Transforming Health Care For Seniors in the Mississauga Halton LHIN Right care, right time, right setting, right cost

Transcription

1 Transforming Health Care For Seniors in the Mississauga Halton LHIN Right care, right time, right setting, right cost Narendra Shah COO MH LHIN September 29,

2 Implications of Alternate Level of Care 2,700 beds occupied in 09/10 ALC is about Safety and Quality of Care Home First MH LHIN Vision Aging at Home ALC is about Patient and Family First ALC is about Care of Seniors mostly >75 years age group (70-80 %) 2

3 MH LHIN Aging at Home Strategic Approach Right Care, Right Place, Right Time, Right Cost LTCH Objectives LOS ALC Admission Avoidance Continuing Care Reform 300+ beds ER Objectives ER Use Treatment Time Strategic Objectives: I. Reduce ALC days and LOS in hospitals II. Reduce demand (wait list) for LTC homes III. Alternatives in Community to LTC for High Need Seniors (MAPLe 3,4,5) IV. Reduce unnecessary ER visits Objectives Demand Right Persons 27 Homes 4,100 Beds I. Invest in targeted areas to enable seniors with complex Needs (usually 75+ age) to stay safely in the community II. III. Invest in LTC homes to reduce ER/hospitalization of 4,000+ residents; and, increase LTC homes capacity to care for higher need seniors Use proven common set of assessment/eligibility tools (RAI family) across all sectors-home care, SDL, ADP, LTC and CCC to ensure right care, right setting, at the right time and right cost 3

4 LTC Home Home Restorative Care in the Community Where do elderly patients expect to or want to go post acute care? 4

5 Home First is About Patient First All acutely ill patients want to return home (community) after the post acute phase. No patient expects to go to a LTC home HOME FIRST is about best way for transition from hospital to home as soon as possible after the decision is made that the patient no longer requires inpatient care In most instances it is about how best to take care of high need seniors post hospitalization in the community/home with appropriate supports It is about changing the provider driven/knows best discharge approaches that is not often reflective of right care, right time, right place at right cost AND not inclusive of patient/family engagement First Message Focus continues to be on going Home as the destinationmobilize necessary community supports to enable safe care

6 Home First From a Quality Paradigm Hospitalization can be hazardous for older adults (Suesada et.al., 2007; Gillick et. al., 1982; Brown et. al., 2004 Hospitalization of elderly often leads to decreased functional mobility, decreased ventilation, delirium, accelerated bone loss and incontinence (Creditor, 1993) Staying in a hospital longer than medically necessary can be detrimental to a patient s health for a number of reasons: Risk of hospital acquired infections For seniors, a decline in physical and mental abilities due to lack of activity Much needed acute beds for patients waiting to be admitted Home provides the best environment to experience a significant life transition, such as a move to a LTC home Second Message Hospitals, MH CCAC and all HSPs must see ALC as a top priority both from a quality and sustainability perspective 6 Narendra Shah Oct 1, 2010

7 Balancing Quality and Risk What is more risky in terms of poor quality of care - continued stay in hospital as an ALC or discharge to an appropriate community/home setting other than LTC home? 7

8 Right Investments in Community Programs for High Need Seniors to Enable Home first Shift away from a facility-based health care system by investing in community-based care: Reduce ALC days and LOS in hospitals Reduce wait list for LTC homes Facilitate and maximize post-acute care services through an emphasis on alternate models - transitioning to lower or more appropriate levels of care Increase capacity to serve high need seniors (MAPLe 4,5 and 3 s) for appropriate home and community based services to extended hours including evenings, weekends and 24/7 where appropriate and feasible MH CCAC services refocused to support high need seniors with enhanced home care, including use of ED P4P funds towards this group Third Message Invest in the right community programs to care for high need seniors & re-focus CCAC and community support services to serve high need seniors. Performance review of investments and realign as necessary 8

9 MH LHIN Aging at Home Strategic Approach Right Care, Right Place, Right Time, Right Cost Transitional Capacity Convalescent Program Post Inn 20 beds LTCH Services in the home Objectives LOS ALC Admission Avoidance Complex Continuing Care Reform 300+ beds ER Objectives ER Use Treatment Time Transitional Beds in Hospitals 21 beds Restore MLC -26 beds Behavioural Unit Sheridan Villia 19 beds CCAC Enhanced SDL and SDL 24/7 Mobile ABI Outreach Objectives Demand Right Persons 27 Homes 4,100 Beds Capacity Enhancement in Home/Community Transportation Falls Program Chronic Diseases CHF/ COPD 24/7 Crisis Response to Mental Health & Addiction Enhanced Palliative Home Help/ Maint. Home Making Continence Mgmt 75+ Specialized Geriatric Outreach Enhanced Respite Home Care by CCAC Adult Day Programs Dementia & Alzheimer s Outreach & Day Programs NP s In LTC Psychogeriatric Outreach CCAC CSS CMHA 9

10 MH LHIN Aging at Home Investments Implications on ER Improvement Right Care, Right Place, Right Time, Right Cost 24/7 Crisis Service For Mental Health & Additions SDL ER Avoidance (YE 09/10) 958 Visits Avoided (Q1 10/11) 231 Visits Avoided CCAC Follow up on all 75+ From ER 10,929 CDPM Mgmt ERs Avoidance Strategies NPs LTC Homes 1,123 encounters 1523 ER visits averted 285 Unique Clients out of hospital Palliative End of Life Capacity in Home Care Urgent Geriatric Clinic Falls Clinic 10

11 Transformation of CSS Sector to Focus on Frail Elderly to Stay at Home Safely Objective: Increase Capacity to Reduce Dependence on Institutions (LTC and Hospital Sector) Pre- LHIN CSS Performance Requirements # Clients Balanced Budget Client Satisfaction Pre-LHIN Supportive 2007/08 Housing Most clients MAPLe 1,2s No 24/7 support Limited integration with hospitals Stand-alone Transportation Services $13.5M Adult Day Services Most clients MAPLe 1,2s $5.5M ABI Residential with Community Outreach Respite Care Day-To-Day Caregiver Relief Home Making/Maintenance Other CSS Increase of $18.7M Support Higher Need At Risk Seniors $3.6M $2.9M $1.5M $1.0M $6.3M $34.3M /11 Reform of SH to Supports for Daily Living Focus on Reducing LTC Needs 24/7; Integrated Approach LHIN-wide Mobile Capacity Extensive Interaction with Hospitals and New Clients CCAC MAPLe 4,5 Adult Day Services Support more at risk Seniors MAPLe 3+ Enhanced Respite Care (High Needs) $25.3M ABI Significant outreach to Hospitals and LTCHs $4.5M $3.9M Integrated Transportation LHIN-wide $1.9M Integrated Home Making/Maintenance$2.2M LHIN-wide $7.0M Other CSS $8.2M Additional Performance Requirements High Risk Seniors (MAPLe 3+) Clients taken from Hospitals, Community and LTC Sectors Integral part of Joint Discharge Process in hospitals and CCAC All referrals from CCAC Higher Needs MAPLe 3 Reduce LTC Demand Expand to Support difficult cases in Hospitals and LTCHs; Clients assisted to avoid ER/Hospiital Reduce ALC Reduce LTC/ER Demand Use of Care Giver Stress (CGS) Tool LHIN-wide Approach Free Existing Hospital Capacity Right Placements in LTC Sector by CCAC SILO Integrated Approach $53.0M 11

12 MH LHIN Transformation of LTC Sector 4, homes Integration (CSS & CMHA with LTC Sector) Psychogeriatric Outreach ABI Outreach NP Program 220 bed LTC Facility at Trillium West Toronto 5.4% 4, homes Quality Improvement with OHQC 8 Homes Quality Improvement Dialysis at 2 homes Convalescent Care Program Post Inn Integration (with Hospitals & CCAC) Behavioural Unit Sheridan Villa Restore Program - MLC Convalescent Care Program Post Inn Specialization Pre-LHIN LHIN September

13 MH LHIN Trend in ALC Days & Patients Impact of Acute Care FY 07/08 FY 08/09 FY 09/10 %Change to 09/10 FY 07/08 FY08/09 Total Days 354, , , % -4.1% Total Pts 60,864 61,408 63, % 3.0% Growth Avg LOS % -6.9% Total ALC Days 35,844 47,650 32, % -30.9% Total ALC Pts 2,174 2,432 2, % 10.1% Results Avg ALC LOS % -37.3% %ALC 10.10% 12.80% 9.21% -8.8% -28.0% 3.59% absolute point reduction in ALC Days in 09/10 Source: CIHI for all 3 years Despite growth we had good results 13 13

14 Acute ALC Rate for Ontario - Fiscal Years 2008/09 & 2009/10 90 beds FYear LHIN ALC LOS (c) 2008/ /10 Total LOS ALC % ALC LOS Total Days (d) (a) Total LOS ALC % Total Days (b) ALC Days reduction 08/09-09/10 (d) - (C) (06) MISSISSAUGA HALTON 47, , % 32, , % -14,747 (05) CENTRAL WEST 24, , % 22, , % -2,144 (01) ERIE ST. CLAIR 30, , % 29, , % -929 (07) TORONTO CENTRAL 104, , % 111, , % 6,914 (02) SOUTH WEST 66, , % 60, , % -6,007 (08) CENTRAL 69, , % 81, , % 11,873 (11) CHAMPLAIN 95, , % 108, , % 12,792 (10) SOUTH EAST 46, , % 43, , % -3,201 (03) WATERLOO WELLINGTON 52, , % 41, , % -10,678 (14) NORTH WEST 32, , % 30, , % -1,318 (09) CENTRAL EAST 85, , % 102, , % 17,904 (12) NORTH SIMCOE MUSKOKA 38, , % 41, , % 3,322 (04) HAMILTON NIAGARA HALDIMAND BRANT (HNHB) 189, , % 158, , % -31,176 (13) NORTH EAST 127, , % 125, , % -2,196 Total 1,011,007 6,298, % 991,416 6,236, % -19,591 *Exclude new born and still born 2,700 beds

15 Change in LTC Demand in 2009/10 Total Long-Stay Waitlist Ontario MH LHIN Mar-08 23,006 1,040 Mar-09 24,648 1,279 April ,033 1,155* % Change in % -9.6% MH LHIN in 2009 Province How? Alternatives to LTC (SDL, Restore) Emphasis upon Home First from hospital has decreased demand LTC beds per 100 people 75+ years Reduction in New LTC Applicants All Sources -13.0% In Hospital -28.7% Acute Care FY 07/08 FY 08/09 FY 09/10 07/08 08/09 ALC-LTC Days 11,092 20,615 8, % -59.8% (1) % Change to 09/10 Patients % -34.3% 15

16 Objectives LOS ALC Admission Avoidance Complex Continuing Care Reform 300+ beds ER Objectives ER Use Treatment Time Overall Results 2009/10 MH LHIN Aging at Home Strategic Approach Right Care, Right Place, Right Time Strategic Objectives: I. Reduce ALC days and LOS in hospitals II. Reduced equivalent of 40 acute occupancy -9.6% in demand for LTC Home Over 80% of new referrals were high MAPLe Reduce demand (wait list) for LTC homes III. Alternatives in Community to LTC for High Need Seniors (MAPLe 3,4,5) IV. Reduce unnecessary ER visits LTCH Objectives Demand Right Persons Sheridan Villa Behavioural Unit 27 Homes 4,100 Beds 16

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