Transcript Slide 1

Home Care Program
Long Term Care Strategy
Linda Dando
October 8, 2008
Current Community Support Options
Home Care Program
Home Care
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Comprehensive, well established program
Supports living in the community versus
institutionalization
Demand continues to rise
Costs are generally less than equivalent level of
service in PCH
Relies on input from family and informal system
Home Care
Support Services to Seniors
Independent
Living
Supports to
Seniors in
Group Living
Expanded
Supportive
Housing
Specialized
Supports
Personal
Care Home
Home Care Program
• Established in 1974
• Mission:
To ensure the provision of effective, reliable and
responsive home health care services to
Manitobans to support independent living
To ensure the coordination of admission to care
facilities when living in the community is not a
viable alternative
Home Care Program
Program Today
• Responsible for providing supports and
services to the elderly and or infirm to remain
safely and independently at home
• Based in
• community sites
• hospital sites
• specialty program sites
• Across lifespan
Philosophy
• Individuals/families are responsible for their own
health
• The role of home care is to support services
available from the families, community and other
resources
• All Manitobans should have equal access to home
care
• Home care is an integral partner in regional
community development
Home Care Program
Objectives:
• To assess for Home Care eligibility and facilitate safe
discharge of clients to community.
• To work with the community to reduce the frequency
of preventable re-admissions.
• To coordinate/facilitate care and services for clients
in Specialty Programs.
• To access the appropriate community resources in a
manner that is cost effective
Eligibility
• Resident of Manitoba
• Functioning in activities essential to independent
living is compromised/has declined
• Support from family, caregivers and others is not
sufficient to maintain the client at home
• The provision of services will: support the client
safely in their own home, maintain or prevent
deterioration, enable family caregivers to maintain
their role in supporting client at home,
• Care services required are not available elsewhere
(family, community, other programs/supports)
Home Care Program
• Services: Personal care, Nursing, Light housekeeping
assistance, Respite, Counseling, Assessment for long term
care / specialty services, Co-ordination of service plans and
Referral to other agencies.
• Key Activities: Intake, Assessment, Care Planning, Service
Coordination and Delivery, After Hours Response, Case
Management, Referral, Health Information, Education and
Community Development
Home Care Coordination
• Community Coordinated – managed by Case Coordinator
based in community area and Direct Service staff are from
community area team
• Nursing Coordinated – managed by Nursing. Only Direct
Service Staff is visiting RN or LPN. Nursing Resource
Coordinator and visiting nurses are from community area
team.
• Specialty Coordinated – managed by centrally located Case
Coordinator. All Direct Service Staff are provided by the
community area team.
How is Service Delivered?
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WRHA Direct Service Employees
Back Up Agencies
Self / Family Managed Care
Special Contracts
Service Purchase Agreements
– Target Populations with Special Needs
Special Programs
• Provincial Ostomy & Home Nutrition Programs, Community
IV, Nursing Clinics, Self/Family Managed Care, Complex
Needs, Palliative, Respiratory, Dialysis, Stroke and
Children’s Specialty Programs
• Who is eligible?
Each program has specific eligibility criteria
Principles of the Referral Process
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Single entry system
Streamlined consultation process
Timely contact with client, family and community
Timely completions of all necessary assessments
Timely and safe discharge / transition
Home Care is a Voluntary Service
• Clients and families can refuse to accept care and care plans
• Care plans are developed with consideration to client level of
risk
• Clients and families are made aware of the risks to the clients
if they choose not to participate in a care plan
Staff Roles
• Direct Service Staff – Nurses, Health Care Aides,
Home Support Workers
• Case Coordinators and Resource Coordinators
• Allied Health Staff – OT and PT
• Team Managers and Community Area Directors
Home Care Program
Direct Service Staff
• Approx. 2000 Home
Care Attendants
• Approx. 450 Home
Support Workers
• Approx. 400 Nurses
Recent Accomplishments
• Implementation Workload Review Recommendations: effective
staffing, technology enhancement and improved processes
• Establishment of best practice teams to facilitate development of
expertise at the direct service level (Nursing)
• Manitoba Home Nutrition Program – increased demand;
reviewed processes; operational changes implemented
• Development of community options for target populations
(Chronic Ventilator / ABI)
Recent Accomplishments
• Expansion of the Home IV program and transition of staff from
St. Boniface Hospital to Home Care Program in progress
• Integration of Children’s Services – partnership between
Children’s Special Services, Home Care & Child Health
• Self / Family Managed Care Satisfaction Survey – 91% of
respondents (97 clients) were satisfied with the overall service
• Collaboration with Centre on Aging to establish entry criteria for
Community Housing Options based on MDS HC data
• Permanent EFT Project
• Care Giver Strategy
Areas for Development
Self Care / Autonomy
• Community Based Care
Partnerships
• Expanding the Home Care Team
Allied Health
• Use of Health Information
(MDS, HC and Procura) to
promote evidence based service
delivery, accountability and
direct program planning
Program Issues
• Balance competing demands from acute and long term to develop programs that
are a cheaper alternative to their services while not eroding the valuable
services presently provided by Home Care in the community
• Increasing expectations from the public that Home Care will be able to provide
the resources for service delivery plans that are increasingly more complex and
comprehensive in order to support individuals with complex care needs
remaining in the community
• Challenged to ensure that programs / sites/ community areas continue to work
together to promote development of best outcomes and service delivery options
for clients rather than preserving program boundaries or compliance with
program criteria over creative solutions
• Better utilization of data to promote translation of knowledge between
researchers, service providers and government into evidence informed policies
and services
Financial Issues
• The top financial pressure for the Home Care program is related
to Direct Service Staff costs. The volume increase for HCA is
consistent with previous projections at 2% while the increase in
nursing volume is mainly attributed to increasing demands for
nursing respite in complex care situations.
• Major volume increase has incurred within the Self & Family
Managed Care Program which is reflective of the complex
needs of the clients managed by that program and the desire of
clients to have more autonomy in planning their own care.
Human Resources Issues
• Shortage of DSS especially HCA’s resulting in
disruption in service, increased use of back-up agency
and overtime
• Workload Pressures – combination of complex service
delivery plans and staff experience and skills that have
not kept pace with client expectations and programs
changes
New Developments / Trends
• Complexity of Service Delivery Plans – special contracts, target
populations i.e. ABI, chronic ventilators, challenging behaviors
• Post Acute Home Care – increase supports during convalescence
following hospital stay
• Care Giver Support
• Different service delivery models i.e. clinics, partnering with
external agencies, expanding Self/Family Managed Care
Program
• Expanding Home Care Team to include Allied Health
Anticipated Changes
• Increased pressure from acute care to develop community
options due to LOS
• Shortage of DSS and increasing dependence on back-up
agencies and creative new partnerships
• Change in philosophy to promote self care where
appropriate
• Greater dependence on family caregivers
• Complexity of service delivery plans