Elderly (ACE) units are available at both sites inpatient acute care program Our team works with these patients, enhancing and maintaining their

functional and cognitive capacity, so they are well enough to return to the community

Our goal is to ensure the wellness of our elderly patients helps to minimize the need to transfer patients to long term care facilities

Medical supervision works closely with the team, including nursing, physiotherapy, occupational therapy, social work, pharmacy, nutrition, and speech language pathology as required.

Our team works closely with each patient every day to discuss the benefits of meeting his/her goals and any challenges that may affect discharge planning.

• General campus - 416-431-8200 ext. 3180• Birchmount campus - 416-594-2574

Alternative Level of Care (ALC) Programme We developed our ALC programme to provide better outcomes

for our Alternate Level of Care (ALC) patients at The Scarborough Hospital

These patients are currently being co-horted on a medical unit, with the goal to maintain or enhance their mobility, functional ability and support cognition

This is done through an abilities focus of care and our VALUE programme which provides recreational therapy activities such as Pet Therapy, Bingo, one-to-one visiting with our specially trained volunteers

There are 2 family practice physicians and 1 geriatric nurse practitioner working in partnership to manage the medical care of these patients

NPSTAT Nurse Practitioners Supporting Teams Averting Transfers

(NPSTAT) is partnered with 14 long term care homes in Scarborough.

Their goal is to decrease the rate of transfer to local hospital emergency departments by addressing acute and episodic illness in LTC residents through nurse practitioner assessment, diagnosis and therapy.

They are available Monday to Friday 0800-1600 hrs and on-call

We currently have 2 nurse practitioners in this role To date they have seen 3041 with only 46 resulting in transfer

to ER

Senior Friendly Hospitals We are currently working with both the CELHIN and the Regional Geriatric

Programme of Toronto to work towards becoming a senior friendly hospital

The hospital is responsive to developmental issues of seniors: circumstances, abilities and needs of older individuals and their families arising from normal consequences of the aging process

Assimilation of gerontological principles, approaches and considerations into care delivery by taking into account normal aging changes, critical elements of clinical knowledge, patient-focused philosophy of care with corresponding team processes

We are doing this by reviewing our policies and accessibility throughout the hospital in order to improve the patient experience

Why be Senior Friendly? Ensures seniors have the opportunity to function at their

maximum level of independence at all times Physical environments designed to accommodate

physiological changes of aging can significantly reduce disability in the elderly experienced while in hospital

Functional impairments that are slow to improve by discharge increases risk of admission to long-term care facilities

Complications such as falls, adverse drug reactions that can increase morbidity and mortality can be prevented

Recognizes, promotes and enhances patients’ abilities to meet their own needs, solve their own problems and mobilize necessary resources to feel in control of their lives

Next Steps….

To continue to build partnerships with our community partners in order to better serve our patients

To further build our VALUE programmeTo work towards achieving a Senior Friendly

Hospital designation

Thank you!