The New Brunswick Extra-Mural Program
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1 The New Brunswick Extra-Mural Program Jean Bustard Department of Health April 17,
2 Mandate Provide an alternative to hospital admissions; facilitate early discharge from hospitals; and provide an alternative to, or postponement of, admission to nursing homes. Services acute, palliative, supportive and maintenance care, rehabilitation services, coordination & provision of support services & home oxygen program. 2
3 Mission Provide a comprehensive range of coordinated health care services for individuals of all ages for the purpose of promoting, maintaining and / or restoring health & provide palliative services to support quality of life for individuals with progressive life threatening illnesses. 3
4 Department of Health Regional Health Authority Deputy Minister Chief Executive Officer Assistant Deputy Minister Community and Institutional Services VP/COO Responsible for Extra-Mural Program Community Health Services EMP Service Delivery Unit Management Unit Interdisciplinary Team 4
5 5 The New Brunswick Extra-Mural Program
6 RHA Extra - Mural Program Director Physicians Secretarial Support Clinical Coordinators/Unit Managers Clinical Nutrition Nursing Respiratory Therapy Social Work Physiotherapy Occupational Therapy Speech Language Registered Nurses Licensed Practical Nurses Rehabilitation Assistant Personal care aids Liaison Nurse Quick Response Nurse Clinical Nurse Specialists 6
7 EMP Liaison Nurses Educate hospital staff on appropriate home health care Facilitate continuity of care for clients requiring hospital care Seek out appropriate hospital patients Provide discharge planning between the hospital & home Arrange for services prior to hospital discharge Facilitate early discharge from hospital & prevent hospitalizations 7
8 Quick Response Home Care Experienced home health care nurses in EDs Educate ED staff & physicians on community services Identify seniors able to return home Facilitate & arrange formal &/or informal services Provide information to seniors & families Prevent unnecessary hospital admissions 8
9 Advanced Practice Nursing Clinical Nurse Specialists Enterostomal Therapy Nurses Individual client care Clinical policies, guidelines & protocols Staff development Expert support and consultation 9
10 Long Term Care Services Single Entry Point: Social Development, MH & EMP A range of personal support & physical/mental health services required by residents age 19+ Long term functional limitations Need assistance to function as independently as possible coordination of & access to a range of services Reduce the premature institutionalization of seniors 10
11 Medical Care Client s care team Medical care of client Medical coverage 24/7 Home visits Communication FFS remuneration Liaise with physicians Consultation & support Mediate issues Clinical advice Strategic planning Provincial EMP MAC Appropriate, timely & accessible home health care 11
12 Care Coordination Client-focused process Appropriate care; right person; right time; right place; right provider Involvement of other team members & partners Case management System navigation My Health Plan Timely & responsive care to meet the client s goals 12
13 My Health Plan Client s goals & wishes Client choice in decision making Client self-care & family participation Open exchange of information within client s circle of care Care is coordinated, integrated & supports individuals to remain in their homes and communities 13
14 14 The New Brunswick Extra-Mural Program
15 15 The New Brunswick Extra-Mural Program
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