Transcript Slide 1

Community Care Access Centres
Your Connection to Community Health
Services and Long Term Care
October 30, 2006
Val Armstrong, CCAC Simcoe County
What is Community Care?
• health care and support services provided
in the home, school, workplace, or other
community setting
• a range of services and supports for
people of all ages
• intended to optimize the individual’s health
and independence
• information and referral to health care
resources
What is Long Term Care?
• the provision of residential and health and
support care services in the non-hospital setting
• offered in “Long Term Care Homes” also known
as Nursing Homes and Homes for the Aged
• For individuals who need
• Higher levels of daily personal care
• Availability of 24 hour nursing care
• Availability of 24 hour supervision or a secure
environment
• regulated by the Ministry of Health and Long
Term Care
Community Care Access Centres
Across the Province
Presently 43 CCACs in Ontario
– Regional or county boundaries
e.g. Durham Access to Care
CCAC Simcoe County
As of January 1, 2007
– 14 CCACs across the province with
same boundaries as 14 LHIN areas
e.g Central West CCAC
North Simcoe Muskoka CCAC
What are Community Care
Access Centres (CCACs)?
CCACs are government agencies that
• are a single point of information and referral to
all community health care services
• works with the individual and their family to
determine and coordinate needed services and
supports
• Arrange for and authorize the admission of
individuals into a Long term care home
• Partner with other health and community
support services to improve the system of care
for all clients and their caregivers
Community Care Access Centres
Core Business
What Services Do CCACs
Provide?
• Information and Referral
• Case Management
• Access to Long Term
Care Homes
 Long stay
 Short stay
 Convalescent care
• Community Nursing
• Personal Support
services (personal
support and caregiver
relief)
• Therapies including:
 Physiotherapy
 Occupational Therapy
 Speech Therapy
 Social Work
 Nutritional Support
• Medical Equipment and
Supplies
• Access to Adult Day
programs
Who Can Receive CCACSC
Services?
Eligible Clients include . . .
• any Simcoe County resident with a valid OHIP
Card
• children who need health services to live at
home and/or attend school
• people who require in-home health services
before and after being hospitalized
• people who need long term therapeutic or
personal support
• older people needing assistance to remain in
their homes or gain access to Long Term Care
Facilities
How Can Someone Become
a CCAC Client?
CCACs takes referrals from . . .
• family doctors and specialists
• hospitals
• therapists and other community health care
workers
• other community agencies – health care or
otherwise
• family members, friends, and neighbours
• and
• directly from the person who needs the help
How Does the CCACSC Deliver
These Services?
• Childrens’ – for children requiring school and
home-based care
• Acute Medical/Surgical – for people going
home from the hospital after surgery or acute
medical care or being treated at home
• Medically Complex – for people with a
significant medical condition or event and an
unpredictable outcome
Programs Provided
• Cognitive Impairment – for people
dealing with dementia, brain injuries,
developmental disabilities, etc.
• Adult Continuing Care – for adults under
75 with lengthy recovery support needs
due to a physical disability or chronic
illness
• Senior Continuing Care – for adults over
75 with chronic illness or disability, frail
elderly
Case Management as a
System Navigator
• Focus is on supporting clients and their
caregivers
• Establish an ongoing relationship with the client
and family based on trust and respect,
understanding and supportive of their needs.
• Completes a comprehensive assessment and
facilitates the implementation of a
comprehensive client service plan that meets
the needs of both the client and family
• Provide planned client/caregiver education,
counselling, linkages to other community
supports and long term planning.
Collaborative Community Initiatives
• To partner with other health and community support
services to improve the system of care for clients and
their caregivers
• Community partnerships with
– Acute care hospitals
– Community mental health services
– Alzheimer Societies
– Attendant Care Services
– Adult day Programs
– Developmental service agencies
– Hospices
– Community networks e.g. Dementia Network, End of
Life Network
Case Scenerio
• Mrs R. who has dementia and Mr. R
• Mr. R. as primary caregiver
expresses concerns about wife’s
behaviours
• Calls the CCACSC and a referrals is
made to the CCAC Cognitive
Program
• Home Visit by Program CM
• Comprehensive assessment
completed
• Review of Welcome package
including community support
information
Role of Case Manager
Following assessment, Program Case
Manager will:
• Assess readiness for services
• Explore with Mr. and Mrs. R what other
service they may already be accessing
• Educate Mr. and Mrs. R. to other service
options
• Provide initial counselling and education re
disease process
• Develop a comprehensive service plan
including referral/linkage to a basket of
services provided by CCAC and other
community agencies
A Comprehensive Plan of Care
In-Home Services
• Cognitive Assessment and Care
Management Service (OT)
• Assistance with personal care
• Caregiver relief
Long Term Care Services
• Short Stay respite
• Access to adult day program
• Long term care placement
A Comprehensive Plan of Care
Specialized Geriatric Services
• Cognitive Assessment and Support Services
Referral to other community services
• Alzheimer respite program
• Alzheimer Society
» Supportive counselling
» Caregiver support groups
» Education
Ongoing Support
• Ongoing education and counselling
throughout the progression of the disease
• Advocacy
• Long Term Care Planning
• Changes in client service plan to meet
changing needs