1 Nancy Sears, RegN, CHE, PhD November 19, 2008

2 Goals To increase access to services and supports for unique circumstances faced by seniors Provide respite for caregivers Divert ED (CTAS IV & V) and ALC episodes of care by acting before frail seniors predictably present to acute care

3 Why SMILE and Not More of the Same? Current community services are built to provide a critical mass of services that meets common needs in common ways Needed a process that is sufficiently nimble to provide ‘one of’ service responses, customizing that response one senior at a time … with a minimalist administrative structure And nimble enough to go away when the ‘one of’ no longer needed

4 Key Program Features Senior presents at an access portal or to the regional centre Functional assessment using InterRAI-CHA Service plan centres on those IADLs that seniors cannot manage by themselves or with the social supports that they have built around them AND on respite for families so they can continue providing daily care to high needs seniors

5 Key Program Features …continued Individualized budget (not cash) for each senior that will be used to purchase IADL supports to meet these needs (up to $150 per week) Reimbursement or direct payment Senior and family choose the service source that makes the most sense for their situation (neighbours, other seniors, ethnic groups, businesses, traditional community support services) Expenditures over the full year rather than week by week Budget moves with the senior if they move

6 How Did We Get To This Point? By listening to seniors re: the “what” By bringing health care providers together with seniors to design the “how” By stealing shamelessly from the successes of others

7 First Came Seniors Asked a senior’s advocacy group that was NOT associated with the delivery of health care services to bring together a Senior’s Forum We did not influence the invitation list

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9 We Asked 2 Questions Question #1 Which principle should we follow? Unique services and programs customized to each community OR Single, shared approach that is available in all communities

10 So We …. Created one regional program that very frail seniors have access to – no matter what South Eastern Ontario urban, rural or remote community they live in

11 We Asked 2 Questions…. continued Question #2 What “kind” of service makes the most sense?

12 Supported living services The most elderly, the most frail and/or those with the most significant conditions should come first Basic needs should be taken care of first

13 Next We Considered What Works Best… continued History of 3 publicly funded programs: Veterans’ Affairs Canada – VIP program (federal) Children’s Special Needs (Ontario – Community and Social Services) Self Managed Attendant Care (Ontario Comm & Soc Services + Health)

14 Health Service Providers Were Then Invited In Health service providers joined the seniors Seniors outnumbered providers Asked the HOW questions

15 Opposing Views At first some HSPs initially regretted that Aging at Home funds in the SE were not used to directly expand their existing budgets, programs and infrastructures

16 What Seniors Said About The Experience At first they were skeptical…………………. We “expected a program to be rolled out and were prepared to dutifully clap” “Congratulations … for setting a new standard in health care planning by asking the recipients first!” And…seniors continue their involvement in the oversight of program implementation

17 Number of SMILE seniors (in first 90 days): 209 Average age: 83 Popular needs Housekeeping Meals Seasonal outdoor chores Shopping Non-traditional providers chosen 56.1% of time Self-managed – 16% Average monthly service cost/client - $255 What We Know About our SMILE Seniors