Meeting Future Need Through Specialization in LTC Homes

Transcription

1 Meeting Future Need Through Specialization in LTC Homes CLRI Conference November 9, 2015 Presenters: Amy Porteous and Zsófia Orosz

2 Presenter Disclosure 2 Research Team: Amy Porteous, Bruyère Continuing Care Peter Walker, Melissa Donskov, Tracy Luciani and Zsófia Orosz, Bruyère Research Institute Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: N/A Consulting Fees: N/A Other: N/A This project is supported with funding from the Government of Ontario through the Bruyère CLRI. The views expressed in this publication are the views of the author(s)/presenter(s) and do not necessarily reflect those of the funder.

3 Disclosure of Commercial Support 3 This program has received financial support N/A This program has received in-kind support N/A Potential for Conflict of Interest: Amy Porteous was involved in the designation process for the Peritoneal Dialysis Specialized Unit at Saint-Louis Residence.

4 Presentation Outline 4 Background/context Project description and research methodology Specialized Units Key findings Specialized Units characteristics Experiences with designation process Operational experiences Meeting future needs through Specialized Units Introducing a multi-stakeholder application toolkit

5 5 SPECIALIZED UNITS (SUs) IN ONTARIO S LONG-TERM CARE HOMES: AN INTRODUCTION

6 Facilitating System Change in LTC 6 From Dr. Samir K. Sinha s report (2013, p. 135): development of new or expanded service delivery models that address system gaps and the location of more specialized longterm care services, like behavioural support units, to promote quality and efficiency in local service delivery.

7 Legislative Framework for Specialized Units 7 LTC Home Act (2007) LTC Homes Regulation (79/10, sec ) (2010) Policy for Designation/Revocation of Specialized Units (July 1, 2015) support and resources required local flexibility enhanced care needs

8 Designation Process 8 Designation is for existing long-stay LTC beds Home Submits proposal to Local Health Integration Network (LHIN) LHIN Reviews and recommends to Ministry of Health and Long-term Care (MOHLTC) MOHLTC PIC Branch Reviews and approves proposal (Performance Improvement and Compliance Branch)

9 Why Designate? 9 Separate wait list Opportunity to get extra funds from Local Health Integration Network 1. must not be available from other LTC initiatives covered by other policies, for example Behaviour Support Ontario 2. must come outside of the LHIN s LTC allocation to the Home 3. could be one-time start-up or ongoing support added to the level-of-care per diem and supplementary funding

10 At the Start of Research 8 Designated Units in Ontario s 629 Homes behavioural support and dialysis 137 designated beds (0.18% of 77,605 LTC beds) Units address specialized care needs and improve the quality of care Residents must be eligible for LTC Home admission and meet the Unit s admission criteria Units are provincial resources Pilots Limited information available on application process 10

11 Existing Specialized Units 11 Home LHIN Number of Type of Duration Beds in Unit Unit Baycrest Jewish Home Toronto Central 23 BSU 3 years for the Aged Cummer Lodge Central 16 BSU 3 years Hogarth Riverview North West 24 BSU 2.5 years Manor Linhaven Home for the Hamilton Niagara 17 BSU 3 years Aged Haldimand Brant Peter D. Clark Centre Champlain 12 BSU 2 years Sheridan Villa Mississauga Halton 19 BSU 5 years Mackenzie Health Central 20 Hemodialysis 2.5 years Long-Term Care Home Saint-Louis Residence Champlain 6 Peritoneal Dialysis 2.5 years

12 Why Specialized Units in LTC? 12 Homes encouraged to expand their services in the continuum of care beyond their traditional areas Homes face barriers (financial, planning capacity, no new LTC beds, competition from other sectors, negative perceptions of LTC) THE NUMBER OF DESIGNATED SPECIALIZED UNITS REMAINS LOW Original research hypothesis: The current number of SUs is the result of a combination of different systemic issues and individual home-related barriers.

13 13 BRUYÈRE CLRI RESEARCH PROJECT

14 Bruyère CLRI Project Objectives 14 Understand specialized care in LTC Explore capacity planning Toolkit LTC SYSTEM CHANGE

15 Project Activities 15 Literature review Comprehensive consultation Specialized Units LTC Homes with specialized care Local Health Integration Networks Community Care Access Centers LTC Associations Ministry of Health and LTC Networks Analysis and summary of findings Draft toolkit and organize review Disseminate findings

16 Selected Examples of Specialized Programs 16 Canadian models: Alberta and Manitoba: special care units in hospitals/complex continuing care BC: care to special populations in all long-term residential care services challenges New Brunswick: Specialized Care Bed Homes Saskatchewan: Special Care Homes may offer special nursing procedures USA: skilled nursing facilities Sweden: special dementia living units in nursing homes The Netherlands: Hogewey Dementia Village

17 What Makes a Unit Specialized? 17 OUR WORKING DEFINITION Specialized Units are a unique service arrangement for Longterm Care Homes that expands the role they can play in the continuum of care. These units provide transitional or permanent higher intensity care that is tailored to the need of a well-defined specific group of clients. These clients care needs go beyond what a Home generally offers but they do not require the complexity and range of care sub-acute, acute or complex continuing care hospitals offer. These residents may require a combination of adjusted services, programs, equipment/supplies or adapted accommodation.

18 From Definition to Interview Inclusion Criteria 18 Inclusion Homes with designated Specialized Unit Homes with specialized care/programs in long stay beds without designation Exclusion Care for a group of residents with specific religious, ethnic and/or linguistic origins covered in Ontario Regulation 79/10 sec.165(2)

19 Research Methodology 19 APPLIED POLICY RESEARCH (Ritchie and Spencer 1994) Category Goal Analysis focus on Contextual Diagnostic Evaluative Strategic Understand the context and reality of Specialized Units and specialized programs Examine the reasons why stakeholders decide to seek designation or not Review elements of current process in terms of effectiveness Identify new practice and actions Unit and program characteristics Perceptions of the Units (internal and external) Who are the stakeholders Expectations of the Units and programs from different stakeholders Why and how are different Units and programs used Home/regional/provincial facilitators and barriers What factors underlie perceived facilitators and barriers Benefits and challenges with separate waitlist Benefits and challenges with extra or different resources for the Home Units and system integration What type of SUs could meet needs Expanding the SU network: the cost of action vs. inaction What strategies to overcome newly defined challenges

20 Framework Analysis Familiarization 5. Mapping & interpretation 2. Identifying a thematic framework 4. Charting 3. Indexing

21 Consultation Process 21 Semi-structured interviews (Jan- June 2015) 2+ team members present 41 interviews and focus groups Draft interview notes Summary notes taken by 2 team members Notes validated by participants Participants edits integrated Anonymized Entered into NVivo Final notes

22 Research Analysis 22 Interview data analysis with NVivo Coding by 2 team members Coding tree developed and refined after test coding Key themes discussed at team meetings

23 23 FINDINGS: PARTICIPANTS CHARACTERISTICS

24 Consultation Participants 24

25 Consulted Homes Characteristics (n=19) 25 Location rural, 7, 37% private, 3 Ownership urban, 12, 63% non-profit, 6 Home staff interviewed (n=38) front line 21% municipal, 10 management 66% unit manager 13%

26 Size unknown Size unknown Size unknown Applicant Homes Characteristics (n=14) applications : 8 approved; 4 rejected; 2 under consideration Topics: Behaviour support, PD, Hemodialysis, Deaf, ABI, Complex residents All in urban settings 1 small Home, 3 medium, 7 large and 3 of unknown size Units represent 3-19% of each Home s total beds (if known) 4 municipal Home applicants, 4 non-profits, 3 private, 3 unknown Ownership type unknown 21% municipal 29% private 21% non-profit 29%

27 27 FINDINGS: DESIGNATION EXPERIENCE

28 Designation Experiences 28 LHINs key role in initiating all designated Units Proposals from partnerships Designation process took 1-2+ years Resource intensive Strengthened partnerships Regular business planning tools and Health System Improvement Proposal form used

29 Why Did They Seek Designation? 29 Identified need by Networks/Committees or invited by LHIN to seek designation Homes recognized opportunity for extra funding and dedicated waitlist Home Characteristics / Facilitators for designation Existing expertise Passion Home has specific mandate / values Committed innovator These SUs are a lot of hard work and need those who have a passion for the work. Not having this passion could be a barrier. Ours is a municipal home in a city where the LTCHs mandate is to meet unmet needs, offer services that are not provided in the community

30 Barriers to Seeking Designation 30 Limited knowledge about designation Human resources capacity for needs assessment and program design Funding lack of internal funding to invest in labor intensive design perception of insufficient and unguaranteed program funding Not within mandate Inertia existing long waitlists Risks perceived and assessed Multi-step designation process Time-limited designation

31 31 FINDINGS: SPECIALIZED UNITS OPERATIONAL EXPERIENCES

32 Each Specialized Unit is Unique 32 Units offer 3 different types of programs Specialized Behavioural Support Units Similarities all Behaviour Support Units provide transitional & high-level support Differences each Behavioural Support Unit has different admission criteria - ensures broadest range of clients benefit - facilitates care tailored to needs in the region - can be confusing for those trying to access services clients and healthcare providers - operations differ (e.g., # of beds and location, funding, staffing levels & mix, programming, partnerships)

33 Benefits of Having a Designated Specialized Unit 33 The Unit s team is amazing, so respectful of each other. This is very hard to replicate. We fill in a need and provide a quality of life for residents that is well beyond what they could have expected elsewhere.

34 34 Challenges of Having a Designated Specialized Unit Funding Insufficient to cover all costs Pilot Initiation Ensuring ideal client flow into and out of the Unit Catchment Lack of access Returning to general population Size Perception of the unit externally How do we know we are successful? What would be the catchment area of this Unit?

35 Challenges for Non-designated Programs 35 Track and manage demand Group residents for tailored care and programming Limited or no access to top up funding (start up and/or per-diem funding) Organizing targeted training and sustaining skills

36 36 SPECIALIZED UNITS ROLE IN MEETING FUTURE NEED

37 In Their Own Words 37

38 This is the Right Time to Talk about Specialized Units 38 Homes with strong partnerships and innovating Designation policy supports both social and medical models of care Provincial commitment to care integration Provincial health system funding reform Better knowledge of LTC population and sub-populations LTC redevelopment

39 39 Who Could Benefit from a Specialized Unit?

40 How Many Units and Where? 40 Difficult to ascertain need for regional demand analysis and capacity planning Population health approach & best practice guidelines # of beds needed what is the right unit size Unit sustainability (finances, future demand, commitment to equal access for urban and rural residents) These Units are not the only solution; the system needs more specialized areas both within and without LTC.

41 The Role of Capacity Planning 41 Q: Does a Specialized Unit fit in our region and how? Comprehensive regional capacity plan Mechanisms to identify Homes for Specialized Units RFP from LHIN Home/group coming forward with an identified need

42 Why and How to Connect Units? 42 What we found: Varied knowledge of Specialized Units Units have expertise and experience to share Limited collaboration among Units Many listed benefits of working together How to connect? Behavioural Support Ontario approach or a Community of Practice / Network

43 43 A TOOLKIT TO HELP NAVIGATE THE DESIGNATION PROCESS

44 Toolkit Needs assessment Partnership building Relevant for different stakeholder Short and accessible Outline complete designation process Include proposal outline Templates and examples Assess readiness for change Develop proposal LHIN review and sign off MOHLTC PICB review Pilot designation Set up, operate and evaluate Unit Request redesignation Non-time limited designation

45 Proposal Elements 45 Project charter Needs analysis (from capacity plan) Environmental scan Description of alignment with MOHLTC and LHIN priorities Impact analysis Unit description Target population / criteria / goals Partnerships Resources required Staffing, space, equipment, training, etc. Financial analysis and budget Communications Engagement Staff, physicians, residents and families, larger community Evaluation Measurement, metrics, targets and outcomes

46 As We Near the End of Our Project Thank you to all the participants The value of policy research Interviews like these offer an opportunity to reflect on what we know and where the gaps are. Next steps : Disseminate our findings Review and refine the toolkit (January 2016) Future opportunity: Integration of the voice of other stakeholders

47 Contact Us 47 We value your ideas and comments. Bruyère Centre for Learning and Innovation in Long-term Care Peter Walker Scientific Director Melissa Donskov Director of Operations Tracy Luciani Knowledge Broker Zsófia Orosz Project Coordinator Ext Ext Ext. 2672