Admission Guidelines for Publicly Funded Continuing Care Living Options (April 15, 2010)

Transcription

1 Admissin Guidelines fr Publicly Funded Cntinuing Care Living Optins () Intent f Living Optin Guidelines Alberta s new Cntinuing Care Strategy: Aging in the Right Place utlines a new way f delivering cntinuing care services, ne that will ffer greater chice and enable senirs and individuals with disabilities t remain in their wn hmes and cmmunities, as ppsed t being admitted t supprtive living r lng-term care. The intent f these Living Optin guidelines is t prvide a set f supprt tls t assist with cnsistent living ptin decisins in relatin t Supprtive Living levels 3, 4 and Lng-term Care. Cnsistent applicatin f these guidelines will ensure that lng-term care beds are used by thse wh mst need them: thse clients with cmplex, unpredictable medical needs requiring 24-hur n-site unscheduled Registered Nurse assessment and services. The attached Guidelines are based n and supplement Alberta Senirs & Cmmunity Supprts Supprtive Living Framewrk Levels 3 and 4 and the rle f Facility Living as described in the Alberta Health & Wellness Cntinuing Care Health Service Standards. The Guidelines are nt meant t be rigid r verly prescriptive. Case managers and assessrs will be persn-centred and will be flexible in accmmdating client needs and chices as much as pssible while cnsidering and managing risk t clients. This will especially be the case ver the transitin perid (three t seven years) as mre facilities are develped and mre ptins are available fr senirs. In the interim, it is recgnized that, because f the lack f intermediate ptins, sme senirs will be accmmdated in mre dependant accmmdatin than they require. These Guidelines are intended t cver the majrity f prgrams and services. Criteria fr specialized living ptins and shrt stay prgrams and units will be develped. Current terminlgy regarding specific prgram names varies greatly acrss Alberta s examples f settings are prvided fr infrmatin. The term designated generally dentes a partnership with an peratr, with funding prvided by Alberta Health Services (AHS) fr health care supprt services. Operatrs may be public, private r vluntary. Admissin and Transitin Prcesses Thrugh the AHS Crdinated Access prcess, all clients will be assessed fr access t the mst apprpriate level f care and identified prgram. All clients will be prvided with infrmatin regarding the range f available services and ptins t meet their assessed needs including access t affrdable accmmdatin. Access criteria fr each level f care serve as general guidelines. Each client will be individually assessed. Temprary changes in status may ccur with acute episdes f illness, falls and pst hspitalizatin and reassessment may be required. Effrts will be made t supprt individuals t stay in their chice f living ptin t enable aging in place including, fr example, the use f added care. Cmmn t All Living Optins Operatrs will prvide a safe and secure envirnment and hspitality services as per the Supprtive Living Accmmdatin Standards r the Lng-Term Care Accmmdatin Standards. Operatrs in partnership with AHS meet r exceed the Cntinuing Care Health Service Standards such as but nt limited t: End f life care and supprt will be prvided. Allied Health assessments and treatment will be prvided accrding t client needs. These include Recreatin Therapy, Physical Therapy, Occupatinal Therapy, Scial Wrk, Speech Language Pathlgy (including swallwing assessments), and Respiratry Therapy. Scheduled prfessinal nursing treatments may include but are nt limited t subcutaneus r intramuscular injectins, cmplex dressings, etc. Dietitian assessments and mnitring will be available if required fr clients with special diets. All clients will have access t medically required physician services and primary care including referral t specialist services. All clients will have access t apprpriate diagnstic and emergency services. Where pssible, urgent assessment and care will be prvided in the living ptin rather than an acute care setting. Clients with unpredictable behaviurs will have access t the apprpriate envirnment fr their needs. Clients with behaviurs requiring certificatin under the Mental Health Act will nly be admitted t living ptins with apprpriate prgrams and setting.

2 Supprtive Living Level 3 Assisted Living (SL3) Definitin: A designated Supprtive Living Level 3 Assisted Living is an envirnment that prvides 24-hur n-site scheduled and unscheduled persnal care and supprt prvided by Health Care Aides. Sme settings may have a secured envirnment. Prfessinal health services including Registered Nurse services with 24-hur n-call availability, case management, assessment and ther cnsultative services such as but nt limited t Geriatric/Psychgeriatric Outreach Teams, Palliative Care, Scial Wrk, Rehabilitatin services, etc. are prvided thrugh AHS. Examples f Settings Living Optins Enhanced Living Enhanced Living Dementia Cttage Enhanced Ldge Level 3 Persnal Care Hmes Special Care Hme Family Care Hmes Clients will be assessed as nt able t safely cpe in their hme r lwer level living ptin with r withut infrmal supprt. They als will be assessed as requiring 24-hur persnal care and supprt in a supprtive, structured and supervised envirnment. Medical Cnditins: Medical cnditin is stable and apprpriately managed withut a 24-hur n-site Registered Nurse r Licensed Practical Nurse PRN (unscheduled) medicatin assistance available if client capable f making request Cgnitive Status: May have mild dementia but behaviurally stable May require unscheduled reassurance N knwn risk f elpement but may wander, is easily redirected Awareness f persnal space f thers Scial behaviur f resident des nt induce fear and anxiety in ther residents in this supprtive living setting N knwn risk f self-harm r harm t thers Functinal Status: Mbilizes independently r with ne-persn transfer Requires unscheduled persnal care (assistance with management f incntinence, cueing and/r assistance with meals, transprtatin t meals, directin and/r cueing fr initiatin and cmpletin f activities, assistance with prepackaged scheduled medicatins) Able t call fr help using a call system Scial Supprt: Infrmal caregivers remain a welcme and integral cntributr t the persn-centred plan f care Exclusin Cnsideratins: Cmplete meal assistance if dietitian supprt / cnsultatin is nt available Mechanical lift transfers Tw-persn transfers Chrnic unmanaged incntinence nt amenable t inverventins Admissin Guidelines fr Publicly Funded Cntinuing Care Living Optins

3 Supprtive Living Level 4 Enhanced Assisted Living (SL4) Definitin: A designated Supprtive Living Level 4 Enhanced Assisted Living is an envirnment that prvides 24-hur n-site scheduled and unscheduled prfessinal and persnal care and supprt, prvided by Licensed Practical Nurses and Health Care Aides. Prfessinal health services including Registered Nurse services with 24-hur n-call availability, case management, assessment and ther cnsultative services such as but nt limited t Geriatric/ Psychgeriatric Outreach Teams, Scial Wrk, Palliative Care, Rehabilitatin services etc. are prvided thrugh AHS. Where there are sufficient numbers, special prgrams may be established fr clients with similar cmplex clinical r cmplex functinal care requirements (e.g., brain injured, ventilatr dependent). If insufficient numbers, clients requiring these services will receive them as part f a general unit r prgram, subject t individual assessment. Examples f Settings Living Optins Designated Assisted Living Level 4 Persnal Care Hmes Clients will be assessed as nt able t safely cpe in their hme r lwer level living ptin with r withut infrmal supprt. Als, they will be assessed as requiring 24-hur prfessinal and persnal care and supprt in a supprtive, structured and supervised envirnment. Medical Cnditins: May be cmplex but are stable and apprpriately managed safely thrugh an interdisciplinary persncentred plan f care Unscheduled prfessinal assessments may be required t adjust the plan f care which may include medicatin management Cgnitive Status: May have varying levels f dementia but are behaviurally stable May require unscheduled reassurance Minimal risk fr elpement but may wander, is easily redirected Scial behaviur f resident des nt induce fear and anxiety in ther residents in this supprtive living setting Minimal risk f self-harm r harm t thers Functinal Status: Will have cmplex physical care needs that cannt be met at hme r in a lwer level f supprtive living May require the fllwing types f assistance with Activities f Daily Living (ADL): - Cmplete meal assistance including tube feeding - Mechanical lift transfers - 2 persn transfers - Ttal assistance t mbilize including prtering - Medicatin assistance r administratin - Chrnic unmanaged incntinence Scial Supprt: Infrmal caregivers remain a welcme and integral cntributr t the persn-centred plan f care Exclusin Cnsideratins: Unpredictable behaviur placing self and thers at risk Require 24-hur n site RN prfessinal services Require intensive and/r extensive rehabilitatin services that cannt be easily accessed Admissin Guidelines fr Publicly Funded Cntinuing Care Living Optins

4 Supprtive Living Level 4 Dementia Enhanced Assisted Living (SL4 D) Definitin: A designated Supprtive Living Level 4 Dementia Enhanced Assisted Living prvides a purpseful hme-like design with small grupings f private bedrms and assciated spaces in a secured therapeutic envirnment. This envirnment prvides 24-hur n site scheduled and unscheduled prfessinal and persnal care and supprt prvided by Licensed Practical Nurses and Health Care Aides. Prfessinal health services including Registered Nurse services with 24-hur n-call availability, case management, assessment and ther cnsultative services such as but nt limited t Geriatric/Psychgeriatric Outreach Teams, Scial Wrk, Palliative Care, Rehabilitatin services etc. are prvided thrugh AHS. Examples f Settings Living Optins Designated Assisted Living Dementia Cttage Enhanced Designated Assisted Living Dementia Unit Clients will be assessed as nt able t safely cpe in their hme r lwer level living ptin with r withut infrmal supprt. Als, they will be assessed as requiring 24-hur prfessinal and persnal care and supprt in a supprtive, structured and supervised envirnment. Medical Cnditins: May be cmplex but are stable and apprpriately managed thrugh an interdisciplinary persn-centred plan f care Unscheduled prfessinal assessments may be required t adjust the care plan including medicatin needs Cgnitive Status: Will have mderate dementia that may prgress t later stages r ther frms f cgnitive impairment (CPS f 3 r greater) Lacks awareness f persnal space f thers Will have unpredictable behaviurs including wandering which may include risk fr elpement May have unpredictable behaviurs placing self and thers at risk but manageable in this envirnment Functinal Status: May have cmplex care needs that cannt be met at hme r in ther supprtive living envirnments May require the fllwing types f assistance with Activities f Daily Living (ADL): - Cmplete meal assistance, including tube feeding - Mechanical lift transfers - 2 persn transfers - Medicatin assistance r administratin - Chrnic unmanaged incntinence Scial Supprt: Infrmal caregivers remain welcme and integral cntributrs t the persn-centred plan f care Exclusin Cnsideratins: Unpredictable behaviur placing self and thers at risk (may nt be an exclusin cnsideratins in sme settings) Requires 24-hur n site RN prfessinal services Requires intensive and/r extensive rehabilitatin services that cannt be easily accessed Admissin Guidelines fr Publicly Funded Cntinuing Care Living Optins

5 Lng-term Care Facility Definitin: Lng-term Care Facility is an envirnment that prvides services fr peple with cmplex unpredictable medical needs requiring 24-hur n site Registered Nurse assessment and/r treatment. In additin, prfessinal services may be prvided by Licensed Practical Nurses and 24-hur n site unscheduled and scheduled persnal care and supprt will be prvided by Health Care Aides. Case management / Registered Nurse and Rehabilitatin Therapy are prvided n site. Other cnsultative services such as but nt limited t Geriatric/ Psychgeriatric Outreach Teams, Palliative Care, etc. are prvided thrugh AHS. Lng-term facility care may have secured lng-term care, dementia care units. Where there are sufficient numbers, special prgrams may be established fr lng-term care clients with similar cmplex clinical r cmplex functinal care requirements (e.g., brain injured, ventilatr dependent). If insufficient numbers, clients requiring these services will receive them as part f a general lng term care unit r prgram, subject t individual assessment. Clients will be assessed as nt able t safely cpe in their hme r in a lwer level living ptin with r withut frmal supprt. Medical Cnditins: Will have cmplex unpredictable needs but are clinically stable and can be managed safely with 24-hur nsite Registered Nurse and regularly scheduled and unscheduled n-site physician supprt - Cmplex end f life care needs - Cmplex medicatin management - Cmplex nursing interventins Unscheduled assessments are ften required t address changing resident care issues Cgnitive Status: May have any stage f dementia May have unpredictable behaviurs placing self and thers at risk Functinal Status: Will have cmplex physical needs with care requirements that cannt be met at hme r in a supprtive living envirnment May require the fllwing types f assistance with Activities f Daily Living (ADL): - Cmplex nutritinal intake requirements - Intensive and extensive rehabilitatin requirements - Cmplex eliminatin requirements Scial Supprt: Infrmal caregivers remain a welcme and integral cntributr t the persn-centred plan f care There may be cmplex family dynamics requiring 24-hurs/7-days RN n-site interventins Exclusin Cnsideratins: Clients with unstable acute medical r psychiatric cnditins wh require acute care hspitalizatin Admissin Guidelines fr Publicly Funded Cntinuing Care Living Optins