Public Health and Home Care

Presentation to ALPHAMay 21, 2002

By: Diane McLeod, VP Policy, Planning & Government RelationsJanis Leiterman, Director Clinical Services

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Agenda

1.1. Welcome and IntroductionsWelcome and Introductions2.2. VONVON3.3. Community Health CareCommunity Health Care

Home Health Care ServicesHome Health Care ServicesHome Support ServicesHome Support ServicesCommunity Support ProgramsCommunity Support ProgramsOccupational Health ServicesOccupational Health ServicesComplementary TherapiesComplementary Therapies

4.4. Recent Changes to Home CareRecent Changes to Home Care

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Agenda Cont’d

5.5. Service Delivery IssuesService Delivery IssuesClientsClientsProvidersProvidersServicesServicesCaregiversCaregivers

6.6. How VON Works with PHHow VON Works with PH

7.7. How PH Might Support VONHow PH Might Support VON

8.8. QuestionsQuestions

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Victorian Order of NursesVON

National, not-for-profit, charitable National, not-for-profit, charitable organizationorganization

Providing community health care services Providing community health care services for 105 yearsfor 105 years

Network of 65 branches across the countryNetwork of 65 branches across the country 30 branches in Ontario 30 branches in Ontario

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Mission

VON, a charity, guided by the principles of VON, a charity, guided by the principles of primary healthcare, works inn partnership with primary healthcare, works inn partnership with Canadians for a healthier society through:Canadians for a healthier society through:

1.1. Leadership in community-based care.Leadership in community-based care.

2.2. Delivery of innovative, comprehensive Delivery of innovative, comprehensive health health and social services.and social services.

3.3. Influence in the development of health and Influence in the development of health and social policy.social policy.

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VON cont’d

Over 8,000 staff nation-wide, approximately 4,000 Over 8,000 staff nation-wide, approximately 4,000 in Ontarioin Ontario

Over 11,000 volunteers nation-wide, Over 11,000 volunteers nation-wide, approximately 10,000 in Ontarioapproximately 10,000 in Ontario

Best known for nursingBest known for nursing Provides many other programs and services Provides many other programs and services

including meals-on-wheels, adult day care, in-including meals-on-wheels, adult day care, in-home Alzheimer respite, volunteer visiting etc.home Alzheimer respite, volunteer visiting etc.

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VON Cont’d

Programs and services developed in Programs and services developed in response to community needsresponse to community needs

Funding comes from a variety of sourcesFunding comes from a variety of sources In Ontario 90% + comes from governmentIn Ontario 90% + comes from government

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Community Health Care

Complex and at times complicated systemComplex and at times complicated system 5 categories to simplify5 categories to simplify

Home Health Care ServicesHome Health Care Services Home Support ServicesHome Support Services Community Support ProgramsCommunity Support Programs Occupational Health ServicesOccupational Health Services Complementary TherapiesComplementary Therapies

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Home Health Care Services

Care received from a registered health professional in Care received from a registered health professional in the homethe home

Services available include:Services available include: Visiting/shift nursingVisiting/shift nursing Palliative carePalliative care Infusion therapyInfusion therapy Enterostomal therapyEnterostomal therapy Respiratory careRespiratory care Mental health careMental health care ChemotherapyChemotherapy

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Home Health Care Cont’d

Continence ManagementContinence Management PhysiotherapyPhysiotherapy Occupational therapyOccupational therapy Speech/language servicesSpeech/language services Social workSocial work Dietary servicesDietary services

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Home Health Care Cont’d

Arranged by:Arranged by: Local Community Care Access Centre Local Community Care Access Centre

(CCAC)(CCAC) PhysicianPhysician Contacting a home health care provider Contacting a home health care provider

directlydirectly

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Home Health Care Cont’d

FundingFunding GovernmentGovernment InsuranceInsurance Direct paymentDirect payment

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Home Support Services

Natural extension of home health care Natural extension of home health care servicesservices

Provided by Personal Support Workers, Provided by Personal Support Workers, Certified Health Care Aides and Home Certified Health Care Aides and Home Support WorkersSupport Workers

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Home Support Services Cont’d

Services available include:Services available include: Home management servicesHome management services Personal carePersonal care Respite careRespite care

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Home Support Services Cont’d

Arranged by:Arranged by: Local CCACLocal CCAC PhysicianPhysician Contacting a home support service provider Contacting a home support service provider

directlydirectly FundingFunding

GovernmentGovernment InsuranceInsurance Direct paymentDirect payment

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Community Support Programs

Designed to extend the scope of community Designed to extend the scope of community health care by providing individuals in the health care by providing individuals in the community with a wide variety of community with a wide variety of additional support servicesadditional support services

Services provided by wide range of staff Services provided by wide range of staff and volunteersand volunteers

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Community Support Programs Cont’d Services available include:Services available include:

Alzheimer’s Day ProgramsAlzheimer’s Day Programs Adult Day CentresAdult Day Centres Meals on WheelsMeals on Wheels Foot Care ClinicsFoot Care Clinics Friendly VisitorsFriendly Visitors Palliative visitingPalliative visiting Caregiver ReliefCaregiver Relief Bereavement SupportBereavement Support

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HandymenHandymen Phone friendsPhone friends TransportationTransportation

Arranged by:Arranged by: CCACCCAC PhysicianPhysician Community health providerCommunity health provider Local community centreLocal community centre

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Community Support Programs Cont’d Funding:Funding:

Many progams rely heavily on volunteers Many progams rely heavily on volunteers and donated funds and donated funds

GovernmentGovernment Direct paymentDirect payment

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Occupational Health Services

A form of community health care designed A form of community health care designed to give the health care knowledge and to give the health care knowledge and services that are required to protect and services that are required to protect and promote personal health and safety at workpromote personal health and safety at work

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Occupational Health Services Cont’d Types of Services:Types of Services:

Immunization clinicsImmunization clinics Ergonomic assessments and educationErgonomic assessments and education Health counsellingHealth counselling Screening programsScreening programs CPR/First Aid TrainingCPR/First Aid Training

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Occupational Health ServicesCont’d Arranged through direct contact with a Arranged through direct contact with a

providerprovider

Funding:Funding: EmployerEmployer Cost sharedCost shared

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Complementary Therapies

Designed to complement traditional medical Designed to complement traditional medical treatmentstreatments

Funding is generally through direct Funding is generally through direct payment or in some cases, insurance payment or in some cases, insurance coverage is availablecoverage is available

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Changes to Home Health Care

Cost-containmentCost-containment Bill 130Bill 130

CCAC ReformCCAC Reform Resource allocationResource allocation

IssuesIssues Diminished levels of careDiminished levels of care Increased pressure on the charitable sectorIncreased pressure on the charitable sector Premature institutionalizationPremature institutionalization

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Service Issues: Clients

Increasingly complex clientsIncreasingly complex clients do not get admitted to hospitaldo not get admitted to hospital leave hospital earlierleave hospital earlier delayed entry to long-term care facilitiesdelayed entry to long-term care facilities de-institutionalization of mentally ill de-institutionalization of mentally ill multiple languages, culturesmultiple languages, cultures co-morbidity'sco-morbidity's people living longerpeople living longer

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Service Issues: Providers

Nurses: EC, BScN, RN, RPNNurses: EC, BScN, RN, RPN Dieticians, Physios, Social WorkersDieticians, Physios, Social Workers Personal Support WorkersPersonal Support Workers VolunteersVolunteers

Bundling of ServicesBundling of Services

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Service Issues: ServicesHospital in the Home Infusion TherapyInfusion Therapy

administration of:administration of: IV antibioticsIV antibioticschemotherapychemotherapybloodbloodUse peripheral & central linesUse peripheral & central lines

infusion pumps for pain controlinfusion pumps for pain control

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Service Issues: ServicesHospital in the Home Continued Dialysis: Hemo and CAPDDialysis: Hemo and CAPD Post-op CarePost-op Care Acute & chronic wound careAcute & chronic wound care Trach CareTrach Care Suprapubic CathetersSuprapubic Catheters Colostomy CareColostomy Care Nephrostomy TubesNephrostomy Tubes

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Service Issues: Services Clinics Post-op CarePost-op Care Initiating Insulin in the HomeInitiating Insulin in the Home FootcareFootcare Wound CareWound Care InfusionInfusion Complementary TherapyComplementary Therapy ImmunizationImmunization

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Demands on Caregivers

Caregivers are assessed on admissionCaregivers are assessed on admission VON & CCAC share goal of self-careVON & CCAC share goal of self-care VON concerned about how to meet VON concerned about how to meet

caregivers’ needscaregivers’ needs CCAC interested in potential for CCAC interested in potential for

delegating/downloading caredelegating/downloading care

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Supports for Caregivers: Respite

In-HomeIn-Home visit and shift carevisit and shift care

Facility-BasedFacility-Based adult day programsadult day programs

Support GroupsSupport Groups education and supporteducation and support

AdvocacyAdvocacy

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How VON Currently Works with PH Antibiotic Resistant OrganismsAntibiotic Resistant Organisms

TuberculosisTuberculosis testing of VON stafftesting of VON staff mandatory observation of PH clientsmandatory observation of PH clients

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VON Working with PH Cont’d

ImmunizationImmunization

Emerging Infectious DiseasesEmerging Infectious Diseases

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How PH Might Support VON

Life Adjustment to Chronic IllnessLife Adjustment to Chronic Illness process skillsprocess skills

adult educationadult educationbehavior change theory/skillbehavior change theory/skill

Wellness Teaching ResourcesWellness Teaching Resources Working with homeless populations?Working with homeless populations?