PRIME. A Health Centre for Seniors. Jo- Ann Lapointe McKenzie. Chief Nursing Officer, Deer Lodge Centre & Judy Ahrens- Townsend Manager, PRIME
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1 PRIME A Health Centre for Seniors Jo- Ann Lapointe McKenzie Chief Nursing Officer, Deer Lodge Centre & Judy Ahrens- Townsend Manager, PRIME Winnipeg Regional Health Authority Deer Lodge Centre Site
2 Manitoba s Long Term Care Strategy Aging in Place Affordable housing opions with supports Promote independence in daily living Maximize overall health and wellbeing
3 Long Term Care ConInuum Independent Living Supports to Seniors in Group Living Expanded Supportive Housing Specialized Supports: PRIME Personal Care Home Home Care Support Services to Seniors
4 Origins PACE USA CHOICE Edmonton
5 Virtual Tour Deer Lodge Centre
6
7 WHO comes to PRIME?
8 Socio- Demographics Age Group (%) Sex (%) PRIME Particip ant (n=145) PRIME Referral (n=116) Home Care Client (n=13,877) Male Female Marital Status (%) Never Married Married Widowed Separated Divorced Other Education (%) Grade 8 or Less Grades High School Greater than High School Unknown
9 Socio- Demographics PRIME Age: % % % Sex: Male 46% Female 54% Marital Status: Married 45% Widowed 44% EducaIon: Greater than HS 28% HOME CARE 15% 40% 45% 31% 69% 32% 53% 23%
10 Top 10 Disease Diagnoses by Client Group PRIME Participants % PRIME Referral % Home Care Client % Hypertension 64.1 Hypertension 64.7 Hypertension 62.8 Arthritis 51.7 Arthritis 59.5 Arthritis 56.9 Diabetes 28.3 Emphysema/COPD/ Asthma Psychiatric Diagnosis 24.8 Psychiatric Diagnosis 30.2 Alzheimer s or Other Dementia Diabetes 21.9 CVA (stroke) 24.1 Diabetes 28.5 Coronary Artery Disease Alzheimer s or Other Dementia Emphysema/COPD/ Asthma Osteoporosis 26.7 Thyroid disease Thyroid disease 26.7 Emphysema/COPD/ Asthma Coronary Artery 17.9 Alzheimer s or 25.9 Osteoporosis 17.6 Disease Other Dementia Cataract 17.9 CVA (stroke) 24.1 CVA (stroke) Congestive Heart Failure * (Thyroid disease) Coronary Artery Disease 19.0 Congestive Heart Failure 15.2
11 Top Disease Diagnoses Hypertension: 60% both groups Psychiatric Diagnosis: 4 th prevalent for PRIME Alzheimer s: 24% both groups Median # of Diagnoses: 4.0 for both groups
12 Priority Levels & Risk for InsItuIonalizaIon PRIME Participants Home Care Client MAPLe Score: Priority Level for Care (%) 1 - Low Mild Moderate High Very High New Institutional Risk CAP (2008) (%) At Risk for LTC Institutionalization
13 PRIME The All Inclusive Journey PRIME
14 PRIME Umbrella of Care Case Manager Day Centre Primary Health Clinic Acer Hours Support
15 Case Manager From Referral to Discharge Partnership Build responsive service package Home Care Case coordinaion
16 Day Centre Monday - Friday TransportaIon Interdisciplinary team Personal care/ grooming/ personal laundry RecreaIonal and social aciviies RehabilitaIon /exercises Health promoion aciviies Lunch meal
17 Primary Health Clinic Monday - Friday Transfer of care to PRIME physician CoordinaIon of on- site & off- site appointments MedicaIons distributed weekly
18 AHer Hours Support You can call any Jme Evening and weekend nurse (weekdays 4:30 8:30 PM; weekends & stats 9 AM 5:15 PM) Home visits and telephone response Provincial Health Contact Centre - nights
19 PRIME Financing Insured services with MB Health Nominal Co- payment Pharmacy benefits
20 PRIME EvaluaIon
21 PRIME August 2013 Opened January 2009 First clients enrolled in March 2009 Capacity: 90 EvaluaIon: January 2009 to March 2011
22 EvaluaIon SaIsfacIon paricipant, family and staff CharacterizaIon of paricipants Clinical indicators Health service uilizaion
23 SaIsfacIon
24 SaIsfacIon Program Domains Responses re: Program impact PRIME services CommunicaIon Program improvements
25 SaIsfacIon Summary of Responses PosiIve impact on paricipants lives PosiIve impact on care givers ParIcipants feel well taken care of Would recommend PRIME PRIME helped reduce ED visits Without PRIME paricipant would have been placed in personal care home
26 Quotes Overwhelming empathy I trust her Whatever he needs it is always there Problems dealt with immediately My mother is happy
27 Quotes What is important to them about PRIME Ø Competency of staff Ø Evening and weekend staff Ø Doctors and nurses on site Ø Everything works together as a team, under one roof Ø They are listening and taking the problems seriously Ø HolisIc approach
28 Quotes What is important to them about PRIME Ø Mental and physical simulaion Ø Regular monitoring of medical needs Ø Do not feel isolated as caregivers Ø Allows paricipants to remain in the community Ø In all honesty, without PRIME, I don t know if I could coninue Ø I am accepted here
29 CharacterizaIon
30 PRIME ParIcipants vs Home Care clients Higher number live with primary care giver Higher number require increased informal support Care giver distress is highest amongst PRIME paricipants Higher numbers with mild cogniive impairment
31 CharacterizaIon cont Required more extensive assistance with ADL s and IADL s High risk for depression, falls and bladder inconinence Higher health instability Psychiatric diagnosis is the 4 th most prevalent diagnosis
32 CharacterizaIon Overall For PRIME paricipants there was greater complexity and care needs idenified as compared to the Home Care clients
33 Clinical Indicators
34 Clinical Indicators Summary DiabeIcs receiving ongoing, complex care including foot care, wound and skin care and monitoring, A1C monitoring Calcium and vitamin D supplements Influenza and pneumovax shots Up to date advance care plan Regular monitoring of BP and INR
35 Health Service UIlizaIon
36 Health Service UIlizaIon Home Care Emergency Department HospitalizaIon Personal care home
37 Home Care Nursing Visits Number of Home Care Nursing Visits Reference Date Visits # Visits PRIME Participants Control Group Month
38 Home Care Nursing Visits PRIME Control Group % +48.4%
39 Home Care Nursing Hours Home Care Nursing Hours 600 Reference Date 500 # Hours 400 Hours PRIME Participants Control Group Month
40 Home Care Nursing Hours PRIME Control Group % +31.6
41 Home Care Support Visits Number of Home Care Support Visits 8000 Reference Date # Visits Visits PRIME Participants Control Group Month
42 Home Care Home Support Visits PRIME Control Group +13.9% +21.2%
43 Home Care Home Support Hours Home Support Hours Reference Date # Hours PRIME Participants Control Group Month
44 Home Care Home Support Hours PRIME Control Group +15.0% +24.3%
45 Emergency Department Visits Emergency Department Visits 70 Reference Date # Visits 40 Visits 30 PRIME Participants Control Group Month
46 Emergency Department Visits PRIME Control Group % %
47 Emergency Department Hours ED Hours 1200 Reference Date 1000 # Hours 800 Hours PRIME Participants Control Group Month
48 Emergency Department Hours PRIME Control Group % %
49 Hospital Admissions Number of Hospital Admissions 16 Reference Date # Admissions 10 Admissions 8 6 PRIME Participants Control Group Month
50 Hospital Admissions PRIME Control Group % %
51 Hospital Days Hospital Days 400 Reference Date # Days Days PRIME Participants Control Group Month
52 Hospital Days PRIME Control Group % +45.3%
53 Admissions to Personal Care Home within 12 months PRIME Control Group 16.2% 22.1%
54 QUESTIONS?
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