Good Care Counts: The Role of Geriatrics in the Health System Transformation Agenda Vida Vaitonis, D

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Good Care Counts The Role of Geriatrics in the
Health System Transformation Agenda Vida
Vaitonis, Director Home Care and Community
Support BranchOntario Ministry of Health and
Long-Term Care November 1, 2005
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Presentation Overview

• Government Priorities in Health Care
• The Strategy
• The Elder Person Framework
• Inspiring Ideas Innovation

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My Key Messages Today

• An Elder Health Framework is being created. It
  will identify essential elements that must be
  addressed in the development of provincial policy
  and integrated services for older persons
• Elder persons have played a central role in the
  development of the framework
• The result will be better integration of care
  and healthier lives for older persons

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Government Priorities in Health Care
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The Transformation Agenda

• Fundamentally transforming the system to make it
  accountable, sustainable, and provide better care
• Implementing transformation through four key
  priority areas
• Improving Access to Services and reducing wait
  times
• Creating Family Health Teams
• Improving Information Management
• Establishing Local Health Integration Networks
• Getting results for each dollar spent
• Helping people to stay healthy in the first place

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Transformation
Current State
Future State
Many hospital beds used as ALC
People move to the right care setting sooner
500 Additional Interim LTC Beds and 340
Supportive Care Beds
More acute care provided at home
More people hospitalized than needed
95,700 New Acute Home Care Clients
Fewer choices for end-of-life care
More end-of-life care at home
6,000 New End-of-life Clients
Fewer hospital admissions
High level of acute mental health hospital
admissions
78,000 New Acute Mental Health Clients
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Transformation
Current State
Future State
Enhanced care Fewer hospitalizations Fewer
contacts with law
Limited community options for Mental Health
Increase of Community Mental Health Clients
Served
Quality care and full public reporting
LTC Home quality challenges increase care needs
More LTC Home Nurses, Improved Care Standards
and Reporting
Bed distribution to meet local needs
Uneven distribution of LTC home beds
Systems Plan and Continuous Monitoring
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The Strategy
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Thinking Behind our Strategy

• Getting the right care, in the right place, at
  the right time, for the right person at the right
  price

Invest in programs that help people avoid
unnecessary hospitalization Help people come
home from the hospital sooner
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Alternative Levels of Care Strategy
Primary Health Care
LTC Homes
Hospitals
Care Mapping Case Management/FHT CCAC
NP Medication Management
Clinical Pathways Telehome care Medication
Management
CCAC NP Medication Management Placement Changes
1.46 B

HOME CARE
112 M New 05/06
CS 30.5M New 05/06 Total funding now 482.2M
Acute
Chronic
End of Life Care
Streamlined Case Management Procurement
e-Health Strategies CCAC Policy
Manual Specialized Geriatric Services
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The Elder Health Framework
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Background Elder Health Framework

• The Elder Health Care Coalition was formed to
  work on a framework that would identify essential
  elements that had to be addressed in future
  provincial policies
• Thirty organizations were represented on the
  Committee which was sponsored by the RNAO
  MOHLTC

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The First Coalition Report

• In January 2005, the Coalition published a
  document called Towards an Elder Health
  Framework for Ontario
• The document outlined three priorities for an
  Elder Health Framework
• Enhance Community Support for Elders
• Establish a comprehensive and integrated system
  of elder care
• Promote recognition of the true health potential
  of seniors

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Follow-Up from the Report

• MOHLTC has recently agreed to work on the
  following policy areas
• Chronic Care
• Accessible Transportation
• Assisted Living Services in Supportive Housing
• Elder Abuse

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Inspiring Ideas Innovation
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Inspiring Ideas Innovation

• Ontarios End Of Life Care Strategy October 3,
  2005
• Continue to Plan and Integrate Local Services
  (EOL Networks ? LHINS)
• Enhance Home Care (based on commitment for home
  care to reduce hospital pressures)
• Strengthen Volunteer Hospice Visiting Services
• Fund and Regulate Residential Hospices

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Inspiring Ideas Innovation

• Spousal reunification
• Amendments made to Regulations that allow for
  spouses to be housed in the same long-term care
  home
• Convalescent Care
• After leaving hospital, the program offers short
  stay services (up to 90-days), housed in
  long-term care homes, to people who need to
  recover the strength and functioning to return
  home

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Ontarios Eight-Point Plan
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The Eight-Point Plan

• 1. Serve an additional 95,700 acute home care
  clients by 2007/08
• 2. Enhanced integration between CCACs and Family
  Health Teams
• This initiative will help integrate and
  coordinate primary care
• CCAC Case Managers would be assigned to Family
  Health Teams
• Chronic disease management would be coordinated
• Clients would be screened to provide them with
  the right care, while preventing unnecessary
  institutionalisation

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The Eight-Point Plan

• 3. Introduction of a client-centred case
  management model
• Identify best practices and document the value of
  community care Case Managers
• Provide recommendations for increased
  efficiencies
• 4. Standardized and cost-effective client care
  through Community Care Access Centre client
  pathways
• CCACs will use a core set of client pathways
  with specific diagnoses and relatively
  predictable needs and outcomes
• Pathways specify timelines, categories, amount
  of care, and interventions
• Also specify intermediate and long-term outcome
  criteria

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The Eight-Point Plan

• 5. Changing the managed competition model for the
  procurement of client services in CCACs
• October 4, 2004 The government announced that
  the Honourable Elinor Caplan would lead an
  independent review of the competitive bidding
  process for home cares services
• We are currently reviewing the recommendations
• 6. Pharmacists roles in medication management in
  home care
• The medication management initiative would
  prevent complications due to incorrect medication
  use
• It would involve collaboration among home care
  service providers, pharmacists and Family Health
  Team physicians
• Eight CCACs have voluntarily developed medication
  management initiatives

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The Eight-Point Plan

• 7. Expanded role for nurse practitioners in CCACs
  
• Nurse practitioners will support and sustain
  acute hospital replacement efforts by
• Managing acute episodes in chronic illness
• Supporting health promotion and disease
  prevention activities
• Supporting early hospital discharges to community
  services and/or long-term care homes
• Participating in hospital avoidance strategies
• 8. Introduce telehomecare technologies to
  alleviate hospital pressures 
• Telehomecare technologies can help monitor
  clients progress by enabling health providers to
  virtually assess, interact with and
  problem-solve health care issues for home care
  clients

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Questions Discussion