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Friendly to Seniors

Friendly to Seniors. December 3, 2012. New Models of Care. Health Sciences North and North East Community Care Access Centre developing and introducing new models of care for seniors

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Friendly to Seniors

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  1. Friendly to Seniors December 3, 2012

  2. New Models of Care • Health Sciences North and North East Community Care Access Centre developing and introducing new models of care for seniors • These new models of care focus on Care Transitions – which means helping patients transition across the continuum of care • Goal is to transcend “silos” created by different institutions, care providers, models of practice, etc. • In keeping with provincial health policy direction

  3. Rapid Response Nurses Telehomecare Complex Diabetes Clinic COPD Clinic Geriatric Day Hospital Geriatric Emergency (GEM) ED Outreach Nurse Practitioner – Palliative Nurse Practitioner – Complex Geriatric CCAC Complex Care Coordinators (dementia, geriatric & end-of-life care) ACE HELP ED CCAC Care Coordinator Geriatric Recruitment Chair in Geriatric Research Patient Advisory Council Community Engagement Mobility Clinics Medication Reconciliation Primary Care Partnership Health Care Connect thehealthline.ca HSN/North East CCAC Friendly to Seniors Initiatives

  4. Care Transitions - Continuum of Care New models in development: Care Transitions/Virtual Ward Integrated Discharge Planning Re-Launch of Home First philosophy PACE (Program of All-inclusive Care for the Elderly) Autumnwood partnership (25 bed unit) Initiatives are being evaluated/carefully measured

  5. Functional Assessment Outcome Unit • FAO Unit at Sudbury Outpatient Centre will close January 2013. Peer Review Report recommended closure in September 2013 • Decision to proceed with closure: • Not optimum care model for seniors • Need to implement sustainable solutions vs. “band-aid” solutions • High cost model of care – stand-alone unit does not allow for cost efficiencies • Funding will be re-directed towards new senior-friendly initiatives aimed at keeping seniors living independently in their home • Patients not placed will be moved to Ramsey Lake Health Centre • Of note: FAO patient not the same patient population targeted for Autumnwood

  6. Role for the Community No combination of publicly funded services provide 1:1, round‐the‐clock care/supervision at home on an ongoing basis. For clients requiring this level of care/supervision who wish to stay in their own homes, a mix of services funded in a number of different ways is needed. North East CCAC Community Support Services For-Profit Agencies Client/Family/Caregiver support and resources

  7. Community Venues of Care Personal Home / Apartment Retirement Home Complex Continuing Care - medical complex - short-stay rehab and convalescent care Long-Term Care Home - short-stay, respite & convalescent care - long-stay placement Hospice

  8. Thank you!

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