Leading knowledge exchange on home and community care

Status Report on Aging at HomeCRNCC/ OCSA Conference, 2010

The CRNCC is funded by the SSHRC and Ryerson University

Janet M Lum, CRNCC CoJanet M Lum, CRNCC Co--ChairChair

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements Alvin Ying, CRNCC Manager

Funders• CIHR Grant #CTP 79849- Team in Community

Care and Health Human Resources (R. Deber, PI))

• SSHRC Standard Grant # 410052352 -Community support services at the margins (A P Williams PI)(A.P. Williams, PI)

• SSHRC Knowledge Impact in Society –CRNCC (J. Lum, PI)

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Key QuestionsKey QuestionsKey Questions Key Questions The stated goals of Ontario’s Aging at

H t t ?Home strategy?

What sorts of programs have received What sorts of programs have received funding over the 3 years?

AaH achievements?

AaH remaining challenges?

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Evidence: Content AnalysisEvidence: Content AnalysisEvidence: Content Analysis Evidence: Content Analysis Press releases, backgrounders, Annual

Reports for each LHIN and any other information on new programs funded from AaH

MOHLTC press release for Year 3 which h d ll i f ll h LHINshowed money allocation for all the LHINs

Will augment analysis with LHINs’ Board Will augment analysis with LHINs Board agenda, minutes, any other reports for all 3 years

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What We Looked AtWhat We Looked AtWhat We Looked At What We Looked At Funding for Year 1 and Year 3g Program names and descriptions Service providersService providers Start year (AaH Year 1, 2 or 3) Focus of the programsFocus of the programs

• Directly emphasize staying at home • Directly addresse ALC/ER (e.g., GEM nurses, y ( g , ,

transition care beds)

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Stated Goals: August 2007Stated Goals: August 2007gghttp://www.health.gov.on.ca/english/public/program/ltc/34_strategy_qa.html

$1.1 billion over four years from the province

“…help older people live healthy, independent lives in the comfort and dignity of their ownlives in the comfort and dignity of their own homes…with supports and services…”

“ id l f i d d d “…avoid unnecessary loss of independence and dignity due to premature admission to higher care long-term care homes or hospitals…”

“…help ensure the sustainability of the overall health system”health system

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Goal Goal –– To Increase Traditional To Increase Traditional S iS iServicesServices “…Expand community support

i t i ithservices…to serve more seniors with chronic conditions to help them remain at home and avoid unnecessary visits toat home and avoid unnecessary visits to emergency departments, and avoid or delay admission to a LTC home…”

LHINs – “…to engage their community… to achieve an integrated system ofto achieve an integrated system of community based services…”

http://www.health.gov.on.ca/english/public/program/ltc/34_strategy_qa.htmlq

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Staying At Home EmphasisStaying At Home EmphasisStaying At Home EmphasisStaying At Home Emphasis Increase in the overall quantity and q y

range of services available to seniors

Proactive wellness approaches to avoid crises

Relieve pressures on hospitals and long t b h l i t fi dterm care by helping to find more appropriate placements for patients

http://www.health.gov.on.ca/english/public/program/ltc/34 strategy qa.htmlp g g p p g _ gy_q

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What Was Funded : Prevention and What Was Funded : Prevention and LTC S b tit tiLTC S b tit tiLTC SubstitutionLTC Substitution Mostly community support services critical

to staying at home • Supportive housing• Intensive case management• Intensive case management • Self management strategies• Respite care/ care giver supportp g pp• Adult day programs• Falls prevention

E t• Emergency response systems• Wellness programs• Tele-health checksTele health checks

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What Was Funded: Prevention and What Was Funded: Prevention and LTC S b tit tiLTC S b tit ti ti dti dLTC Substitution LTC Substitution –– continuedcontinued Mostly, community support servicesy, y pp

• Transportation• Meals on Wheels• Activation • Palliative care

M t l h lth• Mental health • Alzheimer’s program• Ethno specific programs (e g for Somali and• Ethno-specific programs (e.g., for Somali and

Punjabi communities)

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What Was Funded: Acute Care What Was Funded: Acute Care Substitution Substitution Note: goal of relieving ALC/ER pressures

h d ithi th t t f dwere couched within the context of, and guided by the principles of, helping seniors to stay at home safely with dignity and independence

Most common programs funded Most common programs funded • “Home At Last”• Transition care beds• Short stay beds• LTC beds

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Year 1 Year 1 AaHAaH Spending By Spending By LHINLHIN BB P FP FLHINs LHINs BBy y Program FocusProgram Focus

12The bars represent LHINs in random order. One

LHIN was excluded for lack of information.

Good NewsGood NewsGood NewsGood News

Invested in home and community care ysector

AaH helped forge partnerships among sectors (e.g., hospitaland community service sectors)

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Unfinished BusinessUnfinished BusinessUnfinished Business Unfinished Business

Programs tended to bePrograms tended to be piecemeal, one off, task / service specificspecific

Time limited services

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“Integrated Continuum of “Integrated Continuum of C itC it B d S i ”B d S i ”CommunityCommunity--Based Services” Based Services” This was a stated mandate of AaH

strategy

Needed more time to move toward an “integrated continuum of community-g ybased services”that seniors and their caregiverscan easily accesscan easily access

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Care ManagementCare ManagementCare ManagementCare Management Priority for acute care substitution is short

term, time limited services

C Care management to monitor short, medium and long term supports and caresupports and care

Without monitoring andWithout monitoring and supports, people may end up back in ER, hospital, LTC bedsLTC beds

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Monitoring Needs and Monitoring Needs and N i ti th S tN i ti th S tNavigating the SystemNavigating the System For older persons p

discharged from hospitals, we need a system to monitor the services they needservices they need at home in the short, medium andshort, medium andlong term

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Target: Right Care; Right Time; Right Target: Right Care; Right Time; Right Pl Ri ht P id Ri ht C tPl Ri ht P id Ri ht C tPlace; Right Provider; Right CostPlace; Right Provider; Right Cost If goal is to enhance the range of home g g

and community care services for seniors to avoid unnecessary ER visits and hospital admissions, need system to track and identify:

Who needs support services?• Who needs support services?• What sorts of services? • When?When?• By whom?

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Despite UnfinishedDespite UnfinishedDespite Unfinished Despite Unfinished Business, Business,

Goals ChangedGoals Changed

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Shifting GoalsShifting GoalsShifting GoalsShifting Goals By 2009, emphasis shifted to acute y p

care substitution - relieving pressures on hospital ALC beds

MOH memo to LHINs to align AaHwith ALC/ER strategywith ALC/ER strategy

Total amount of resources going to Total amount of resources going to to ALC/ER directly related programs increased dramaticallyincreased dramatically

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Year 3 Year 3 AaHAaH Spending By LHINs Spending By LHINs B P FB P FBy Program FocusBy Program Focus

22The bars represent LHINs in random order. One LHIN was excluded for lack of information.

There was no available information on unallocated funds for the LHIN with a star.

Whatever Happened to Aging Whatever Happened to Aging t H ?t H ?at Home?at Home? Goals changed from aging atGoals changed from aging at

home to getting out of hospital

From prevention and LTC psubstitution to ALC/ER focus

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Whatever Happened to Aging Whatever Happened to Aging t H ?t H ?at Home?at Home? ALC/ER priorities legitimate andALC/ER priorities legitimate and

important• Much needed programs to promote faster p g p

discharge from hospitals –GEM nurses, transition care, interim LTC beds, specialized acute care services at home

BUT – so are the priorities of agingBUT so are the priorities of aging at home, prevention and LTC substitutionsubstitution

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Growing and Credible EvidenceGrowing and Credible EvidenceGrowing and Credible EvidenceGrowing and Credible Evidence

A growing body of international research g g yevidence suggests that home and community care can play and important role in maintaining the health, well being and autonomy of individuals and carers, while moderating the demand for morewhile moderating the demand for more costly emergency, hospital and LTC beds

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Balance of Care Research Balance of Care Research K Fi diK Fi diKey FindingKey Finding Upward substitution

• Barriers to accessing “lower level” supports (e.g., transportation or nutrition) have often meant using “higher level,” more costly healthmeant using higher level, more costly health care (e.g., LTC or hospital beds)

Versus downward substitutionVersus downward substitution• Access to appropriate “lower level” community

supports avoids or delays use of more expensive formal health careexpensive formal health care

AP. Williams, R.Deber, JM. Lum, K. Spalding, W. Wodchis, K.Kuluski, F. Morton, J. Watkins, A. PeckhamFunded by CIHR Team in Community Care and Health Human ResourcesFunded by CIHR Team in Community Care and Health Human Resources

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Balancing Care with Balancing Care with S ti H iS ti H iSupportive HousingSupportive Housing Reinforce the findings of the BoC studies

Similarities in characteristics of residents currently living in supportive housing and those on the LTC

it li t t th t i t t i tiwait list suggest that investments in supportive housing pay off in “diverted” people from the wait list

Supportive housing is capable of maintaining the independence of a significant portion of seniors who might otherwise be destined for institutionalwho might otherwise be destined for institutional care

JM Lum, A.P. Williams, J. Sladek & A. YingFunded by the SSHRC: Fund number 458323Funded by the SSHRC: Fund number 458323

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PennywisePennywise –– Pound FoolishPound FoolishPennywise Pennywise Pound FoolishPound Foolish

Changing goals g g gis resulting in even less money ffor community care sector

BUT – Original rationale for AaHrationale for AaHremains

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It Costs Before It PaysIt Costs Before It PaysIt Costs Before It PaysIt Costs Before It Pays Need investment in a wide range ofNeed investment in a wide range of

home and community care services as a cost effective way to improve theas a cost effective way to improve the lives of Ontario seniors --top line

It can also help ensure the sustainability of the overall healthsustainability of the overall health system --bottom line

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It Takes Time BeforeIt Takes Time BeforeIt Takes Time Before It Takes Time Before It PaysIt PaysIt PaysIt Pays

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