Agenda

1. Public Health and Home CarePresentation to ALPHAMay 21, 2002By: Diane McLeod, VP Policy, Planning & Government RelationsJanis Leiterman, Director Clinical Services

2. Agenda 1. Welcome and Introductions 2. VON 3. Community Health Care • Home Health Care Services • Home Support Services • Community Support Programs • Occupational Health Services • Complementary Therapies 4. Recent Changes to Home Care

3. Agenda Cont’d 5. Service Delivery Issues • Clients • Providers • Services • Caregivers 6. How VON Works with PH 7. How PH Might Support VON 8. Questions

4. Victorian Order of NursesVON • National, not-for-profit, charitable organization • Providing community health care services for 105 years • Network of 65 branches across the country • 30 branches in Ontario

5. Mission • VON, a charity, guided by the principles of primary healthcare, works inn partnership with Canadians for a healthier society through: 1. Leadership in community-based care. 2. Delivery of innovative, comprehensive health and social services. 3. Influence in the development of health and social policy.

6. VON cont’d • Over 8,000 staff nation-wide, approximately 4,000 in Ontario • Over 11,000 volunteers nation-wide, approximately 10,000 in Ontario • Best known for nursing • Provides many other programs and services including meals-on-wheels, adult day care, in-home Alzheimer respite, volunteer visiting etc.

7. VON Cont’d • Programs and services developed in response to community needs • Funding comes from a variety of sources • In Ontario 90% + comes from government

8. Community Health Care • Complex and at times complicated system • 5 categories to simplify • Home Health Care Services • Home Support Services • Community Support Programs • Occupational Health Services • Complementary Therapies

9. Home Health Care Services • Care received from a registered health professional in the home • Services available include: • Visiting/shift nursing • Palliative care • Infusion therapy • Enterostomal therapy • Respiratory care • Mental health care • Chemotherapy

10. Home Health Care Cont’d • Continence Management • Physiotherapy • Occupational therapy • Speech/language services • Social work • Dietary services

11. Home Health Care Cont’d • Arranged by: • Local Community Care Access Centre (CCAC) • Physician • Contacting a home health care provider directly

12. Home Health Care Cont’d • Funding • Government • Insurance • Direct payment

13. Home Support Services • Natural extension of home health care services • Provided by Personal Support Workers, Certified Health Care Aides and Home Support Workers

14. Home Support Services Cont’d • Services available include: • Home management services • Personal care • Respite care

15. Home Support Services Cont’d • Arranged by: • Local CCAC • Physician • Contacting a home support service provider directly • Funding • Government • Insurance • Direct payment

16. Community Support Programs • Designed to extend the scope of community health care by providing individuals in the community with a wide variety of additional support services • Services provided by wide range of staff and volunteers

17. Community Support Programs Cont’d • Services available include: • Alzheimer’s Day Programs • Adult Day Centres • Meals on Wheels • Foot Care Clinics • Friendly Visitors • Palliative visiting • Caregiver Relief • Bereavement Support

18. Handymen • Phone friends • Transportation • Arranged by: • CCAC • Physician • Community health provider • Local community centre

19. Community Support Programs Cont’d • Funding: • Many progams rely heavily on volunteers and donated funds • Government • Direct payment

20. Occupational Health Services • A form of community health care designed to give the health care knowledge and services that are required to protect and promote personal health and safety at work

21. Occupational Health Services Cont’d • Types of Services: • Immunization clinics • Ergonomic assessments and education • Health counselling • Screening programs • CPR/First Aid Training

22. Occupational Health ServicesCont’d • Arranged through direct contact with a provider • Funding: • Employer • Cost shared

23. Complementary Therapies • Designed to complement traditional medical treatments • Funding is generally through direct payment or in some cases, insurance coverage is available

24. Changes to Home Health Care • Cost-containment • Bill 130 • CCAC Reform • Resource allocation • Issues • Diminished levels of care • Increased pressure on the charitable sector • Premature institutionalization

25. Service Issues: Clients • Increasingly complex clients • do not get admitted to hospital • leave hospital earlier • delayed entry to long-term care facilities • de-institutionalization of mentally ill • multiple languages, cultures • co-morbidity's • people living longer

26. Service Issues: Providers • Nurses: EC, BScN, RN, RPN • Dieticians, Physios, Social Workers • Personal Support Workers • Volunteers • Bundling of Services

27. Service Issues: ServicesHospital in the Home • Infusion Therapy • administration of: • IV antibiotics • chemotherapy • blood • Use peripheral & central lines • infusion pumps for pain control

28. Service Issues: ServicesHospital in the Home Continued • Dialysis: Hemo and CAPD • Post-op Care • Acute & chronic wound care • Trach Care • Suprapubic Catheters • Colostomy Care • Nephrostomy Tubes

29. Service Issues: Services Clinics • Post-op Care • Initiating Insulin in the Home • Footcare • Wound Care • Infusion • Complementary Therapy • Immunization

30. Demands on Caregivers • Caregivers are assessed on admission • VON & CCAC share goal of self-care • VON concerned about how to meet caregivers’ needs • CCAC interested in potential for delegating/downloading care

31. Supports for Caregivers: Respite • In-Home • visit and shift care • Facility-Based • adult day programs • Support Groups • education and support • Advocacy

32. How VON Currently Works with PH • Antibiotic Resistant Organisms • Tuberculosis • testing of VON staff • mandatory observation of PH clients

33. VON Working with PH Cont’d • Immunization • Emerging Infectious Diseases

34. How PH Might Support VON • Life Adjustment to Chronic Illness • process skills • adult education • behavior change theory/skill • Wellness Teaching Resources • Working with homeless populations?