Transcript Presentation to: Overview of Elder care in Long Term Care

Overview of Elder Care and
Long Term Care Issues
 Date: September, 2013
 Presentation to: GNAO
 By: Sheila Bauer, Administrator Peter D. Clark LTC
Centre
Agenda
• Global context
• Ministry of Health and Long Term Care Directions
• Champlain Local Health Integration Network
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Strategic Directions
Elders -- who are we talking about?
Data, profiles
Where is care provided – what is LTC like?
What are the challenges and opportunities?
What we have learned?
Where are we going?
Why Population Aging Matters
 “We are aging—not just as individuals or
communities but as a world. In 2006, almost 500
million people worldwide were 65 and older. By
2030, that total is projected to increase to 1
billion—1 in every 8 of the earth’s inhabitants.
Significantly, the most rapid increases in the 65and-older population are occurring in developing
countries, which will see a jump of 140 percent by
2030”. (National Institute on Aging, 2007)
Global context
• Population trends
• An aging population
• Increasing life expectancy
• Rising number of the oldest old
• Growing burden of non-communicable diseases
(people are living longer with chronic diseases such as
diabetes, cardiovascular disease, arthritis, cerebral
vascular accident, Parkinson's disease, cancer, mental
health illness, Alzheimer's and other related
dementias)
Global context continued
 Aging and population decline
 Changing family structure
 Shifting patterns of work and retirement
 Evolving social insurance systems
 Emerging economic trends
 Why Population Matters: A Global Perspective,
National Institute on Aging U.S. Dept. Of State 2007
Global Perspective
Worldwide Share of Deaths, by Cause
Chronic Disease
 Healthy aging can delay and minimize the severity of
chronic diseases and disabilities in later life, thus
saving health care costs and reducing long-term care
needs (Laditka, 2001). Chronic diseases account for an
enormous human and economic burden in Canada.
The prevalence increases with age and is highest
among older people in vulnerable communities (e.g.,
Aboriginal and economically disadvantaged groups)
(Public Health Agency of Canada (PHAC), 2005a).
Canadian Context
 2011 Census data: People over the age of 65 surged to
over 5 million between 2006-2011 growing 14.1%
 Note this is more than double the 5.9% increase of the
population as a whole
 People aged 60-64 grew 29.1% between 2006-11
 2011 -- median age in Canada 40.6 years (oldest ever);
it was 39.5 in 2006 and 33.5 years 1991 (20 years ago).
 Dr. Sinha said 14.6% of Ontarians are 65 and older, yet
account for nearly half of all health and social care
spending
Alzheimer’s Disease
 Alzheimer Society of Canada – 2012 the number of
Canadians living with cognitive impairment, including
dementia, stood @ 747,000 and projected to double to
1.4 million by 2031.
 So what? The combined direct (medical) and indirect
(lost earnings)- cost of dementia total is $33 billion per
year. By 2040 ----- $293 billion annually
Alzheimer’s Continued
 Pressures on families – 2011, families spent $444
million unpaid hours per year. In 2040 – devoting 1.2
billion unpaid hours per year.
 A quarter of all family caregivers are seniors
themselves (1/3 older than 75 creating a situation
where we have the elderly caring for each other)
Funding Allocation by Sector
(2011-12) Base Allocation
 Note in millions
 20 Hospitals
$1,700,224 71.3%
 61 LTC Homes $310,439 (13%)
1
CCAC
$189,232
7.9%
 36 CMH $64,894
2.7%
 11 CHC (including satellites) $52,472
 83 CSS $50,369
2.1%
2.2%
Provincial Action Plan Priorities
and LHIN System Imperatives
Champlain LHIN Priorities
 Strategies for an integrated system
 Build a strong foundation of integrated primary, home
and community care
 Improve coordination and transitions of care
 Increase coordination and integration of services
among hospitals.
 Not population based, where do seniors fit?
MoHLTC Priorities
 Ontario’s Action Plan for Health Care
 Keeping Ontario Healthy
 Faster access to Stronger Family Health Care
 Right care, right place, right time
 KOH – diabetes, obesity, mental health
 FA – Healthcare Connects
 RCRPRT – CHC, CCAC
 Focus on seniors, not direct policy
Who are we talking about in
LTC?
• Demographics: average age, range of ages in LTC,
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gender, culture, languages, co-morbidities
Resident assessment instrument (RAI)- Minimum
Data Set (MDS) scales
CPS, ABS, CHESS,
CMI trends
Creates a picture of increased complexity partnered,
increased care needs and specialization
Data
 How long does someone wait?
 Is that too long? Why?
 Median number of days to long-term care home
placement Provincial median for
January-March 2011: 113 days
 Provincial median for January-March 2010: 112 days
 Waitlists -- too long for some, yet others are not ready
PDC – Age Ranges
100
90
80
70
60
50
40
30
20
10
0
0-30
31-50
51-65
2013
66-75
2012
2011
76-85
86 and older
Length of Stay
Discharge LOS - Median
800
700
600
500
400
300
200
100
0
2011 Q1
2011 Q2
2011 Q3
2011 Q4
2012 Q1
Discharge LOS - Median
2012 Q2
2012 Q3
2012 Q4
Case Mix Index
CMI
1.015
1.012
1.01
1.0059
1.005
1
CMI
0.9986
0.9951
0.995
0.99
0.985
2010
2011
2012
2013
Aggressive Behaviour Scale
(ABS)
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2011 Q1
2011 Q2
2011 Q3
0
1
2
2011 Q4
3
4
5
2012 Q1
6
7
8
9
2012 Q2
10
11
12
2012 Q3
2012 Q4
Depression Rating Scale (DRS)
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
2011 Q1
2011 Q2
2011 Q3
0
1
2011 Q4
2
3
4
5
2012 Q1
6
7
8
9
2012 Q2
10
11
2012 Q3
2012 Q4
What do people want/need?
• Stay in their own home
• Is there a price point? At any cost?
• Continuum of care and housing needs
• Affordable assisted living
• Instrumental activities of daily living (IADL) support
• ADL support
• 24 hour supervision required in many cases
What is LTC like
 Funding model profit and for-profit homes
 Legislation - programs
 Much care is provided by PSWs
 24 RN on-site
 Recreation and leisure – programming (stratification
of ages, different degrees of capacity, different
interests)
 Specialized units (few)
What is long term care like?
 Legislation = individualized care
 Staffing requires routines – need to find a balance
 Elderly requires patience, time, expediency, respect,
CARING throughout ADLs
 Nursing rehabilitation program
 Education and knowledge transfer
 Expertise – access
What do we mean by care of the
elderly in LTC?
 Is it different than care of anyone at any age?
 Yes and no
 Values are the same
 Application is different, elderly people are different
 Significant deterioration can occur and hard to recover
 Changes in senses, changes in muscle mass, changes in
bone mass, changes in hormone levels
 Medically complex, frail seniors
 Rehabilitation, medicine, psychiatry
What do we mean by care of the
elderly in LTC?
• Primary reason why LTC is considered – dementia
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and/or incontinence
Complex treatment plans
Urinary tract infections
Pressure ulcers
Falls
Restraints (physical and chemical)
Responsive behaviours
What do we mean by care of the
elderly in LTC?
• Bladder and bowl management
• Skin and wound management
• Peripherally inserted central catheters (PICC)
• Feeding tubes and pumps
• Pain pumps
• Assistive devices
• Ambulation devices
What do we mean by care of the
elderly in LTC?
 Infection prevention and management
 Memory challenges
 Plethora of co-morbidities and associated care
requirements
 Extremely complex care in specific cases
Challenges
• Funding (flexibilities and physio changes)
• Staffing ratios
• Programs
• Human resource challenges
• Retention and Recruitment
• Education, knowledge transfer
• Fear
• Salaries
Challenges continued
 Prescriptive legislation
 Image – complaints, action lines, annual inspections,
critical incidents, media, health partners
 Resident profiles
 Family expectations (LTC fees)
 Health partner expectations
 Ministry expectations
 Primary care coverage with consultants prn
 Accountabilities
LTC Opportunities
 To make a difference
 To share our expertise
 To collaborate with health care partners
 To re-vitalize its image
 To be an important part of the continuum of care
 Supportive environments
 Self-care in choices and actions
 To be a choice
What we have learned
• Staffing levels
• Education and knowledge transfer
• People providing most of the direct care have minimal
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education
Very few challenges are unique to long term care but
LTC is treated differently and challenges are
exacerbated
Care is complicated
Service delivery model
Important, necessary part of the health care system
Where are we going?
• Advocacy
• Specialized units (younger adults)
• Incidence trending
• Profiles
• Increase in prevalence of residents with responsive
behaviours
• Community presence
• Care of the elderly +
The Challenge
 The evidence compels us to build on existing
opportunities, to put in place interventions that are known
to be effective, and to show leadership by supporting
innovative approaches.
 Experience provides us with some models and successful
interventions that can be replicated in different settings.
 Opportunities to build on existing strategies in aging and
healthy living that are already underway in most
provincial/territorial, federal and local
jurisdictions....sometimes we want to do it our way
Ending Comment
 Seniors make a significant contribution to the
richness of Canadian life and to the economy.
Older people provide a wealth of experience,
knowledge, continuity, support and love to younger
generations. The unpaid work of seniors makes a
major contribution to their families and communities.
Some 69 percent of older Canadians provide one or
more types of assistance to spouses, children,
grandchildren, friends and neighbours (National
Advisory Council on Aging (NACA), 2001).
Ending Comment
 Can we agree that it is time for a new vision on healthy
aging — a vision that:
 Values and supports the contributions of older people;
 Celebrates diversity, refutes ageism and reduces
inequities: and
 Provides age-friendly environments and opportunities for
older Canadians to make healthy choices, which will
enhance their independence and quality of
life.....regardless of whether you live in your own home or
LTC?
The clock is ticking………
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