FACTS: HOME CARE IN ONTARIO FOR PERSONS WITH DEMENTIA

Transcription

1 Oct 1, 2013 DEMENTIA NUMBERS IN ONTARIO 200,000 people in Ontario have dementia The number of people who have dementia across the province will increase by 31% from 2012 to 2020 Growth in prevalence in the Central West LHIN is projected to reach 52% by 2020 Hopkins, R. (2010). Dementia projections for the counties, regional municipalities and census divisions of Ontario. PCCC Mental Health Services. Kingston, ON. FACTS: HOME CARE IN ONTARIO FOR PERSONS WITH DEMENTIA HOME AND COMMUNITY CARE FACTS Ontario provided 653,730 clients with home care services through Community Care Access Centres (CCACs) in 2012/ out of 10 people referred from the community receive home care within 12 days of agreeing to receive services CCACs employed 6220 full time employees in 2012/2013 OACCAC. Provincial Data Health Quality Ontario. Home Care Reporting - January to March 2012 WHO ARE THE PEOPLE RECEIVING HOME CARE? Average age of people assessed from home care 77 o 82.5% of people are over age 65 40% of people assessed to receive home care upon discharge from hospital have some form of dementia 21% of people assessed to receive home care while living in the community have some form of dementia CIHI data on home care WHO CARES AND HOW MUCH? 97% of people who need home care had an unpaid caregiver at the time of assessment o 50% of these caregivers are children or children-in-law o 30% are spouses o 20% are other relatives/friends/neighbours On average they provided 20hrs of care per week Caregiver Distress Feeling unable to continue, expressing distress, anger or depression: For people assessed for homecare while in hospital 41% of caregivers showed distress

2 For people assessed for homecare while in the community 24% of caregivers showed distress CIHI data on home care HOW MUCH IS ONTARIO SPENDING ON HOME CARE? In 2013, the Ontario government increased the amount invested in home and community care by 5% annually for 3 years an increase of $260 million for this fiscal year. Average cost of providing home care per day - $42 Ministry of Finance, Ontario Budget 2013 Ontario Home Care Association Home care in Ontario Facts and Figures IMPROVING HOME CARE FOR PERSONS WITH DEMENTIA WHAT IS NEEDED TO IMPROVE HOME CARE? 1. Make dementia clients and their families the priority in the next round of community funding through explicit policies for the provision of dementia care in the community Target additional investment already committed to in the budget to dementia care services

3 FACTS: LONG-TERM CARE IN ONTARIO FOR PERSONS WITH DEMENTIA LONG-TERM CARE FACTS Ontario has 77,683 long-term care beds that serve111,777 residents each year across 634 homes (more residents than beds due to patient transfers or deaths.) 19,000 people in Ontario are waiting for a bed How long do they wait, on average? Ontario average 113 days LHIN comparison Half have longer wait times than the provincial average: Central East 127 days Central 132 days Waterloo-Wellington 134 days North East 153 days Champlain 163 days Mississauga-Halton 164 days North West 269 days HQO LHIN Comparison 2010/2011 data OLTCA (2012). Why Now Now? A Bold, Five-Year Strategy for Innovating Ontario s System of Care for Older Adults. Long Term Care Innovation Expert Panel. In 2011, there were 3,216 critical incidents that related directly to abuse and neglect in Ontario long-term care homes. These incidents accounted for 19.3% of all critical incidents reported to the Ministry. 2,773 were related to abuse or neglect; Of these, 57% were resident-to-resident encounters (1,568), 33% were staff-to-resident (900 incidents) and 2% were visitor to resident encounters (53) There were also; 207 reported incidents of improper or incompetent treatment of a resident resulting in harm or risk, 154 reported cases of misuse or misappropriation of a resident s money 82 cases of unlawful conduct that resulted in harm or risk of harm to the resident Gail Donner (2012). Long-Term Care task force of resident care and safety. An action plan to reduce abuse and neglect in Long-Term Care homes WHO ARE THE PEOPLE IN LONG-TERM CARE? As the numbers of people with dementia increase, the need for long-term and specialized care will also increase. 60% of people in long-term care have dementia diagnosis; This number has increased 4% since % of people in long-term care show cognitive impairment 45% of all long-term care residents have significant behaviour symptoms. CIHI data on residential care facilities

4 The use of anti-psychotic medication in residents without psychosis is a symptom of a system unable to effectively respond to resident care needs. 32% of residents in long-term care take antipsychotic medication without a diagnosis of psychosis 24% of residents received this medication for the first time once admitted to a long-term-care home Rochon P, Stukel T, Bronskill S, Gomes T, Sykora K, Woodchis W, et al. Variation in nursing home antipsychotic prescribing rates. Arch.Intern.Med Apr 9;167(7): Bronskill S, Anderson G, Sykora K, Wodchis W, Gill S, Shulman K, et al. Neuroleptic drug therapy in older adults newly admitted to nursing homes: incidence, dose, and specialist contact. J.Am.Geriatr.Soc May;52(5): LHIN comparison Half have higher anti-psychotic medication use than the provincial average: North Simcoe Muskoka 32% Waterloo-Wellington 35% South East 37% North East 40% Erie-St. Clair 45% Hamilton Niagara Haldimand Brant 45% Central East - 53% In comparison, the Central West LHIN has rates as low as 19% HQO LHIN Comparison 2010/2011 data The use of physical restraints on residents can also be considered a symptom of a system unable to effectively respond to resident care needs. 14% of residents have been physically restrained across Ontario long-term care homes LHIN comparison Nearly half have higher physical restraint use than the provincial average: North East 14% Erie-St.Clair 14.7% South West 15% Hamilton Niagara Haldimand Brant 15% South East 20% Champlain 20.5% In comparison, the North Simcoe Muskoka LHIN has rates as low as 8% HQO Public Reporting Information Physical Restraints in Long-Term Care WHO PROVIDES DIRECT CARE IN LONG-TERM CARE HOMES? In 2012, there were 45,000 full-time equivalent staff providing care, with 88% providing direct care to residents

5 28,900 are Personal Support Workers 10, 650 are licensed Nurses 3,600 are Allied Health Professionals Personal Support Workers provide the majority of direct care to residents, but there is no common educational standard across training programs. There is no requirement for any health professional working with people living with dementia to have training on how to effectively respond to behaviours that arise as dementia progresses. Gail Donner (2012). Long-term care task force of resident care and safety. HOW MUCH IS ONTARIO SPENDING ON LONG-TERM CARE? Ontario spends $3.4 billion annually on long term care homes, accounting for 7.5% of the provincial health budget. Average expenditure is $ per day per bed, $28.30 less per resident per day than the national average Compared to other provinces we are spending far less: Quebec $254.30/day Saskatchewan $216.70/day Alberta $201.80/day OLTCA (2012). Why Now Now? A Bold, Five-Year Strategy for Innovating Ontario s System of Care for Older Adults. Long Term Care Innovation Expert Panel. IMPROVING LONG-TERM CARE FOR PERSONS WITH ADVANCED DEMENTIA WHAT IS NEEDED TO IMPROVE LONG-TERM CARE? 1. Provide for more staff in long term care with specific skills to support persons with dementia Use Behavioural Supports Ontario as the model Anti-psychotic medication should never be used on a resident when non-pharmacological options are available 2. Establish a fair and standardized wait time for long term care so that persons with dementia have equal access and Ontarians do not wait longer in some parts of the province an average of 8 months in some regions is far too long.