Home-Based and Long-Term Care Presentation to Health PEI Board of Directors November 6, 2012
Divisional Profile The Home-Based and Long-Term Care Division provides supportive services to people in need of home care and/or long term care across Prince Edward Island Budget - $ 92.8 Million Staff - 876.2 FTEs The division includes: -5 Home Care offices - 4 Dialysis locations, - Provincial Gereatric Program - Palliative Care Service - 9 Public Nursing Homes - Sherwood Home - 9 contracted Private Nursing Homes
Home Care The Program is focused on maintaining Islanders in the community for as long as possible, helping individuals have an expedited and coordinated discharge from hospital, and connecting Islanders to care and support. Home Care Program includes: Home Care Support Home Care Nursing and Professional Services Adult Protection Services Adult Day Programs Integrated Palliative Care Program Provincial Renal Program
Long Term Care There are nine public and nine private facilities in the province which provide nursing level care. Most residents have multiple complex diagnoses, including dementia, stroke, and diabetes, and all require a high level of nursing care that can no longer be provided at home or in an assisted living environment.
Key Divisional Issues Introduction of Nurse Practitioner to LTC Medication Utilization in LTC Implementation of Person Centered Care in LTC Province Wide Introduction of LEAP (Learning Essentials Approaches to Palliative and End of Life Care) in Palliative Care Dialysis?? Wait Times to Access LTC
Strategic Initiatives Continued implementation of the manor replacement initiative as outlined in the Healthy Aging Strategy. The addition of new long-term care beds to the private sector to maintain a LTC bed to population (age 75 +) ratio of 101. Continued implementation of Collaborative Model of Care throughout Home-Based and Long-Term Care Manors. Continued work in the evolution of Person-Centered Care within the Long-Term Care facilities.
Strategic Initiatives cont d Continued work on the Palliative Care projects in both acute and long-term care. Introduction of the strategy for the management of dementia care on Prince Edward Island. Introduction of the strategy for the management of challenging behaviors in long-term care environment. Continued work on Enhanced Home Care Pilot and the Home Care Renewal Initiative.
Key Accomplishments Enhanced Home Care for Frail Seniors Partnership between Queens Home Care and QEH Offered additional hours + care coordination to transition frail seniors home sooner Focus of 2011/12 investment ($600K) 36 clients admitted during 1 year pilot Average 10 hours per client per week (range 3 to 32) 80%+ hours are Home Support Worker (least expensive service) Average cost $50 per client per day Impact on One Island Health System Case Study: 77 years old. admitted to program with Vascular disease, amputations, confusion while in hospital. Goal is to delay LTC, caregiver lives at home. 225 days on EHCFS Total cost of services on EHCFS $27,840 LTC cost avoided $34,875 ($155/day) Potential acute cost avoided - $31,000* ($1000/day) Potential total cost avoided - $65,875 (*based on average 31 days length of stay ALC-LTC in QEH, 2010/11 and 2011/12) Pilot Totals: 2064 LTC days avoided (equates to 5.5 beds) 1876 CCF days avoided 13 clients at home instead of in LTC 8 clients at home instead of CCF 14 clients convalesced at home instead of in acute care or convalescent care
Home Care Renewal Strategic Initiative Home Care Renewal Strategic Initiative Plan, develop, implement and evaluate a renewal of PEI s Home Care Program 17 projects are targeted at renewal of existing services and resources and enhancement of services to meet existing and emergent needs that cannot be addressed within existing resources Integrates existing and proposed Home Care projects under one strategic direction that will result in a single, integrated program, accessible to all Islanders and supportive of their decision to remain at home as long as possible Home Care Goals: Maintain Islanders in the community as long as possible Help individuals get out of hospital as quickly as possible Connect Islanders to care and support
Key Accomplishments CMOC and Care Coordination All Home Care sites have implemented new business process (April 2012) ISM (front end) aligned with new business process Positive feedback from staff: time efficiencies gained and better information available on new clients Standardized, central referral and intake All Home Care clients have been assigned a Primary Coordinator (June 2012) Primary Coordinator is primary contact for client Primary Coordinator is accountable for assessment, care coordination, care planning, evaluation and discharge Have initiated the development of a Primary Coordinator Toolkit to provide educational resources on care coordination (July 2012)
Successes Home Care Renewal -Successes and Opportunities Investments have been focused on increasing capacity for direct client care to support clients to remain at home longer and return from hospital sooner In-kind support from Home Care to develop, implement, monitor initiatives Partnerships and collaborations strengthened with other areas of Health PEI Increasing awareness of role of Home Care in One Island Health System Significant improvement in consistency and equity across Home Care sites Staffing increases to Queens to improve allocation of resources according to population Opportunities Shift more focus to earlier points of continuum (preventing acute admissions) Address barriers to clients remaining at home (cost of meds, supplies, equipment) Manage change and its impact on staff
Divisional Challenges / Opportunities Improve Coordination of Care between Sectors Improve LTC Utilization Decrease unnecessary hospital visits and hospital utilization by LTC clients Improve access