Regional Geriatric Programs and Specialised Geriatric Services

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Regional Geriatric Programs and Specialised
Geriatric Services
Mr. Cal MartellDirector, Ottawa-Carleton
Regional Geriatric Assessment Program

• OHA - November 23, 1999

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Specialised Geriatric Services Context

• Responding to the needs of an aging population
  will likely be the single most significant
  challenge facing our health system, and is cited
  as a major factor in health system
  restructuring
• HSRC recommended all hospitals take measures to
  further develop their geriatric capabilities

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Specialised Geriatric Services Role

• Fundamental Assumption
• Much of the disease, disability and dependency in
  old age is preventable, treatable, or manageable.
• Diagnostic Difficulties (co-morbidity,
  atypical presentation)
• Loss of health and independence sometimes
  associated with inaccurate diagnoses resulting in
  inappropriate treatment.

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Specialised Geriatric Services Role

• Comprehensive Geriatric assessment, short term
  treatment, rehabilitation and management for
  older adults with complex health problems.
• Consultation advice to older adults, their
  families, physicians and other caregivers
• Promote high quality geriatric care through
  education, research and evaluation
• A resource for more successful aging to
  reduce unnecessary the human and financial
  burden of population aging

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Specialised Geriatric Services Description

• Inpatient
• Geriatric Assessment Unit
• Geriatric Consultation Service
• Geriatric Rehabilitation Unit
• Ambulatory /Outpatient
• Geriatric Outpatient Clinic
• Geriatric Day Hospital
• Geriatric Outreach Service

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Geriatric Assessment Units

• Function Comprehensive geriatric assessment,
  care and treatment.
• Location Acute Care
• Target Older hospitalised patients with complex
  health care problems requiring full range of
  geriatric and therapeutic services.
• Team Geriatrician-lead interdisciplinary team
• Referrals Other hospital services, through
  consult team, and community.
• Length of Stay 2-3 weeks
• Discharge Community

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Geriatric Rehabilitation

• Function Geriatric Rehabilitation and
  reactivation
• Location Complex Continuing Care or Acute
• Target Frail individuals experiencing loss of
  independence following acute illness or injury,
  with multiple problems requiring individualized
  inpatient rehabilitation.
• Team Interdisciplinary team.
• Referrals Acute hospitals, some community.
• Length of Stay 4-8 weeks.
• Discharge Community

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Geriatric Consultation Service

• FunctionComprehensive geriatric assessment
  triage
• Target High risk older patients in acute care
• Team Geriatrician, CNS
• Referrals Hospital.
• Length of Stay 1 visit, occasional follow up.
• Discharge (N/A) Existing service, triage to
  geriatric service.

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Geriatric Outreach Teams

• Function Multidimensional geriatric screening,
  assessment and triage.
• Target High-risk elderly in their own homes.
• Team Multidimensional geriatric assessors with
  physician support.
• Referrals Community - Family physicians, CCACs,
  Families, Discharge planners.
• Length of Stay 1 visit with some follow up.
• Discharge n/a - Advice and referral to day
  hospital and other services.

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Geriatric Day Hospital

• Function Outpatient Comprehensive geriatric
  assessment and short term treatment and
  management
• Location Acute or complex continuing care.
• Team Geriatrician lead interdisciplinary team.
• Referrals Family physicians - may be triaged
  through Outreach.
• Length of Stay 4-8 weeks.
• Discharge Community services as required.

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Geriatric Clinics

• Function Comprehensive geriatric medical
  assessment and consultation - may include follow
  up or be targeted e.g. falls, memory disorder,
  continence
• Location Acute , continuing or long-term
  care....
• Team Geriatrician, may include CNS.
• Referrals Family physicians, discharge planners
• Length of Stay 1 visit with some follow up.
• Discharge Existing residence

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Geriatric Rehabilitation Unit
Outpatient Clinics
Community Referrals
Hospital Referrals
Geriatric Assessment Treatment
Outreach Assessment Teams
Consultation Services
Geriatric Assessment Units
Day Hospitals
An Organised Delivery System for Seniors with
Complex Health Problems
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Regional Geriatric Programs The Original
Network

• Established in 1988
• Seen as first step in province-wide
  comprehensive, integrated system for frail
  elderly.
• Mandate for Specialised care, education,
  evaluation, research and program development.
• Physician Alternate Payment Plan.
• Academic Health Science Centres.
• Regional Approach

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RGPs Where Art Thou?

• Hamilton Specialised Health Care for the Elderly
  Program
• London Southwestern RGP
• Toronto Metro Toronto RGP
• Kingston Southeastern RGP
• Ottawa Ottawa-Carleton RGAP

• Provincial Survey 1998
• 50 of Ontarios population 65 reside within
  primary catchment area of RGPs. (52 of 75).
• 17 reside in other areas receiving clinical
  service from RGPs e.g. Renfrew, Pembroke, Moose
  Factory, Kenora, Dryden, Kirkland Lake,
  Manitoulin,

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RGPs Where Are You Going?

• Provincial Review
• Enhanced accountability and consistency
• Improved access to SGS
• Distinguish network coordination role and funding
  of RGPs
• Review approach to Alternate Payment Plan
• RGP Strategic Planning
• More integrated regional network of SGS (e.g.
  Dementia Networks)
• Increase capacity of primary continuing care
• More joint education / research initiatives.