Hamilton District Health Council

Transcription

1 Hamilton District Health Council Conseil régional de santé de Hamilton Review of Recommendations For Long-Term Care Programs and Services, December 2002

2 Review of Recommendations For Long-Term Care Programs and Services, December 2002 Hamilton District Health Council 10 George Street, Suite 301, Hamilton, Ontario L8P 1C8 tel: rue George, bureau 301, Hamilton, Ontario L8P 1C8 fax:

3 Table of Contents INTRODUCTION...3 APPROACH...3 LONG-TERM CARE PLANNING NEXT STEPS...4 A. Community Support Services...7 Adult Day... 7 Alzheimer s Overnight Service Meals on Wheels Diners Club/Meals to Wheels/Congregate Dining Transportation Home Maintenance and Repair/Home Help Friendly Visiting Security Checks/Reassurance Service Caregiver Support and Counselling Respite Psychogeriatric Consulting Foot Care Emergency Response Team B. Homemaking/Personal Support/Attendant Care...49 Homemaking/Personal Support/Attendant Care Supportive Housing C. Professional Services...67 Case Management Placement Coordination Nursing Physiotherapy Occupational Therapy Social Work Speech Language Therapy i

4 Dietetic Services Physician Palliative Care Education Community and Facility Palliative Care Interdisciplinary Education Pain and Symptom Management Services for Blind and Visually Impaired Persons Services for Persons with Hearing Loss D. HIV/AIDS Related...84 E. Children s Treatment Centres...85 F. Other Recommendations Related to LTC Services...86 CCAC Health Promotion and Prevention Strategies Volunteers Diverse Community Integration and Co-ordination of Community-Based LTC and Related Services System Accountability and Client Rights Physical Accessibility Health Human Resources Palliative Care Information for Planning LTC Facilities Physician Services at LTC Facilities Substance Abuse and Gambling Services For LTC Populations Independence Training Planning Process Improvements REFERENCES ii

5 INTRODUCTION The Central-South Regional Office of the Ministry of Health and Long-Term requested (October 2002) that the District Health Councils review the relevance of DHC recommendations for longterm care programs and services in the past five years. The stated purpose of the review is to assist the Ministry to strategically assess LTC planning needs in Central South. (MOHLTC, October 17, 2002). The Ministry provided a framework for the organization of information. APPROACH The Hamilton District Health Council (HDHC) identified 23 DHC reports relevant to long-term care programs and services between and 2002 (see Table 1). Sixteen reports made specific recommendations for LTC programs and services; these recommendations were directed to the MOHLTC and/or other stakeholders including other Provincial Ministries, the City of Hamilton, and local funders, among others. The recommendations were organized by program area. Those recommendations not specific to programs and services within the Ministry long-term care funding envelop, but nonetheless important for sustained independence and well being, were included in this review. Each recommendation was reviewed for relevance, and comments were added to support the recommendation status. To assist in the review, key informants by sector, and DHC Planning Staff, were asked to comment on the status of recommendations. Long-term care facilities were surveyed regarding recommendations related to their operations. A recommendation was deemed relevant from the perspective of the DHC if it met one or more of the following criteria: a recommendation for funding for which funding has not yet been awarded to meet defined need; unmet client need continues to exist; additional planning required to delineate needs and the appropriate policy or funding response; and work in progress. A recommendation was considered not relevant if the recommendation has been re-addressed in a later recommendation and/or the issue of interest has been fully addressed. It is noted that there are several community support services included in the MOHLTC Planning, Funding and Accountability Manual for which the Regional Office did not request information on. These include Alzheimer Strategy Patient Education Co-ordinator (09C) Independence Training for Physically Disabled Adults (09G) Client Intervention and Assistance Services (Seniors)(09I) Social Recreational Services (09J), and Independence Training (ABI Outreach)/Aphasia (09K, 09T). 3

6 LONG-TERM CARE PLANNING NEXT STEPS The most recent HDHC environmental scan to support long-term care planning foci was carried out December 2001-January It is currently being updated to reflect changes in the policy, funding, and service delivery environments. Similarly, a nominal inventory of programs and services was developed at the same time. However, its usefulness is limited as there is little trend data on utilization as compared to need, appropriateness of intervention and effectiveness. This inventory is currently being updated based on information in Service Plans, DHC surveys and other inquiries. This review shows that the following funded program and service areas have not been addressed by HDHC LTC planning initiatives: foot care emergency response team (currently addressed in part by the Hamilton Emergency Services Network) dietetic services services for blind and visually impaired persons, and services for persons with hearing loss. Among these services, anecdotal evidence suggests that it is timely to assess the adequacy of services, now and in the future, for blind and visually impaired persons and persons with hearing loss. In addition, there are not yet in place comprehensive plans for elder care and support in Hamilton, respite care for clients and families of all ages, and housing and support requirements for young disabled adults. As well, there may be opportunities to complement the strategic planning underway at CONTACT for children s services by assessing requirements for children s health services; however, a review any current planning in this area has not been carried out. Confidence in the capacity of the community to provide for seniors is being eroded by certain events. These include the clarification and implementation of eligibility criteria for CCAC brokered services (December 2001), the recent closure of VHA in Hamilton (August 2002), proposed cuts to City of Hamilton social and health programs (December 2002), and, concern about the future requirements of an aging population in Hamilton. These suggest that a priority area for planning is a multi-dimensional systemic framework for planning and service delivery for older adults, using an inter-sectoral approach. The intent of the approach would be to establish a planning process that starts from the level of functional need (rather than service or support) and consider how to address these needs from community up to the highest level of government. Two questions would frame the approach: 1. What factors and variables make a difference for individuals choosing to live at home or in an institution? Pre-disposing factors are individual characteristics such as age, sex, income, and living arrangements. Enabling factors are those conditions within the family or the community that make services or support available to the individual. 4

7 Need factors refer to health problems that generate demand for care or support, such as chronic conditions or activity restrictions How can the complexity of these multiple factors and underlying characteristics, conditions and problems be addressed through coordinated planning and longerterm resource development and action? Mapping out and understanding the predisposing and need factors can contribute to a preliminary method of estimating current and future requirements to build the capacity of enabling older adults to maintain residence in an environment of their preference and need, as well as quality of life. These is turn would be related to how governments, communities, families and individuals can create policies and supports to build the capacity of enabling. In summary, Health Council is preparing for future long-term care planning in the following ways: Reviewing current agency/program service plans available to the DHC for trends, issues and pressure points; Surveying local funders and Hamilton faith groups for the trends and issues from their perspective regarding long-term care populations needs; Developing a data base of LTC programs and services to serve as a basis for trending service patterns; and Developing a framework for an inter-sectoral approach to improving the health and well being of older adults for discussion with Ministry and stakeholders. In addition, Health Council will continue to work with the Ministry of Health and Long- Term Care to ensure appropriate access to data and information relevant to system planning. R:\Long Term Care\2002 Strategic LTC Document Review\report\HDHC LTC Str Rev doc 1 The analytical framework is based on a model of determinants of health proposed by Anderson and Newman., and used in recent Statistics Canada home care analyses. This model suggests that the use of health care and social care services is motivated by factors arising from the environment and the individual (Anderson, R. Newman, J., Societal and Individual determinants of medical care utilization in the United States, Milbank Memorial Fund Quarterly, 1973, 51, ; Anderson, R., McCutcheon, A., Aday L. et al, Exploring Dimensions of access to medical care, Health Services Research, 1983, 18(1),

8 Table 1: HDHC LTC Planning Projects and Documents, January to December 2002 Publication Date Title August 2002 Transportation Service Issues for Clients of Adult Day Service Programs in Hamilton July 2002 Physician Coverage for Residents of Long-Term Care Facilities June 2002 Implementation Plan to Strengthen Hamilton s Substance Abuse Treatment System June 2002 A Palliative Care Program for Hamilton March 2002 Older and Wiser: Preparing Communities for Healthy Aging. April 2002 Long-term Care Planning and Service Directions for Hamilton, October 2001 Background Report: Housing and Support for Persons with Serious Mental Illness May 2001 Summary of Long-Term Care Beds Status - Hamilton. April 2001 Hamilton Long-Term Care Supportive Housing Report. March 2001 Palliative Care Services in Hamilton: A Background to System Design April 2000 Inventory of Long-Term Care Services. February /2001 Directions for Long-Term Care Planning March 1999 Advice to the Ministry of Health on New Long-Term Care Facility Beds for Hamilton-Wentworth. February 1999 Overview of Recommendations from the District Health Council's Long-Term Care and Annual District Service Plan. January 1999 Inventory of Long-Term Care Services. January 1999 Towards a Framework for Evaluating Long-Term Care Services March 1998 Speech and Language Services for Pre-Schoolers in Hamilton-Wentworth: System Design and Enhancement January /1999 Long-Term Care Annual District Service Plan November Long-Term Care Services/Programs Progress Report July A Report on the Communication and Evaluation of the Long-Term Care January Long-Term Care Annual District Service Plan January for Long-Term Care Services in Hamilton-Wentworth Contains LTC Recommendations? No Yes Yes Yes No Yes Yes No Yes No No No Yes Yes No Yes Yes Yes Yes No Yes Yes 6

9 A. COMMUNITY SUPPORT SERVICES Adult Day Recommendation That transportation barriers for access to adult day programs be monitored. (Recommendation 1) Cross reference Transportation Year and Name of Document LTC Planning and Service Directions , April 2002 Status R/NR/UK Comments There is no protocol in place to monitor transportation barriers for access to adult day programs. HDHC published a report (August 2002) highlighting transportation barriers for clients of adult day programs. Two user surveys are being done: The Developmental Service Sector Transportation Committee in Hamilton is investigating issues for people with developmental and cognitive disabilities. The Transportation Action Subcommittee of the Seniors Advisory Committee for the City of Hamilton is distributing a questionnaire to community LTC agencies serving seniors. That funding for adult day service programs include client transportation, as a component of the service program, with additional funding made available for this. (Recommendation 2) LTC Planning and Service Directions , April 2002 Funding for adult day service programs does not include transportation costs. Cross reference Transportation HWDHC to develop a respite plan in partnership with community stakeholders. The consultation process identified the following principles for the development of a respite plan: Funding needs to be client centred and caregiver centred All LTC populations/age groups need access to respite There needs to be multiple options for service delivery self-managed, regular planned, emergency and crisis prevention HDHC 2000/2001 Directions for LTC Planning, February 2000 No comprehensive respite plan has been developed for Hamilton. In September 2000, ten initiatives were announced as part of the provincial Alzheimer Strategy, which has meant new funding: In January 2000, the Alzheimer Society of Hamilton-Halton, received funding for a public education co-ordinator. In April 2000, six Hamilton adult day programs 7

10 There needs to be flexibility between options and within options Respite needs to be accessible The system needs to be accountable The system needs to include end-of-life respite care Cross reference Alzheimer overnight service and Respite received one-time funding totalling $119,287 for capital equipment. In September 2000 $6.3 million for the expansion and enhancement of adult day service programs and respite services for people with Alzheimer disease was announced. This meant a total of $361,000 for five Hamilton organizations. HWDHC staff to review the Regional Transportation Master Plan, the activities of the Regional Transportation Committee, and the recommendations of the Regional Progress Team to summarize what initiatives and recommendations currently exist in the area of transportation initiatives for LTC populations. HDHC 2000/2001 Directions for LTC Planning, February 2000 Not A new multi-year plan for transportation services in the City of Hamilton has not yet been released. In August 2002, HDHC published a report on the investigation of transportation barriers for clients of adult day programs. Cross Reference Transportation It is recommended that the Minister of Health fund additional adult day program places to eliminate waiting lists. (Recommendation A1) LTC Annual District Service Plan, January 1998 Placement with adult day programs in Hamilton is now coordinated by the CCAC. As of December 20, 2002, the CCAC reported 172 people on the waiting list for placement. New funding has been awarded, which has increased the number of units of service provided by these agencies: In September 2000, a total of $361,000 was announced for expansion and enhancement of services for Alzheimer patients at five adult day programs in Hamilton. In November 2002, a 1.4% increase to operating budgets was announced for all agencies providing LTC services. It is recommended that the Minister of Health develop a model for funding adult day LTC Annual District Funding for adult day programs does not reflect the acuity of the client caseload. 8

11 programs that reflects differing levels of client acuity and services rendered. (Recommendation A10) Service Plan, January 1998 In 2001, a number of clients attending adult day programs at VON Hamilton were reclassified as frail elderly with Alzheimer disease or another dementia (Category 01C). It is recommended that since integrated day services are not always appropriate for clients, that the providers of adult day services develop and co-ordinate day programs for specific target groups. (Recommendation C9) LTC Annual District Service Plan, January 1998 Not There are four distinct adult day program client groups, based on age, frailty and type of impairment or disability. Programs at St. Joseph s Villa and the VON are more capable of accommodating individuals with late stage cognitive impairments. To facilitate the integration between adult day services and transportation, it is recommended that providers of day services work with providers of volunteer assisted transportation to: (Recommendation C10) LTC Annual District Service Plan, January 1998 This work is in progress. Providers of adult day programs meet regularly with providers of public and volunteer-assisted transportation services to facilitate operations. A majority of adult day program clients rely on DARTS for transportation (57% in 2002). Nine per cent rely on volunteer-assisted transportation services. Persons with cognitive impairments other than Alzheimer Disease are not currently eligible for public transportation through DARTS. (a) Develop a neighbourhood approach to day services programming to facilitate coordination of transportation; (b) Develop criteria for the use of volunteerassisted transportation services for adult The Hamilton CCAC is now responsible for placement of adult day clients. The need for specialized adult day programs may require clients to travel to locations distant from their home. Most clients rely on the DARTS servi ce, which runs on a Master Schedule system. Persons with cognitive impairments other than Alzheimer Disease are not currently eligible for DARTS services, and must find other means. Some rural clients experience greater problems obtaining a spot on a scheduled route. Adult day service clients using wheelchairs or scooters are not eligible for the majority of volunteer-assisted 9

12 day service clients; and transportation services, which rely on private vehicles, which are not wheelchair or scooter accessible. (c) Provide drivers with training to ensure the safe transportation of frail or cognitively impaired clients. Training for volunteer drivers is not perceived to adequately prepare them to assist the increasing number of adult day clients who are frail, elderly and have Alzheimer s disease or another form of dementia. Individuals with a cognitive impairment other than Alzheimer disease are not currently eligible for DARTS, and may seek volunteer-assisted transportation services as an alternative. It is recommended that Day Service Providers assess the need for increasing hours of services (e.g. why are clients requesting more hours? Is service coordination an issue?) (Recommendation C11) LTC Annual District Service Plan, January 1998 Each adult day program should monitor and report demand for increased hours of service, as part of their annual service plan. In answer to demand, VON Hamilton has introduced a Saturday adult day program. The recent HDHC investigation into transportation issues effecting adult day program clients suggests that not all clients are receiving the minimum of 5.5 hours per day of programming, because of transportation barriers, and that caregivers desire programming beyond the 9 to 5, Monday to Friday time period. That modern, appropriately designed residential and day program facilities are developed for younger persons who are disabled. (Recommendation 42) MYP for LTC Services in Hamilton- Wentworth, January There is no adult day program facility funded through the MOHLTC that has been specifically designed for younger persons with disabilities. There are 166 supportive housing units for adults with physical disabilities, and 16 for individuals with an acquired brain injury. That funding for adult day services for persons with special needs, including persons with acquired brain injury, Alzheimer and cognitive impairment be increased. (Recommendation 40) MYP for LTC Services in Hamilton, January As of December 20, 2002, the CCAC reported 172 people on the waiting list for placement at an adult day program. In 2002, the majority of the 600 adult day clients attend integrated programs (78%). Another 18% attended special Alzheimer programs and 3% attended ABI programs. New funding has been awarded to adult day programs: 10

13 In September 2000, a total of $361,000 was announced for expansion and enhancement of services for Alzheimer patients at five adult day programs in Hamilton. In November 2002, LTC agency base operating budgets were increased by 1.4%. That adult day programs be distributed across the Region to reflect geographic distribution of need. (Recommendation 41) MYP for LTC Services in Hamilton, January Four of seven programs are located in central Hamilton; one is in Flamborough, one in Dundas and one in the east end of Hamilton. A program operated in Ancaster in 2001, but did not receive operating funds from the MOHLTC to continue. There is an increasing demand from Glanbrook, where a number of a large number of adult retirement communities are located. The projected population growth for Glanbrook for the next five years is 7.5%, and fourteen subdivision plans are registered for development, including adult lifestyle units and a retirement facility. 2 2 Appendix E, Schedule 2, Glanbrook Home Support Programme Inc., March 13,

14 Alzheimer s Overnight Service Recommendation HWDHC to develop a respite plan in partnership with community stakeholders. The consultation process identified the following principles for the development of a respite plan: Funding needs to be client centred and caregiver centred All LTC Populations/age groups need access to respite There need to be multiple options for service delivery self-managed, regular planned, emergency and crisis prevention There needs to be flexibility between options and within options Respite needs to be accessible The system needs to be accountable The system needs to include end-of-life respite care Cross reference Adult Day and Respite Year and Name of Document HDHC 2000/2001 Directions for LTC Planning, February 2000 Status R/NR/UK Comments No comprehensive respite plan has been developed for Hamilton. In September 2000, ten initiatives were announced as part of the provincial Alzheimer Strategy, which has meant a new funding: In January 2000, the Alzheimer Society of Hamilton-Halton, received funding for a public education co-ordinator. In April 2000, six Hamilton adult day programs received one-time funding totalling $119,287 for capital equipment. In September 2000 $6.3 million for the expansion and enhancement of adult day service programs and respite services for people with Alzheimer disease was announced. This meant a total of $361,000 for five Hamilton organizations. 12

15 Meals on Wheels Recommendation It is recommended that providers of community LTC programs and services investigate strategies to enhance the availability of a range of food and nutrition services. (Recommendation C12) Cross reference Diners Club/Meals to Wheels/Congregate Dining Year and Name of Document LTC Annual District Service Plan, January 1998 Status R/NR/UK Comments A Food Access Committee meets twice annually, and is trying to establish linkages with Social and Public Health Services, City of Hamilton. A proposal to develop a comprehensive food access and referral plan is being submitted to the Trillium Foundation for funding. A Food Focus group meets regularly regarding food banks and hot meal programs provided in shelters, some of which are congregate dining. This group is a sub-committee of the City Food and Shelter Committee. Food programs such as Wesley Urban Ministries rely on donations. Fresh food contributions from Hamilton FoodShare have increased. However, storage of fresh food and maintaining high nutritional standards are ongoing challenges. The proximity to the on-site health center allows easy access to additional nutritional supplements, for those with special health needs. That a range of nutrition services be developed by: (Recommendation 45) Cross reference Diners Club/Meals to Wheels/Congregate Dining A comprehensive City of Hamilton Food Access Guide 2002 was produced by North Hamilton Community Health Center and City of Hamilton Social and Public Health Services Department, with input form the Food Access Committee. It identifies where individuals can get free or low cost food or meals. (a) Implementing a 7 day/week meals-to-thehome programs in areas where they are currently not available; VON provides a seven-day service, including weekends and statutory holidays for Hamilton and Stoney Creek. A seven-day meals-to-home service is not available in all parts of the city. (b) Assessing the need for congregate dining programs in the Region on the basis of nutritional need, social contact, transportation resources and seasonal weather; A needs assessment for congregate dining has not been conducted. At present, there are at least 12 congregate dining sites 13

16 operating in Hamilton: five are administered by VON Hamilton, three in co-operation with SEN Community Link, two at St. Joseph's Community Health Center and one at Idyllwild Manor. Details on other congregate dining groups are provided in the 2002 Food Access Guide. (c) Exploring the development of collective kitchen programs to support life skills development and social networks; and (d) Expanding the availability of grocery shopping services, including no-profit and commercial wheels-to-grocery programs. The impact of collective kitchen programs on life skills development is not fully known. The total number of collective programs in Hamilton is not known by the DHC, although it is known that programs currently operate through North Hamilton Community Health Center and the Dundas branch of the Salvation Army. A Supports for Daily Living Program at Wesley Urban Ministries provides a limited life skills program for tenants of the Wesley Community Homes. GrocerEase is a not-for-profit grocery shopping service funded by the MOHLTC. Although funding levels have remained the same, client reach has expanded through limits on the number of trips made per client. There is a waiting list for service. In July 1995, VON Hamilton and SEN Community Link initiated a Shopping By Bus program. Local grocery stores sponsor bi-weekly trips by a HSR bus from specific apartment buildings to the neighborhood location. A VON volunteer assists clients on the bus and in the store, schedules the trips, and advertises the service. The routine availability of grocery delivery services through retail stores is limited, especially for hard-toserve clients. 14

17 That a comprehensive plan be developed in Hamilton-Wentworth to support people to live independently in their residences. The Plan must include: (Recommendation 33) (a) Attendant care services; (b) Meal services; (c) Grocery shopping services; (d) Home maintenance and home help services; (e) Life skills programs, health education and rehabilitation; (f) Retro-fit/home adaptation programs; (g) Programs to provide a sense of safety and security (e.g. friendly visits); and (h) Palliative care services. Cross reference Diners Club/Meals to Wheels/Congregate Dining, Home Maintenance and Repair, Independence Training, Security Checks/Reassurance, Case Management, Palliative Care A comprehensive plan has not been developed for all these services. A City of Hamilton Food Access Guide 2002 is one effort to provide a directory of meal and food services. The Hamilton CCAC is leading the development of a comprehensive program for palliative care services at home and in other settings, based on recommendations from the HDHC report. Attendant care services for adults with physical disabilities living in supportive housing units may be supplemented with services through the CCAC. The CCAC refers clients to community-based agencies for the remaining identified services as requested, on a non-contractual basis. 15

18 Diners Club/Meals to Wheels/Congregate Dining Recommendation It is recommended that providers of community LTC programs and services investigate strategies to enhance the availability of a range of food and nutrition services. (Recommendation C12) Cross reference Meals on Wheels Year and Name of Document LTC Annual District Service Plan, January 1998 Status R/NR/UK Comments A Food Access Committee meets twice annually, and is trying to establish linkages with Social and Public Health Services, City of Hamilton. A proposal to develop a comprehensive food access and referral plan is being submitted to the Trillium Foundation for funding. A Food Focus group meets regularly regarding food banks and hot meal programs provided in shelters, some of which are congregate dining. This group is a sub-committee of the City Food and Shelter Committee. Food programs such as Wesley Urban Ministries rely on donations. Fresh food contributions from Hamilton FoodShare have increased. However, storage of fresh food and maintaining high nutritional standards are ongoing challenges. The proximity to the on-site health centre allows easy access to additional nutritional supplements, for those with special health needs. That a range of nutrition services be developed by: (Recommendation 45) Cross reference Meals on Wheels A comprehensive City of Hamilton Food Access Guide 2002 was produced by North Hamilton Community Health Center and City of Hamilton Social and Public Health Services Department, with input form the Food Access Committee. It identifies where individuals can get free or low cost food or meals. (a) Implementing a 7 day/week meals-to-thehome programs in areas where they are currently not available; VON provides a seven-day service, including weekends and statutory holidays for Hamilton and Stoney Creek. A seven-day meals-to-home service is not available in all parts of the city. (b) Assessing the need for congregate dining programs in the Region on the basis of nutritional need, social contact, transportation resources and seasonal weather; A needs assessment for congregate dining has not been conducted because funding had not been procured. At present, there are at least 12 congregate dining sites 16

19 operating: five are administered by VON Hamilton, three in co-operation with SEN Community Link, two at St. Joseph's Community Health Center and one at Idyllwild Manor. Details on other congregate dining groups are provided in the 2002 Food Access Guide. (c) Exploring the development of collective kitchen programs to support life skills development and social networks; and (d) Expanding the availability of grocery shopping services, including no-profit and commercial wheels-to-grocery programs. The impact of collective kitchen programs on life skills development is not fully known. The total number of collective programs in Hamilton is not known by the DHC, although it is known that programs currently operate through North Hamilton Community Health Center and the Dundas branch of the Salvation Army. A Supports for Daily Living Program at Wesley Urban Ministries provides a limited life skills program for tenants of the Wesley Community Homes. GrocerEase is a not-for-profit grocery shopping service funded by the MOHLTC. Although funding levels have remained the same, client reach has expanded through limits on the number of trips made per client. There is a waiting list for this service. In July 1995, VON Hamilton and SEN Community Link initiated a Shopping By Bus program. Local grocery stores sponsor bi-weekly trips by a HSR bus from specific apartment buildings to the neighborhood location. A VON volunteer assists clients on the bus and in the store, schedules the trips, and advertises the service. The routine availability of grocery delivery services through retail stores is limited, especially for hard-toserve clients. 17

20 That a comprehensive plan be developed in Hamilton-Wentworth to support people to live independently in their residences. The Plan must include: (Recommendation 33) (a) Attendant care services; (b) Meal services; (c) Grocery shopping services; (d) Home maintenance and home help services; (e) Life skills programs, health education and rehabilitation; (f) Retro-fit/home adaptation programs; (g) Programs to provide a sense of safety and security (e.g. friendly visits); and (h) Palliative care services. Cross reference Diners Club/Meals to Wheels/Congregate Dining A comprehensive plan has not been developed for all these services. A City of Hamilton Food Access Guide 2002 is one effort to provide a directory of meal and food services. The Hamilton CCAC is leading the development of a comprehensive program for palliative care services at home and in other settings, based on recommendations from the HDHC report. Attendant care services for adults with physical disabilities living in supportive housing units may be supplemented with services through the CCAC. The CCAC refers clients to community-based agencies for the remaining identified services as requested, on a non-contractual basis. 18

21 Transportation Recommendation That transportation barriers for access to adult day programs be monitored. (Recommendation 1) Cross reference Adult Day Year and Name of Document LTC Planning and Service Directions , April 2002 Status R/NR/UK Comments There is no protocol in place to monitor transportation barriers for access to adult day programs. HDHC published a report (August 2002) highlighting transportation barriers for clients of adult day programs. Two user surveys are being done: The Developmental Service Sector Transportation Committee in Hamilton is investigating issues for people with developmental and cognitive disabilities. The Transportation Action Subcommittee of the Seniors Advisory Committee for the City of Hamilton is distributing a questionnaire to community LTC agencies serving seniors. That funding for adult day service programs include client transportation, as a component of the service program, with additional funding made available for this. (Recommendation 2) LTC Planning and Service Directions , April 2002 Funding for adult day service programs does not include transportation costs. Cross reference Adult Day That changes in public transit schedules, routes and stops consider the implications for client access to LTC program and service sites across the City. (Recommendation 12) LTC Planning and Service Directions , April 2002 A copy of the HDHC report Transportation Service Issues for Clients of Adult Day Service Programs in Hamilton, August 2002 was provided to the Accessible Transportation Services department of the City. There is a coordinating committee of City Council addressing transportation issues. That planning for integrated transportation services include representatives of LTC service providers and ATS service users, to ensure that the needs of clients of provincial governmentfunded programs are taken into consideration. LTC Planning and Service Directions , April 2002 An nine-member citizen advisory committee of City Council is addressing issues for persons with disabilities, including transportation issues. HWDHC staff to review the Regional HDHC 2000/2001 Not A new multi-year plan for transportation services has not 19

22 Transportation Master Plan, the activities of the Regional Transportation Committee, and the recommendations of the Regional Progress Team to summarize what initiatives and recommendations currently exist in the area of transportation initiatives for LTC populations. Directions for LTC Planning, February 2000 been developed, since the amalgamation of municipalities into the new City of Hamilton in To decrease the demand for volunteer assisted transportation, it is recommended that providers of volunteer assisted transportation and other community services: (Recommendation C3) LTC Annual District Service Plan, January 1998 The overall demand for transportation services, especially accessible transportation services is increasing. The challenges in recruiting and retaining volunteer drivers, and the limited availability of wheelchair and scooter-accessible volunteer vehicles has increased the unmet need. (a) Encourage community agencies, government agencies and local businesses to provide transportation for their clients; and (b) Assist clients to identify a range of transportation alternatives. Not The HDHC is not aware of the development of a comprehensive, integrated transportation program for Hamilton. A local grocery store has sponsored a volunteerassisted Shopping by Bus program since July The program operates through the auspices of the VON and SEN Community Link. Local businesses have limited capacity to provide transportation for individuals with physical disabilities requiring wheelchair- and scooter-accessible vehicles. Transportation for non-commercial reasons such as medical and other appointments must come through other programs. Most community agencies providing volunteer-assisted transportation will assist seniors requiring canes or wheeled walkers, but not wheelchairs or scooters. Clients are charged a small fee for the ride and must pay any parking charges. Adult day programs review transportation alternatives available to each new client at intake, and will contact Accessible Transportation Services to facilitate 20

23 enrolment and arrangements. To improve cost-efficiency, it is recommended that providers of volunteer-assisted transportation in collaboration with their community partners: (Recommendation C4) LTC Annual District Service Plan, January 1998 (a) Build strategic alliances among community agencies to support ongoing recruitment and training of volunteers (e.g. sharing of costs and resources); Alliances have not been established among community agencies providing volunteer-assisted transportation services, in support of recruitment and training. The recruitment and training of volunteer drivers remains a challenge for agencies providing this service. The mileage reimbursement rates vary across agencies. (b) Collaborate to provide central dispatch for after-hours support for volunteers; and A centralized dispatch has not yet been established. (c) Request that all Hamilton hospitals waive parking fees for volunteer assisted transportation drivers. St. Joseph s Hospital and St. Joseph s Community Health Centre offer free parking for volunteer drivers. It is recommended that providers of volunteer assisted transportation collaborate with hospital volunteers to develop strategies which will support clients using volunteer assisted transportation (*e.g. to accompany clients to appointments and escort them back to volunteer driver). (Recommendation C5) LTC Annual District Service Plan, January 1998 Hospital volunteers are not consistently available to assist all clients arriving through volunteer-assisted transportation services. VON volunteer drivers do assist clients for the duration of medical appointments. It is recommended that the Minister of Health increase funding to rural volunteer-assisted transportation programs. (Recommendation A2) LTC Annual District Service Plan, January 1998 A 1.4% increase in base subsidy was announced for all community-based LTC agencies in Clients residing in Glanbrook and Flamborough must travel farther to access many LTC services, and the level of demand from these high-growth areas of the city exceeds the increases in funding levels for rural volunteer-assisted transportation programs. It is recommended that the Minister of Health LTC The appropriateness of funding levels for rural 21

24 develop a model of funding rural-based volunteer assisted transportation to reflect distances travelled. (Recommendation A9) To facilitate the integration between adult day services and transportation, it is recommended that providers of day services work with providers of volunteer assisted transportation to: (Recommendation C10) Cross reference Recommendation 65, MYP for LTC Services in Hamilton, January Annual District Service Plan, January LTC Annual District Service Plan, January 1998 volunteer-assisted transportation programs remains an issue. (a) Develop a neighbourhood approach to day services programming to facilitate coordination of transportation; (b) Develop criteria for the use of volunteerassisted transportation services for adult day service clients; and (c) Provide drivers with training to ensure the safe transportation of frail or cognitively impaired clients. The Hamilton CCAC is now responsible for placement of adult day clients. The need for specialized adult day programs may require clients to travel to locations distant from their home. Most clients rely on the DARTS service, which runs on a Master Schedule system. Persons with cognitive impairments other than Alzheimer Disease are not currently eligible for DARTS services, and must find other means. Some rural clients experience greater problems obtaining a pot on a scheduled route. Adult day service clients using wheelchairs or scooters are not eligible for the majority of volunteer-assisted transportation services which rely on private vehicles, which are not wheelchair or scooter accessible Training for volunteer drivers is not perceived to adequately prepare them to assist the increasing number of adult day clients who are frail, elderly and have Alzheimer s disease or another form of dementia. Individuals with cognitive impairments other than Alzheimer disease are not currently eligible for DARTS, and may seek volunteer-assisted transportation services as an alternative. That the health sector work closely with the social MYP for LTC The City of Hamilton is developing a framework to guide 22

25 service sector to develop an integrated transportation system that makes effective use of all resources including ambulance transfer services, parallel transit, volunteer assisted transportation, and school transportation. (Recommendation 54) Services in Hamilton- Wentworth, January the development of a new Official Plan, including transportation services. That the Regional transportation plan be developed to ensure a positive impact on the community s health. (Recommendation 55) MYP for LTC Services in Hamilton- Wentworth, January The City of Hamilton is developing a framework to guide the development of a new Official Plan, including transportation services. That the impact of any changes in health programs on access and the need for accessible transportation be assessed. (Recommendation 56) MYP for LTC Services in Hamilton- Wentworth, January The DHC can review the impact of program and service changes on client access and the need for accessible transportation. In 2002, HDHC reported on transportation barriers for adult day program clients. That any major change in health services that will lead to an increase in patient or staff volumes at health care sites will be assessed for its impact on transportation patterns, including general accessibility, vehicular traffic and transit access. (Recommendation 57) MYP for LTC Services in Hamilton, January The DHC can review the impact of health program and service growth on transportation patterns, and its implications for client access. That the Hamilton-Wentworth Elective Patient Transfer Pilot Project is supported, marketed and evaluated. (Recommendation 58) MYP for LTC Services in Hamilton, January The service was implemented and evaluated by the City of Hamilton in In 2002, the IBI group was commissioned by the MOHLTC to review the issue on a provincial basis. The report has not yet been released. That the long-term care system advocate for programs that support personal vehicle retrofit for persons with special needs or their families. (Recommendation 59) MYP for LTC Services in Hamilton, January No progress or action has been taken to date. The issue continues to be relevant for families and caregivers. That resources for volunteer-assisted MYP for LTC Resourcing of volunteer-assisted transportation 23

26 transportation across the Region be enhanced. (Recommendation 60) Services in Hamilton, January programs does not match the increasing level of demand. Funding for reimbursement of volunteer driver expenses, and the availability of volunteers are the chief limitations. That mileage for volunteer assisted transportation programs be covered by other than the volunteer driver. (Recommendation 61) MYP for LTC Services in Hamilton, January Reimbursement for the mileage travelled by volunteer drivers is provided by the agency coordinating the transportation service. The rate of reimbursement varies between agencies, and may be set by the provincial office of the agency. It is felt that current mileage reimbursement rates do not offset the actual cost to the volunteer drivers providing the service. That parking fees at hospitals charged to volunteer assisted driver programs for the transport of patients and clients be eliminated. (Recommendation 62) MYP for LTC Services in Hamilton, January St. Joseph s Hospital and St. Joseph s Community Health Centre offer free parking for volunteer drivers. Cross Reference Recommendation C4 in1998 ADSP That alternative coverage of differential in insurance fees for volunteer drivers be explored. (Recommendation 63) MYP for LTC Services in Hamilton, January Not There are no extra insurance costs for individuals providing volunteer driving services. Volunteer drivers are advised to have a minimum of $1 million in automobile insurance coverage against liability. That accessible transportation systems between regions be developed. (Recommendation 64) MYP for LTC Services in Hamilton, January Planning for parallel transit is not co-ordinated or integrated across regions. Individuals needing to travel outside Hamilton for medical appointments, therapy, work, school or recreation have a limited number of accessible transportation options. Wheelchair and scooteraccessible ramps are available on a number of GO system trains operating between the GTA and Hamilton. That standards for driver escort and accompaniment for the medically fragile, MYP for LTC Services in Most agencies have introduced screening processes for volunteers working with vulnerable individuals, and 24

27 ambulatory confused persons, persons requiring personal assistance, and children and adolescents be developed. (Recommendation 65) Cross reference Recommendation C10, LTC Annual District Service Plan, January 1998 Hamilton, January driver training programs for assisting persons with special needs. Training for volunteer drivers is not perceived to adequately prepare them to assist the increasing number of adult day clients who are frail, elderly and have Alzheimer s disease or another form of dementia. Individuals with cognitive impairments other than Alzheimer disease are not currently eligible for DARTS, and may seek volunteer-assisted transportation services as an alternative. 25

28 Home Maintenance and Repair/Home Help Recommendation Pending a review of supportive housing eligibility criteria, bridge funding be made available to the Visiting Homemaker s Association s Community Link Program which provides supports to tenants living in specified seniors rent geared to income housing. (Recommendation 5) Cross reference Security Checks/Reassurance Services and Homemaking/Personal Support/Attendant Care Year and Name of Document Hamilton LTC Supportive Housing Plan, April 2001 Status R/NR/UK Comments Bridge funding was not made available to the VHA Community Link Program 2001/02. VHA folded in August The Community Link Program now operates within the St. Joe s Home Care division of SEN Community Health Care. Current funding for the program comes from the federal homelessness program, Supporting Communities Partnership Initiative (SCPI), and extends until March That a comprehensive plan be developed in Hamilton-Wentworth to support people to live independently in their residences. The Plan must include: (Recommendation 33) (a) Attendant care services; (b) Meal services; (c) Grocery shopping services; (d) Home maintenance and home help services; (e) Life skills programs, health education and rehabilitation; (f) Retro-fit/home adaptation programs; (g) Programs to provide a sense of safety and security (e.g. friendly visits); and (h) Palliative care services. Cross reference Diners Club/Meals to Wheels/Congregate Dining, Home Maintenance and Repair, Independence Training, Security Checks/Reassurance, Case Management, Palliative Care A comprehensive plan has not been developed for all these services. A City of Hamilton Food Access Guide 2002 is one effort to provide a directory of meal and food services. The Hamilton CCAC is leading the development of a Palliative Care Network for Hamilton. Attendant care services for adults with physical disabilities living in supportive housing units may be supplemented with services through the CCAC. The CCAC refers clients to community-based agencies for the remaining identified services as requested, on a non-contractual basis. That retrofit programs to co-ordinate and facilitate home adaptation initiatives for persons of all ages be encouraged. (Recommendation 46) Not Central Mortgage and Housing Corporation has a four programs to facilitate home adaptation and retrofitting: 26

29 RRAP (residential rehab program) HASI (Home Adaptation for Seniors Independence) SEP (Shelter Enhancement Program) ERP (Emergency Repair Program) That the availability of formally organized and coordinated home maintenance/home help services be expanded. (Recommendation 48) As of August 2002, SEN is now responsible for this service on a brokerage basis, with the closure of the Visiting Homemakers Association in Hamilton. It is unknown how the current demand for these services compares with the supply. 27