Enhancing Capacity in the Community
At last week's HealthAchieve 2011 conference, Health and Long-Term Care Minister Deb Matthews emphasized the government's continued commitment to providing better value, better care and spending smarter and highlighted its focus on home and community care. In the HNHB LHIN, enhancing community capacity is a priority, outlined in the Integrated Health Service Plan 2010-2013.
Working together with the Community Support Services (CSS) sector, the HNHB LHIN established four 'Community Continuum Collaboratives' - Brant and Haldimand Norfolk, Hamilton, Burlington and Niagara. These CSS-led planning tables consist of LHIN-funded health service providers from all sectors, and non-LHIN funded community partners.
Each planning table has been tasked with developing a local plan to enhance community capacity by identifying unmet needs, gaps and duplication in service, inefficiencies and opportunities for improvement.
As a starting point for initial planning, these planning tables are using the Ministry's Updated Assisted Living Policy for High Risk Seniors to identify seniors who may be at risk of an avoidable hospital stay or premature admission to long-term care. The planning tables are looking at creating cross-sector service hubs in the community to help high risk seniors to live at home. Service models based on the St. Catharines Wellness Supportive Living Program's Assisted Living Demonstration Model will be rolled out and adapted in other LHIN communities, beginning with Burlington, Brantford and Welland. The HNHB Community Care Access Centre (CCAC) is a key partner in these initiatives.
The intended outcomes of this community planning process include:
- Better understanding of local needs and system capacity – both locally and across the LHIN
- Greater capacity in the community to help seniors continue to live independently at home and avoid hospital stays and premature admission to long-term care
- Improved coordination and integration of services
- Greater efficiencies across the system by realigning roles and services to improve quality and value
- Strengthened partnerships across the health care sector at the local level to sustain ongoing collaboration, planning and integration
For health service providers who want to learn more about the planning process, please click here.
Connecting Seniors with Care Early
We have heard time and time again that seniors want to live independently at home for as long as possible. A new screening tool - a result of planning with local providers and stakeholders - is helping to make this possible.
The tool - a checklist - is designed to identify seniors who are at risk of an avoidable emergency department visit or hospital stay. The risk factors include seniors who have challenges with daily living activities, such as preparing meals, dressing and bathing, lack of caregiver support, and who have fallen at home.
The tool is currently being piloted among nine family doctors in Burlington. Senior patients are screened and if identified to be at risk, are referred to the HNHB Community Care Access Centre (CCAC) to get the proper assistance in the community to prevent any deterioration in their health. Early feedback from the doctors is positive and to date, all individuals identified as at risk have received community services, such as help with daily living activities and home assessments to prevent falls.
The checklist has also been adapted for use in emergency departments, beginning with Brantford General Hospital and Norfolk General Hospital. The goal is to identify seniors at risk and connect them with the appropriate services so they get the best care, in the right place, at the right time. This aligns with one of the solutions identified in a report to the LHIN from Pricewaterhouse Coopers to improve patient flow (how people move between services within the health care system).
The flexibility of the tool is garnering interest to adapt it for use in other health care environments, like flu clinics.
Initiatives like this are helping seniors get the care they need, when they need it, to help them continue living independently at home.
One small step for diabetics, one giant leap for the health system
Imagine you are walking down the street and you notice small rocks in your shoes. The discomfort from the rocks would likely make you stop to remove them. But if you were diabetic, you probably wouldn't even feel the rocks. Due to a lack of circulation, people with diabetes often lose feeling in their feet, meaning pressure from rocks in shoes, or tight socks, or bed sheets may go unnoticed. If diabetics' feet aren't checked regularly, ulcers and infections can develop which can lead to a foot or leg amputation.
That's why foot care is so important for people with diabetes. Preventing ulcers and catching them early keep feet healthy and prevent amputations. This improves quality of life, while reducing visits to the emergency department and hospital stays as a result of foot complications.
The LHIN expanded access to foot care close to home for people with diabetes to maintain healthy feet, healthy lives and independence with Feet First and Best Foot Forward. These programs provide people with diabetes who are at high risk of foot complications with access to a team of health professionals. These programs also teach people how to better care for their own feet.
In one year, more than 1,800 local residents were seen by the two foot care programs. In that year, there was a reduction in the number of people who visited the emergency department because of foot complications and more than half of 198 people with an ulcer healed within six months. Had these ulcers progressed and required treatment or an amputation, the cost to the health care system would be between $3.5 and $6.7 million*. More importantly, the quality of life for these individuals would be significantly reduced. These programs help to keep people healthy, get them good care, and contribute to the sustainability of the health care system.
Of 372 clients surveyed in the Best Foot Forward program, 65% said they had a better understanding of how to care for their feet. One client commented, "Great program! As I am very arthritic, I cannot reach my feet - one less worry for me."
Providing regular foot care for people with diabetes represents one small step with big benefits for these individuals, and one giant leap for the health care system.
*Cost of treatment for foot ulcers based on $18,000, Bloomgarden, A., (2000) American Diabetes Association: The Diabetic Foot. Diabetes Care, Volume 24, Number 5, May 2011. Cost of amputation based on $34,000, Singh, N., Armstrong, D., Lipsky, B., (2005) Preventing foot ulcers in patients with diabetes. Journal of American Medical Association. 2005; 293(2); 217-228.
HSPs: Health System Planning and You
Are you a health service provider experiencing service pressures? Have you identified unmet needs? If you are thinking about creating, expanding, reducing or ceasing programs or services, the HNHB LHIN has developed some resources to help you.
Video: Steve Isaak, Director, Health System Transformation talks about the importance of health system planning.
The HNHB LHIN’s overarching goals are to improve the health of the population, improve the experience of care for people as they go through the system and ensure a sustainable health system. Therefore, any decisions to create, expand, reduce or cease programs or services are required to be based on robust evidence of client/patient needs and best practices in service delivery.
At the same time, new funding in the health care system is either very limited and targeted or non-existent. Existing resources must be leveraged to achieve health system goals. If you are experiencing service pressures or have identified unmet needs, the expectation is that you will develop partnerships that integrate the system, finding resources through that integration.
A new Health Services Planning Process has been developed to help you explore your client/patient needs, best practices in service delivery, and integration/partnership opportunities needed to make a successful case for change.
Following this planning process will lead you to explore:
- Service change - shifting focus within the current budget and mandate to better meet need
- Integration - partnering, collaborating, or amalgamating to create client-centred integrated service delivery models that leverage existing resources
- Health system improvement - if all other options are explored and a gap in service still remains, a pre-proposal form will help identify gaps for HNHB LHIN review
Here is the planning process at-a-glance:
- Align your direction and priorities
- Look inside your own organization to find efficiencies
- Partner and integrate - define your client population and their needs, identify current services, gaps and duplications, and explore opportunities to partner and integrate
- Complete and submit forms as appropriate
Each of these steps is outlined in detail on our website and contains resources to help you work through them. A printable version is also available. Click here for more information.
Thank You to Our Health Service Providers
Big thanks to all our health service providers for your hard work and patience in completing the second quarter reports!
Donna's Blog - November 2011
Check out an excerpt from Donna Cripps' latest blog post and be sure to read her next post on Monday, December 5, 2011.
Helping seniors stay healthy and improving their health care experiences is one of the HNHB LHIN’s priorities and is important work that is very near and dear to my heart. Each and every day, we work to ensure that our parents and grandparents receive the care they need, when they need it. They raised and cared for us, taught us values and worked hard to give us a future. That’s why it is so important that we ensure the health care system cares for them as they did for us.
We are working to help them get the care they need close to home, help them live independently at home as long as possible, identify risks early, improve their experience in hospital, improve transitions between health care services, and enhance their experience in long-term care.
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Submit Your Nomination for SAGE 2012
The call for nominations is now open for the 9th annual Service Awards for Geriatric Excellence (SAGE)!
SAGE celebrates the outstanding contributions of individuals and organizations committed to providing the highest quality of care to seniors.
Nomination Deadline: February 10, 2012
Click here for more details and to submit a nomination.
The Service Awards for Geriatric Excellence (SAGE) is a joint initiative of the Regional Geriatric Program central (RGPc) and St. Peter's Hospital, Hamilton Health Sciences.
The program was introduced in 2003 to formally recognize the outstanding achievements of individuals and organizations who demonstrate excellence in positively influencing the quality of life of seniors and to highlight geriatrics as a critical area of health care. These unsung heroes work tirelessly so that seniors can live with independence and dignity in their own homes or communities. They also provide the highest quality of care for older adults in hospital and long term care.
This unique program is the only one of its kind in Ontario to celebrate the professional excellence of individuals and organizations that provide health care and community services for seniors and their families.
Good News from Our Partners
More Access to Cancer Services in Brant
Access to the Cancer Clinic at Brantford General Hospital is expanding from three days per week up to five days, with the addition of a full-time medical oncologist and a general practitioner of oncology.
Read the column in the Brantford Expositor.
Volunteer Caregivers Honoured by HNHB CCAC
The HNHB Community Care Access Centre (CCAC) honoured 34 volunteer caregivers for their efforts in helping people in need remain at home and active in the community.
Read the article in the Simcoe Reformer.
Physiotherapist Receives 1st Ever SPIRIT Award from Hotel Dieu Shaver
Senior physiotherapist Assunta Berardocco has been named the first winner of the Hotel Dieu Shaver Health and Rehabilitation Centre SPIRIT award. The honour was developed to showcase what the hospital belives is an acronym for spirituality, professionalism, innovation, responsible stewardship, integrity and teamwork.
Read the rest of the article in the St. Catharines Standard.
Bridges CHC Celebrates Grand Opening of New Port Colborne Site
On November 9, 2011, Bridges Community Health Centre celebrated the Grand Opening of its new Port Colborne site.
Read the article in The Welland Tribune.
Nurse Navigator Guides Lung Cancer Patients through the System
Colleen Stang is a nurse navigator who guides and supports lung cancer patients through their journey of care. For Erika, Colleen made the process "so much better." The nurse navigator position is part of a joint hospital project.
Read the article in the St. Catharines Standard.
Read a related article in the Hamilton Spectator.
Mac ER is More Kid Friendly
On November 3, 2011, Hamilton Health Sciences' celebrated the official opening of Phase 1 of the McMaster children's emergency department. New features of the space include calming colours, touch screens for kids to play with, and separate areas for walk-ins and ambulance arrivals. Phase 2 is expected to be complete in late 2012.
Read the article in the Hamilton Spectator.
Safer Hospital Stay for Seniors
When the new West Lincoln Memorial Hospital (scheduled for construction start-up in 2013) opens up in 2015, it will be designed to meet the needs of the majority of its population — seniors. In the meantime, small changes are being rolled out at the existing hospital to make it a safer, healthier place for older people. These developments align with the Senior Friendly Hospital Strategy.
Read the article in Niagara This Week.
Click here to read more good news stories.
November 21, 28 & December 5, 2011
Next Steps: First Link learning series for family members and friends of individuals with dementia
10:00 a.m. - 12:00 p.m.
November 24 & December 8, 15, 2011
Craving Change: A How-to Workshop for Changing Your Relationship with Food
5:00 - 6:30 p.m.
Thursday, December 1, 2011
Pre-Diabetes: A presentation on what it is and how to manage it
10:00 - 11:00 a.m.
Health Service Provider Events
November 23, 2011: Innovations in Hospice Palliative Care
November 30, 2011: Drugs and the Elderly: Too many or too few?
For more HSP events, click here.
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