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

Overview of Elder Care and Long Term Care IssuesDate: September, 2013

Presentation to: GNAO

By: Sheila Bauer, Administrator Peter D. Clark LTC Centre

AgendaGlobal contextMinistry of Health and Long Term Care Directions Champlain Local Health Integration Network Strategic Directions Elders -- who are we talking about? Data, profilesWhere is care provided what is LTC like?What are the challenges and opportunities?What we have learned?Where are we going?

Why Population Aging MattersWe are agingnot 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 billion1 in every 8 of the earths inhabitants. Significantly, the most rapid increases in the 65-and-older population are occurring in developing countries, which will see a jump of 140 percent by 2030. (National Institute on Aging, 2007)Global contextPopulation trendsAn aging populationIncreasing life expectancyRising number of the oldest oldGrowing 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 continuedAging and population declineChanging family structureShifting patterns of work and retirementEvolving social insurance systemsEmerging 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 DiseaseHealthy 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 Context2011 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 wholePeople aged 60-64 grew 29.1% between 2006-112011 -- 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

Alzheimers DiseaseAlzheimer 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 annuallyAlzheimers ContinuedPressures 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 millions20 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 2.2% 83 CSS $50,369 2.1%

Provincial Action Plan Priorities and LHIN System Imperatives

Champlain LHIN PrioritiesStrategies for an integrated systemBuild a strong foundation of integrated primary, home and community careImprove coordination and transitions of careIncrease coordination and integration of services among hospitals.Not population based, where do seniors fit?

MoHLTC PrioritiesOntarios Action Plan for Health CareKeeping Ontario HealthyFaster access to Stronger Family Health CareRight care, right place, right timeKOH diabetes, obesity, mental healthFA Healthcare ConnectsRCRPRT CHC, CCACFocus on seniors, not direct policy Who are we talking about in LTC?Demographics: average age, range of ages in LTC, gender, culture, languages, co-morbidities Resident assessment instrument (RAI)- Minimum Data Set (MDS) scalesCPS, ABS, CHESS, CMI trendsCreates a picture of increased complexity partnered, increased care needs and specialization DataHow long does someone wait?Is that too long? Why?Median number of days to long-term care home placement Provincial median forJanuary-March 2011: 113 daysProvincial median for January-March 2010: 112 daysWaitlists -- too long for some, yet others are not ready

PDC Age RangesLength of StayCase Mix IndexAggressive Behaviour Scale (ABS)Depression Rating Scale (DRS)What do people want/need?Stay in their own homeIs there a price point? At any cost?Continuum of care and housing needsAffordable assisted livingInstrumental activities of daily living (IADL) supportADL support 24 hour supervision required in many cases What is LTC likeFunding model profit and for-profit homesLegislation - programsMuch care is provided by PSWs24 RN on-siteRecreation and leisure programming (stratification of ages, different degrees of capacity, different interests) Specialized units (few)What is long term care like?Legislation = individualized careStaffing requires routines need to find a balanceElderly requires patience, time, expediency, respect, CARING throughout ADLsNursing rehabilitation programEducation and knowledge transferExpertise access

What do we mean by care of the elderly in LTC?Is it different than care of anyone at any age?Yes and noValues are the sameApplication is different, elderly people are different Significant deterioration can occur and hard to recoverChanges in senses, changes in muscle mass, changes in bone mass, changes in hormone levelsMedically complex, frail seniors Rehabilitation, medicine, psychiatryWhat do we mean by care of the elderly in LTC?Primary reason why LTC is considered dementia and/or incontinenceComplex treatment plansUrinary tract infectionsPressure ulcersFallsRestraints (physical and chemical)Responsive behavioursWhat do we mean by care of the elderly in LTC?Bladder and bowl managementSkin and wound managementPeripherally inserted central catheters (PICC) Feeding tubes and pumpsPain pumpsAssistive devicesAmbulation devicesWhat do we mean by care of the elderly in LTC?Infection prevention and managementMemory challengesPlethora of co-morbidities and associated care requirementsExtremely complex care in specific casesChallengesFunding (flexibilities and physio changes)Staffing ratiosProgramsHuman resource challenges Retention and RecruitmentEducation, knowledge transferFearSalaries

Challenges continuedPrescriptive legislationImage complaints, action lines, annual inspections, critical incidents, media, health partnersResident profilesFamily expectations (LTC fees)Health partner expectationsMinistry expectationsPrimary care coverage with consultants prnAccountabilitiesLTC OpportunitiesTo make a difference To share our expertiseTo collaborate with health care partnersTo re-vitalize its imageTo be an important part of the continuum of careSupportive environmentsSelf-care in choices and actionsTo be a choiceWhat we have learnedStaffing levelsEducation and knowledge transferPeople providing most of the direct care have minimal educationVery few challenges are unique to long term care but LTC is treated differently and challenges are exacerbatedCare is complicatedService delivery modelImportant, necessary part of the health care system

Where are we going?AdvocacySpecialized units (younger adults)Incidence trending ProfilesIncrease in prevalence of residents with responsive behaviours Community presenceCare of the elderly +

The ChallengeThe 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 CommentSeniors 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 CommentCan 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: andProvides 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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