An Overview for the Senior Environment in Ontario and Canada Candace Chartier, CEO Safe Haven Consulting Inc.
A System Under Strain: Key Findings Premier’s Council on Improving • Patient and caregiver stress is Health Care and Ending Hallway Medicine released first report in increasing. Wait times too long. late January • System does not have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures. • Needs to be more effective coordination of services, both at system-level and patient- level. Health care system not efficient.
Changes to health care • Bill 74 (The People’s Health Care Act ) acclaimed. New “Super Agency” Ontario Health , will absorb/replace LHINs and many health care agencies. • Goal is to reduce and restructure bureaucracy that currently manages the flow of money between MOH and providers such as hospitals and long-term care • “ MyCare Groups” Ontario Health Teams of providers that form a unit to provide care • Digital Health is a priority, improving access to secure digital tools, including online health Susan Fitzpatrick records and virtual care options for patients Interim CEO Ontario Health
MyCare Groups (Ontario Health Teams) • Integrated care delivery and funding • Groups of providers are held clinically and fiscally accountable for delivering coordinated care to a group of patients or region • Public reporting on performance • Similar systems exist in the US
Current Environment
Long Term Care Plus POST-ACUTE CARE MODEL • short term intensive nursing and rehab care for medically complex and injured or disabled older adults • follows a hospital stay • focus is on stabilizing or improving the person’s condition so they can return home
Long Term Care Plus THE HUB MODEL • long-term care home is the centre for delivery of a wide range of seniors’ services, some located in the home and others managed by the home • could include primary care, chronic disease management, rehabilitation, adult day/night programs, and specialized geriatric services • particularly well suited to homes in smaller communities or rural and northern areas
Long Term Care Plus CONTINUUM OF CARE MODEL • many long-term care providers also offer retirement homes on the same site • providers that currently have these continuums of care could also offer a variety of integrated health care and support services for seniors
Long Term Care Plus DESIGNATED ASSISTED LIVING MODEL • long-term care homes are caring for residents with much higher physical and cognitive needs than even five years ago • seniors with a lesser degree of physical and mentally frailty need a protected environment where they can live independently with assistance and publicly funded services
Long Term Care Plus SPECIALIZED CARE MODEL • a higher level of care for populations with special needs • includes those with late stage dementia, severe mental illness and addictions, and those at the end of life • offers a blend of medical and social care, with an emphasis on specialized care, pain and symptom management, quality of life, and family support
Ministry falls prevention strategy: ideas • Falls are climbing - Ontario • Ministry looking for is now among highest in innovative solutions and Canada successful programs from vendors and homes • Ministry developing LTC falls strategy • Ministry seeking to enhance their fall Solid line is Ontario; dotted line is Canada overall
Ministry falls prevention strategy: goals Objectives: • Reduce the number of falls • Reduce the number of fall-related injuries • Reduce transfers to hospital emergency department from LTC • homes • Reduce avoidable hospitalizations of LTC residents • Promote increased mobility and The LTC Falls Prevention Strategy will also help quality of life for residents deliver on a key government priority of reducing hallway health care.
Falls and ED visits • In Ontario, there were approximately 1,000 ED visits from LTC residents per month. • Overall, 18% (or approximately 1 in 5) of all ED visits for LTC residents in Ontario were related to falls. • Direct costs of these ED visits were at least $4.5 Million. 14 14 14
LTC Strategies to End Hallway Health Care 1. Improving and innovating on LTC program supports will reduce the flow of LTC residents into hospitals. 2. Adding new LTC capacity where it is needed and ensuring the appropriate level of service is available will increase system flow into LTC homes. 3. Refining eligibility and making improvements to the placement process will ensure that applicants are placed faster and LTC capacity is maximized. 15
Deli livering on Government Commitments & Priorities Expanding access to specialized services, enhancing resident experience and ensuring resident safety 16
Expansion of non-invasive mechanical ventilation to long-term Care The ministry is considering further extension in ADP policy to enhance support for medically complex residents who require non-invasive ventilation (NIV) and Cough Assist Devices (CAD). • The ministry is considering further extension in ADP policy to enhance support for medically complex residents who require non-invasive ventilation (NIV) and Cough Assist Devices (CAD). • Under the current ADP policy as of January 2019, to receive life- support equipment from Ventilator Equipment Pool (VEP), the residents of Long-Term Care (LTC) homes are not eligible to receive VEP-provided life-support equipment. • In December 2018, the ministry convened a Program Engagement Meeting to discuss options to expand access to NIV in LTC, including an overview of VEP, the current and future patient journey, and training requirements to placement. This group will reconvene in February 2019 to discuss user pool estimates and process mapping. • These program meetings will be used inform ongoing ministry discussions of amending current ADP policy and how a future program could be successfully delivered. 17
Caring for Canada’s Seniors Opportunities for meeting the needs of an aging population caltc.ca
Current Trends Population estimates for 2015 indicated that the number of persons 65 and older outnumbered those under the age of 15. Source: Statistics Canada. Population Projections for Canada (2013 to 2016), Provinces and Territories (2013 to 2038) Source: Statistics Canada. Canada year book 2012, seniors. Canadian Association for Long Term Care | caltc.ca
Current Trends Residents are more frail and need complex care. Our seniors are living longer and coming into long-term care at a later stage of life, with more complex health issues and more physically frail. 61.5 1.4 Diabetes 25.5 0.6 39 0.6 Hypertension 58.3 1.7 70.8 0.2 Gastrointestinal Disease 20.9 3.4 0 10 20 30 40 50 60 70 80 % of assessed long-term care residents Prevalence as of 2015-2016 Source: Canadian Institute for Health Information, Continuing Care Reporting System (CCRS 2011-2012 and CCRS 2015-2016) Canadian Association for Long Term Care | caltc.ca
CIHI: Top 5 Reasons for Hospitalizations
So What Does This Mean? Timing is critical: Same trends across the country, same pressures, more focus on alignment related to quality programs and innovations (CIHI, Digitalization, etc.) Federal government feeling the pressures of an aging population and need to work with provinces (Dementia Strategy, End of Life Strategy) Commercial industry aligning Value ads to address the pain points operators are facing in a new fiscally restrained environment Recognizing the day to day challenges in a LTCH and how their products and/or programs can alleviate some of those pressures (i.e., falls, wounds, ED transfers)
Ontario Long Term Care 627 homes are homes licensed and approved to operate in Ontario, this is going to increase over the next five years 77,574 long-stay beds are allocated to provide care, accommodation and services to frail seniors who require permanent placement, this government is adding 15,000 beds over the next 5 years and committed to an additional 15,000 beds within the next 10 years 619 convalescent care beds are allocated to provide short-term care as a bridge between hospitalization and a patient's home, this is going to change and increase with the introduction of LTC+ (additional models of care)
Ontario Long Term Care 343 beds are allocated to provide respite to families who need a break from caring 24/7 for their loved one, this is going to increase due to new Care Giver Strategy and models of care Average time to placement is 161 days, Wait list for long-stay beds is 33,080, this has to end and is this governments mandate to end Hallway Medicine and LTC is right at the center Business planning is happening right now with a major provincial digital strategy, Virtual Long Term Care, Focus on Home Care-putting patient at the centre OHT focus: If they include at a minimum hospital, Home Care, Community Care, Primary Care and Long Term Care Services will be prioritized at application stage
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