Seniors’ Strategy in Champlain

Chantale LeClerc, CEO, Champlain LHIN

Presentation to the Regional Geriatric Program of Eastern Ontario

Annual General Meeting, October 24th, 2014

Overview

• A word on the Champlain LHIN

• Seniors’ Strategy in the Champlain Region

• Where we’ve been

• Where we are today

• Where we are going

• Where you fit

2

The Champlain LHIN

The Champlain LHIN

4

• Easternmost region

• 18,000 square kilometers

• 1.2 M people

• 168,000 seniors

• 3% seniors are frail

• 18,400 people with dementia

• 176 accountability agreements for health services

Champlain Seniors Strategy

Where We’ve Been

Mrs. Smith (or someone you know…)

6

Percentage ALC Days in Champlain LHIN

10%

12%

14%

16%

18%

20%

22%

06-Q

1

06-Q

2

06-Q

3

06-Q

4

07-Q

1

07-Q

2

07-Q

3

07-Q

4

08-Q

1

08-Q

2

08-Q

3

08-Q

4

09-Q

1

09-Q

2

09-Q

3

09-Q

4

10-Q

1

9

Concept of Health Pathway

Tenuous

Coping

Health /

Resource

Crisis

Health /

Resource

Recovery

Health /

Resource

Stabilization

De-stabilization Decline

Improve

capacity for

selfcare

Prevent

further

deterioration

Restore

Health

Maintain

Stability Re-stabilize Control rate of

deterioration

Adapted from A Potential Model for Health Care for Ontario’s Elderly, Mary Lou Kelley, March 1999

Where We’ve Been

• Reaching Seniors Health Potential

• Making it Easier to Access Services

• Building System Capacity and Responsiveness

• Expanding Housing Options

Where We’ve Been

• Mobilize leaders to achieve results

• Change how we think about seniors and their health needs

• Make better use of what we have

• Help seniors move through the health system

• Implement innovative alternatives to long-term care homes

12

Champlain Seniors Strategy

Maximizing Good Health

and Avoiding Unnecessary

Use of Acute Care

• Prevention:

Respite and Dementia Care

Exercise and Falls Prevention

• Wellness:

Self-Management of

Chronic Conditions

Wellness Clinics

Access to primary care providers

• Outreach:

Crisis intervention to prevent

hospital admissions

Nurse Led Outreach Teams

Primary Care Outreach 13

Champlain Seniors Strategy

Ensuring Effective Urgent

and Acute Care

Urgent Care:

• Regional Geriatric and Community

Intervention Program

• Nurse Led Outreach Teams to Long

Term Care Homes

Acute Care:

• Senior-Friendly Hospital Initiative

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Champlain Seniors Strategy

Providing Post Acute-Care so

seniors can remain at home

as long as possible

• Restorative Care: Assess &

Restore, Convalescent Care

• Home and Community Care:

Home First, Assisted Living

Services for High-Risk Seniors

• Specialized Care: Behavioral

Supports 15

We’re We Are Today

Mrs. Smith’s story revisited

Where We Are Today

8 7 9 8 9 6 6 7 8 7 5 4

14.01%

14.91%

15.18%

13.64%

14.01%

13.40%

14.20%

12.72%

13.81%

12.78%

12.97%

11.35%

9.0%

10.0%

11.0%

12.0%

13.0%

14.0%

15.0%

16.0%

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

2011/12 2012/13 2013/14 2014/15

Per

cen

t A

LC

Rank % ALC Days Target

Where We Are Today

Where We Are Today

Where We Are Today

• 300 fewer seniors awaiting discharge from hospital to a more

appropriate location on any given day

• 58% fewer admissions to long term care homes from hospitals

• 1000 fewer seniors waiting for an admission to a long term care home

• Reduction in length of stay in long term care home by 3 and a half

months (= 720 new beds)

• Rare cancellation of elective surgeries because of lack of hospital

beds

• 32% improvement in time spent in emergency department waiting for

a hospital bed

Where We Are Going

• Integrated dementia program

• Greater use of technology (eConsultation, telehome care)

• Health Links

• Home and community care alignment

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Where You Fit

• Seniors:

• Stay healthy!

• Manage health conditions

• Self management programs

• Peer support

• Health Care Connect

• Plan your health and care

• Know availability of service

• Integrated care plan

• Advanced directives

22

Where You Fit

• Providers and Decision Makers:

• Be obsessively senior centred

• Accept the need for change

• Critically analyze what you are doing

• Look for opportunities for integration

• Honour your obligations to the

health system