Transcript Diversion Programs

Meeting with OPADD:
Ontario Partnerships in Aging
and Developmental Disabilities
Supporting LTC Residents with Developmental
Disabilities
Presentation by:
Tim Burns
Director
Long-Term Care Homes Branch
Community Health Division
MOHLTC
Karen Slater
Program Manager
East Region
MOHLTC
October 30, 2006
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The Ministry is focusing on seniors health in the
context of the integrated health service planning
Canada’s National Advisory Council on Aging describes aging
successfully as:
• maintain a high level of mental and physical functioning ; and
• active engagement with life
• the ability to adapt to change and compensate for limitations; and
• having a low risk for disease-related disability
In 2031 after the full effect of the baby boom has occurred seniors will
represent 21.8% of the population of Ontario compared to 12.8% now.
Where are we now?
The confidence of Ontarians in the health care system is most
threatened by the following concerns:
Patient-/Resident-centred care– ensuring decision making processes are
equitable
Access – better access to publicly funded health care services
Quality - getting value from the growing financial investment in health care
Sustainability – having a system in place they can depend on in the future
To address these concerns, the ministry has embarked on a transformation
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The entire process will be based on principles that put
Ontarians at the centre
Transparency (the results of public consultations and policy reviews
will be posted on the web)
Diversity (public engagement will directly engage a broad group of
Ontarians)
Direct engagement (the engagement will give voice to Ontarians
typically neglected in traditional stakeholder engagements)
Respect (the process will build on consultations with Ontarians from
the last five years)
Evidence-based ( the process will support the role of evidence in
determining the likely effectiveness of policies)
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Key areas to improve Senior’s Health
The 5 key areas to improve the health, dignity, independence and quality
of life for seniors are:
•
•
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Prevention to facilitate healthy living and to reduce the burden and
progression of chronic diseases
Community Supports to enable community living for the frail elderly
and to better sustain the health care system
System level changes to produce quality integrated care and case
management for seniors and high risk elders
•
Organizational changes to improve quality of care to integrate care
•
Knowledge transfer to support its adoption of the ‘shared’ model
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Community Health Services Overview
Long-Term Community Care Agencies
Over 800 agencies provide personal support and homemaking services, meal
programs, transportation and other community services.
Community Health Centres
54 centres that provide primary care services with an emphasis on priority
populations with access barriers to health care.
Long-Term Care Homes
619 homes with 75,444 beds providing nursing, personal support, dietary and
programming services to seniors and other vulnerable members of the
community.
• Admissions by consent of the applicant or Substitute Decision Maker
• Care is delivered consistent with individualized care plan
• All homes are accountable to meet common provincial standards
• New proposed legislation, the Long-Term Care Homes Act further strengthens
residents rights and safeguards.
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Community Health Services Overview
Community Care Access Centres
42 CCACs determine eligibility and coordinate visiting health care services in the
home and in schools as well as admission to long-term care homes.
CCACs served over 500,000 clients in 2005/06. Age breakdown of admissions
are:
• 53% are seniors - the majority of home care clients are seniors
• 36% are adults
• 11% are paediatrics
CCACs are responsible for admissions into LTC homes, including the RAI-HC
assessment, obtaining consent from the applicant or Substitute Decision Maker,
and management of the referral-to-placement process consistent with legislation,
preferences and availability of beds.
Community Mental Health Investments
$601.4M in 2006-07, growing to $631.2M serving 79,000 clients by 2007-08.
LTC homes sector capacity
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The long-term care home sector has the capacity to serve a range of
residents with both health and personal care needs as long as the
appropriate planning is conducted and supplementary resources are
available.
The joint efforts of MCSS and MOHLTC are required to develop:
• Resources for LTC Home Operators to provide appropriate
accommodations, equipment and services, and the skills and expertise to
sustain support for developmentally disabled adults entering the long-term
care sector.
• Community and professional educational strategies to foster/promote a
positive professional profile for those working or aspiring to work in the
developmental sector
• Case management resolution mechanisms at the local and regional levels
for all clients with a developmental disability.
LTC homes sector capacity (contd.)
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Resources required to increase capacity in the LTC Homes Sector to
serve this special needs population, could include accommodation and
services such as:
1. Small, developmental service units in long-term care homes so
that friends and lifelong roommates could continue to reside
together;
2. Specialized equipment and specialized support services to
support special needs;
3. Training and education of long-term care homes, community and
CCAC staff;
4. Individual transition support planning and implementation;
and
5. Other special ongoing long-term care supports to improve
individual’s quality of life, e.g., day program and case management
supports
Community Capacity
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Community Capacity to develop expertise, provide services and supports
needs to be assessed to maintain a quality of life for individuals with a
developmental disability in these communities.
• Assessments of MCSS and MOHLTC Service Supports in those
communities where these individuals will likely be placed, to close any
gaps in services and ensure transition is seamless.
• Coordinated Placement and Case Management to enable access the
appropriate community service supports.
• Community Supports to attract volunteers and service agencies to:
- meet the recreational, social, spiritual and developmental needs of
this special population,
- ensure their integration into the community, and
- promote positive and mutually reinforcing experiences in the
community.
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Developmentally Disabled Residents in LTC Homes
• Developmentally disabled residents account for about 2.2% of the total
LTC Home resident population across the province.
• About 1,691 residents in LTC homes are classified with one or more
developmental disabilities from a list of diagnoses selected by MCSS.
• The average age is 52.6 years; the average age of the general LTC
population is about 30 years older-median is 83 years.
• Differences in the developmentally disabled residents and the general
population result in differences in care needs.
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Developmentally Disabled Residents in LTC Homes (contd.)
Age distribution is broader than the general LTC population
Figure 1 – Age of All Residents (maximum count = 4,000 residents)
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Figure 2 – Age of Developmentally Disabled Residents (maximum count = 40
residents)
The difference in age between developmentally disabled and other residents has impacts on
such issues as illness acuity, the nature of secondary diagnoses, care needs, and
medication needs.
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Developmentally Disabled Residents in LTC Homes (contd.)
• Developmentally disabled LTC residents are physically healthier—
more independent and use less medication (about 15% less):
– Physical care needs for Activities of Daily Living (ADLs) are one-fifth
(22% less than) the requirements for the average older LTC resident.
– 13% have movement-related diagnosis-- neurological, muskoskeletal
coordination as a secondary diagnosis
• Developmentally disabled residents have higher Behaviours of
Daily Living (BDLs) needs for the following listed behaviours (2 to 3
times greater than the general LTC population):
– hoarding, aggression, agitation, inappropriate sexual conduct,
demands for attention and anxiety (general population more likely to
exhibit wandering, sadness/depression)
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Developmentally Disabled Residents in LTC Homes (contd.)
• Secondary diagnosis also includes combination diagnoses such as
cerebral palsy(17%), Down’s or Klinefelter’s Syndrorme (11%)
• Dual diagnoses as secondary diagnosis for developmentally
disabled residents include:
– ‘non-specific’ mental disorders(20%), schizophrenia (28%), affective
disorders, e.g. manic depression (14%), neurotic disorders (13%);
paranoid states (3%)
compared with 1% each for the above secondary diagnosis in the
rest of the general LTC population.
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LTC homes with Developmentally Disabled residents
 Developmentally delayed residents live in LTC homes throughout the
province. Divided into 7 MOHLTC regions, LTC homes with these residents
have the following average portion of LTC residents as developmentally
disabled residents by region:






4.5% in Central West
3.6% in Central South
7.5% in Central East Region
11.5% in East Region
6.0% in North Region
7.3% in the South West
 Some of these LTC homes have a number of developmentally disabled
residents living in group-type arrangements:
-
7 homes have 8 or more developmentally disabled residents
27 homes have 6 or 7 developmentally disabled residents
65 homes have 4 or 5 developmentally disabled residents
the remaining homes have 3 or less.
Current Context of Joint MOHLTC- MCSS Initiatives
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A joint initiative to create an accessible, fair and sustainable system of
community-based supports, including MOHLTC to ensure a seamless
transition for aged people who have a developmental disability into:
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Long-Term Care Homes;
Complex Continuing Care; and
Supports in the community.
Jointly develop protocol(s) for working together to integrate services
and ensure a continuum of care for DS adult individuals who are
eligible for transferring from MCSS-DS facilities and the community
into LTC Homes.
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Joint MOHLTC & MCSS “Directors Steering Committee”
Established in June 2005, membership consists of three corporate
Directors and two Regional Directors from each Ministry.
Objectives:
• Plan for services that follow each client where their needs exceed the
services generally available through the long term care system.
• ensure the coordination of policy, business practices and programmanagement decision across ministries;
• deal with the complex inter-ministerial issues of resource sharing, to
meet the needs of adults requiring long term care supports coming from
Group Homes anticipated in the future; and
• serve as an effective forum to discuss common approaches to
stakeholders, such as the Ontario Partnerships in Aging and
Developmental Disabilities (OPADD).
The Planning Principles
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• Include older adults who have a developmental disability in the life and
services of the community to the extent possible.
• Work on processes that ensure a secure and comfortable transition for
the individual requiring placement, and that is safe and comfortable for
residents already in long-term care homes.
• Provide common advice and input to all stakeholders, including the
Ontario Partnership on Aging and Developmental Disabilities
• Jointly determine models for specific services, equipment and
accommodations, essential to these individuals to maintain their quality
of life in LTC homes.
• Co-ordinate community services and resources.
The MOHLTC – MCSS Protocol
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• Protocol approved by the Joint Committee for the admission of
developmentally disabled adults into Long-Term Care in May
2006 and recommends the following approach:
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Information Sharing and coordination of activities
Obtaining and analyzing information and assessment data
on this developmentally disabled population and on longterm care and community resource capacities
Issues Identification at the Local Level
Issues Resolution at Corporate Level
Building capacity for Specific Groups and Individuals
• November 1, 2006 meeting of regional program managers from
both ministries will meet to address protocol issues.
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Long-Term Care (LTC) Home Admissions
Community Care Access Centres (CCACs) are the designated
placement co-ordinators under the Nursing Homes Act, Charitable
Institutions Act and the Charitable Homes for the Aged and Rest
Homes Act
LONG-TERM CARE ELIGIBILITY CRITERIA IS SAME
FOR ALL APPLICANTS :
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at least 18 years old
have a valid OHIP card
need 24/7 nursing care or help with ADLs or ongoing
supervision or risk of abuse at home or risk of harm at home
or may harm others
community-based resources to meet client needs exhausted
care requirements can be met in a nursing home
LTC Home Placement Application
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CCACs will work with MCSS Regional Placement Facilitators (RPFs) ifa
facility resident qualifies for LTC home placement, given the
individual’s health care needs
The Planning process for individuals moving from DS facilities to LTC
homes is an extension of the established, individualized planning
process in the developmental services sector that focuses on the
individual and involved the Substitute Decision Marker [SDM] if the
individual is not competent.
Although CCACs are responsible for the LTC home placement process,
RPFs are responsible for placement planning, transition and
placement follow-up on the indivituals moving from DS facilities.
LTC Placement Application (contd.)
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The request for admission to a LTC home is made by the individual or
their Substitute Decision Maker [SDM], with assistance from the agency
or the Regional MCSS Placement Facilitators [RPFs] supporting the
individual in a facility.
The request is made to the local CCAC. The agency or RPF coordinates
the development of a individualized Support Plan based on information
collected from family, friends, agency staff, health care professionals and
relevant assessments.
The CCAC, in collaboration with the agency or RPF, obtains the required
consents and releases of information for admission to a LTC home and
releases of information
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LTC Home Placement Application (contd.)
• If the individual is determined eligible for LTC home placement,
the individual or the SDM is able to select up to a maximum of
three LTC homes.
• The agency or RPF works with the applicant, family/SDM, other
community-based developmental services and the local CCAC
to identify/coordinate appropriate services options within the LTC
home where the individual is to move.
• Where a LTC placement does not occur within a six-month
period consent must be obtained from the individual, if
competent, or their SDM for reassessment to keep the
application active.
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Highlights of Placement Process
• Once the eligible individual has made the selection of one to three LTC
home(s), the individual/SDM must apply for authorization of admission.
The CCAC, in collaboration with the designated RPF, will assist the
individual/SDM to complete the applications.
• The application will then be sent to the selected home(s) along with all
the assessment information, and will indicated the individual/SDM’s
preferences for accommodation (private, semi-private, or basic). The
individual/SDM may select LTC homes based on factors, which include
ethnic, spiritual, linguistic, familial and cultural preferences.
• If an appropriate vacancy exists in one of the LTC homes to which an
application has been made, the CCAC will notify the individual/or SDM.
The individual, if competent or the SDM will have 24 hours within which
to accept or decline the offer.
Highlights of the CCAC Role
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The CCAC must determine, as the first step of the LTC home placement
process, that all community-based resources to meet client needs have been
exhausted.
LTC home placement planning for an individual includes identification of
necessary supports for successful placement through the development of a
Personal Plan.
The plan may include additional supports are specific to the individual’s
developmental disability, beyond the basic LTC home service offering.
Where applicable le, planning will include a confirmation of the service
providers who would be involved in providing direct of indirect support through
the developmental services system.
Highlights of the RPF Role
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• The RPF coordinates the development of a draft Personal Plan based
on information collected from family, friends, facility staff, health care
professionals and relevant assessments.
• The RPF may coordinate with the assistance of the CCAC, visits by
the individual and/or family member/SDM to the proposed LTC
home(s).
• The RPF will work with all relevant stakeholders to identify and
coordinate access to any additional resources necessary to support an
individual within the selected LTC home(s) e.g. training LTC home staff
and establishment of arrangements for the provision of services by DS
service providers.
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Specific Placement Details for DS facility residents
transferring to LTC Homes
• Individuals will not move from the DS facilities until the appropriate
supports are in place.
• The Support Plan will become finalized through a written agreement
between the individual, SDM (if applicable), family, DS supporting
agency (if applicable) and LTC home provider which will state what
supports will be provided, by whom, and the roles and responsibilities
of each party in relation to the ongoing assessment/ evaluation of the
Support Plan.
• The RPF will conduct a 3 month post-placement follow-up in
conjunction with the LTC home provider, CCAC and DS service
provider (if applicable) as appropriate to review the individual’s
status/progress and the Support Plan in relation to the individual’s
current situation and circumstances.
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Alternative placement options
Where a LTC placement is not appropriate:
•
•
CCACs also assist agencies in planning alternative delivery options for
health-based supports.
Alternative placement options may include in-home health care
supports and training DS providers to provide specific personal support
services that are not provided by staff or family members or where staff
or family members do not have the expertise and require training and
support.
Effective and Appropriate LTC Placements
Working towards effective and appropriate placements in LTC Homes
requires the involvement of:
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Residents (LTC Home Resident Councils)
Families (Family Councils)
LTC Staff and administration
LTC community volunteers
LTC Home Associations (OANHSS and OLTCA) and advocacy
groups (e.g., Concerned Friends, ACE)
Community service providers and agencies
Medical and Therapeutic Care Professionals
The Community
Governments and ministries
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Questions?