Transcript No Slide Title

Patient Flow – Long Term
Care Barriers & Opportunities
Lori Lamont, Executive Director PCH Program
Long Term Care Association of Manitoba
October 8, 2008
What you will learn?
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Long Term Care continuum
Client/resident profiles
Barriers and opportunities
Using Resident data to inform change
Long Term Care Strategy
• 2006 – Manitoba Health approval of the WRHA Long Term
Care Strategy and Provincial announcement regarding the
Aging in Place Policy
• Long Term Care Strategy is a 5 Year Business Plan that:
Creates affordable community living with support
options
Improves quality of PCH environments (reduce multibedded spaces)
Supports the Aging in Place policy
The Case for Change
• Too many multi-bedded spaces personal care home spaces (about 30
% of Winnipeg’s PCH capacity)
 Causes multiple moves for seniors
 Family / Resident preferences
 Infection control issues
 Patient Safety: Resident to Resident aggression issues
• Need to increase the range of options
 About 30 % of individuals paneled in Hospital and 50% paneled in
community are level 2s – there may be other options for some of
these individuals
 Manitoba has the highest rate of institutionalization (people age
75+ in 24 nursing home facilities ) and the most comprehensive
Home Care Program in Canada
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Thousands of People
Supply and Demand
Winnipeg Population Projections, Ages 75 to 84 and 85+
50000
40000
30000
20000
10000
0
75 to 84
85+
Year
WRHA Projected Population Aged 75 and Older
60000
55000
50000
45000
40000
35000
30000
1998
2000
2005
2010
2015
2020
2025
WRHA Projected Population Aged 85 and Older
16000
15000
14000
13000
12000
11000
10000
1998
2000
2005
2010
2015
2020
2025
Enhanced Supportive Living
Continuum
Independent
Living
Supports to
Seniors in
Group Living
Expanded
Supportive
Housing
Home Care
Support Services to Seniors
Specialized
Supports
Personal
Care Home
Supports for Seniors in
Group Living
• Enhanced support services provided to
individuals living in existing community
congregate settings.
• Services will depend on identified needs
• Target population: Seniors who do not
require 24 hour support and supervision.
• Cost: Resident is responsible for rent
Supportive Housing
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Housing with supports based on eligibility
criteria
Target Population: Individuals who require 24
hour support and supervision and additional
supports in order to live in a group, congregate
setting
Cost: Resident is responsible for rent and
service package and WRHA funds care
component (per diem funding) and professional
home care services
Specialized Supports
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Provision of enhanced specialized supports in
specifically designated locations or through funding of
individualized service plans.
Target Population: Individuals with complex health
and personal care needs requiring special supports to
live in the community.
Cost: Resident pays for rent and service package.
WRHA funds the care component.
Personal Care Homes
Who are we and what is our future?
Who are we?
Beacon Hill Lodge
Bethania Mennonite PCH
Calvary Place
Charleswood Care Centre
Concordia Place
Convalescent Home
Deer Lodge Centre
Donwood Manor
Fred Douglas Lodge
Foyer Valade
Golden Door Geriatric Centre
Golden Links Lodge
Golden West Centennial Lodge
Heritage Lodge
Holy Family Home
Kildonan PCH
Lions Manor Personal Care
Centre
Luther Home
Maples PCH
Meadowood Manor
Middlechurch Home
Misercordia Health
Centre
Oakview Place
Park Manor
Parkview Place
Pembina Place
Poseidon Care Centre
River East
Riverview Health Centre
River Park Gardens
St. Amant Centre
St. Joseph’s Residence
St. Norbert
Saul & Claribel Simkin
Centre
Taché Centre
Tuxedo Villa
Vista Park Lodge
West Park Manor
Regional Program Team
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Executive Director
Pharmacy Manager
2 Clinical Nurse Specialist
Program Educator
Infection Prevention and Control Manager
RAI Coordinator
Safety Coordinator (shared with DLC)
Regional Services
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Speech Language Pathology
Respiratory Therapy
Clinical Nutrition
Quality Improvement
Community Therapy Services
Who do we work with –
System Partners
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Geriatric Mental Health
Acute Care – Emergency Program
Palliative Care
Home Care – Access and IV Therapy
Community groups
PCH Services PCH
Standards & Regulations
•24
hour nursing
•Personal care
•Physician services
•Medication
•Basic supplies
•Recreation
•Limited rehab service
•Accommodation services
•Gov’t
Regulation
• 26 Standards
•Reviewed q2years
•Licensed annually
•PPCO
•Critical Incidents
•Complaints
•Unscheduled reviews
Who lives in PCH
35
30
25
<75
75 to 84
85 to 89
>90
20
15
10
5
0
Age
Male = 27.9%
Female = 72.1
Diagnosis
50
45
40
35
30
25
20
15
10
5
0
Dementia
Hypertension
Arthritis
Cardiac
CVA
Diabetes
CHF
Hypothyroid
Physical Functioning: ADL Self-Performance Hierarchy Scale
100%
80%
60%
40%
20%
0%
Private
Dwelling
Assisted
Living
Supportive
Housing
PCH
Resident
6 (Total dependence)
0.5
0.1
0.0
13.2
5
1.3
0.5
0.2
17.8
4
2.7
2.0
0.8
8.2
3
6.5
4.9
8.5
26.9
2
15.1
15.9
12.8
18.3
1
8.2
7.3
13.5
6.2
65.6
69.4
64.3
9.5
0 (Independent)
Centre on Aging Study
Continence
Bladder
Bowel
100.0
80.0
60.0
40.0
20.0
0.0
Private
Dwelling
Assisted
Living
Supportive
Housing
PCH
Resident
Private
Dwelling
Assisted
Living
Supportive
Housing
PCH
Resident
4.8
4.1
5.3
34.3
1.9
1.1
2.5
25.8
4
11.0
12.9
12.5
19.0
2.6
2.4
4.3
10.5
3
9.1
10.2
8.0
9.0
2.7
3.0
2.7
7.6
2
11.3
13.1
16.3
12.2
5.3
5.4
5.5
13.7
1
2.2
2.2
0.5
0.0
1.5
1.0
0.5
0.0
61.4
57.3
57.5
25.5
85.9
87.1
84.6
42.5
5 (Incontinent)
0 (Continent)
Centre on Aging Study
Cognition: Cognitive Performance Scale
100%
80%
60%
40%
20%
0%
Private
Dwelling
Assisted
Living
Supportive
Housing
PCH
6 (very severe impairment)
0.5
0.1
0.0
12.0
5
3.2
1.3
7.3
15.9
4
1.2
0.6
2.5
5.3
3
18.9
21.7
47.7
28.5
2
11.5
14.1
18.9
11.8
1
14.8
18.2
11.6
14.0
0 (intact)
49.9
44.0
12.0
12.5
Centre on Aging Study
Dementia
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12.5 % are cognitively intact
25.8 % have mild cognitive impairment
33.8 % are moderately impaired
27.9 % are severely impaired
Behaviours by Care Setting
30
25
20
%
15
10
5
0
Wandering
Verbal Abuse
Physical
Abuse
Private Dwelling
2.28
2.13
0.42
0.94
4.52
Assisted Living
2.62
1.18
0.25
3.65
3.63
Supportive Housing
7.48
3.32
1.33
0.63
8.47
PCH
15.44
14.22
8.84
13.33
24.9
Centre on Aging Study
Socially
Resists Care
Inappropriate
Aggressive Behaviour Scale – PCH Residents
% of residents
70.0
65.8
60.0
50.0
40.0
30.0
23.9
20.0
10.2
10.0
0.0
0
1 to 3
Aggressive Behaviour Scale Score
Centre on Aging Study
4+
Challenging Behaviours
34% of Residents have some aggressive
behaviors in PCH
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What to do when this aggression creates
high risk to other residents and staff?
Case Example - Lori
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45 year old woman with acquired brain
injury
Physically, verbally and sexually aggressive
behaviours
PCH to PCH to Behavior Treatment Unit to
St. Amant
Took over 5 years to find the right spot
Case Example - Joe
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72 year old with mild dementia, history of ETOH, and
anti-social behavior
• Unpredictable physical aggression toward staff and other
residents
• Trips to ER following aggressive incidents
• Geriatric psychiatry, Service Coordination involved
• 24 hour security guard for nearly 2 years
• Possible transfer to Selkirk Mental Health Centre
• Died suddenly at PCH
Challenges to flow –
Hospital Use
Overnight Hospital
Admissions in
Last 90 Days
None = 92.8
ER Visits in the
Last 90 Days
5.5% of residents
1 = 6.6
2+ = 0.6
Long Waiting Lists
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107 people waiting in hospitals
294 people waiting at home
No significant change in wait list for
past 18 months
Wait List Management
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Wait list based on panel date – fair and
equitable process?
How to match residents with behaviours to
sites that may have capacity to manage?
How to balance case-mix within PCH with
system needs?
Factors Associated with Move to PCH
Private Dwelling
RAI-HC
Indicator
Live Alone
With
Spouse
Age
Age 75+
Age 75+
With Others
Supported Living
Assisted
Living
Supportive
Housing
Female
Gender
Education
< Grade 8
ADL Decline
Any
Bladder
Incontinence
Any
IADL
Great
difficulty
Cognition
Any decline
Behaviour
< High school High school
Any
Any
Any
Any
Any
Great
difficulty
Any decline
Any decline
Any decline
Problem
present
Problem
present
Problem
present
Caregiver
Distress
Any present
Any present
Any present
MAPLe
Mild score +
Mild score +
Moderate +
Centre on Aging Study
Any
High +
System Initiatives
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Move of Long Term Care Access
Centre to PCH Program
Use of RAI-HC measures in panel
Why are “independent” people in PCH
Address Care Giver Burden in
community
PCH New Initiatives
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Nurse Practitioner in PCH
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Early results show decreased acute
care and ER use
• Reduced medication use
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PIECES Education
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Education and a tool kit for front-line
professionals to assess and manage
challenging behaviours
Staffing
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Manitoba Health increased staffing to 3.6
hours per resident day
Standardize staff model and mix across all
sites
Highest staffing levels in the country
Implemented over next 3 years
Increases coming to Allied Health staffing
Long Term Care Strategy
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Ensure people are placed in most
appropriate alternative
Create more private PCH accommodation
Specialized options for some complex
cases
Questions