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
14
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
21
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