Residential Hospice Cost-Effective, Community-Based Solutions To the Right Care, at the Right Time, by the Right Providers

Purpose Hospice Can Help! Free up acute care hospital beds and reduce wait times Enable more healthcare $$$ to be used for acute care services Provide timely access to quality, comprehensive HPC services

DEATH – Today’s Reality 80% die of a chronic illness (palliative diagnosis) 80% die of a chronic illness (palliative diagnosis) 20% die an acute death 20% die an acute death In Greater Saint John: 1,000 deaths / year 800 are palliative In Region 2: 1,500 deaths / year 1,000 are palliative

Death – Reality in 20 years 25% of NB population >65 years old 25% of NB population >65 years old Seniors account for 75% of annual deaths Seniors account for 75% of annual deaths Number of deaths/year will double Number of deaths/year will double Projections for Greater Saint John: Projections for Greater Saint John: 2000 deaths/year 1600 palliative deaths 1600 palliative deaths 400 acute deaths 400 acute deaths

Where do People Die? Most want to die at home – breakdown in last weeks/months of life Most want to die at home – breakdown in last weeks/months of life Most in fact die in institutions – 90% Most in fact die in institutions – 90% (75% die in hospital, 15% in NH ) Saint John Regional Hospital Saint John Regional Hospital PCU annual palliative deaths: ~ 200 PCU annual palliative deaths: ~ 200 “ Other beds ” annual palliative deaths: ~ 200 “ Other beds ” annual palliative deaths: ~ % of the area ’ s identified annual palliative deaths occur in one Hospital 50% of the area ’ s identified annual palliative deaths occur in one Hospital

Palliative Patients in Acute Care Beds – Outside of the PCU Inappropriate level of care Inappropriate level of care Expensive Expensive Affects access to acute care beds Affects access to acute care beds Not as holistic as the care offered in a Hospice setting Not as holistic as the care offered in a Hospice setting

CHPCA Norms of Practice Hospice Palliative Care is a set of services offered in four settings: Hospice Palliative Care is a set of services offered in four settings: Home Home Hospital Hospital Nursing Homes Nursing Homes RESIDENTIAL HOSPICES RESIDENTIAL HOSPICES

Residential Hospice Frees Up Actue Care Beds ALOS for palliative patient in acute care bed is 22 days in comparison to 5-10 days for acute care patients ALOS for palliative patient in acute care bed is 22 days in comparison to 5-10 days for acute care patients Using the same bed for acute care services will reduce wait times for elective surgery and admissions from the ER

Residential Hospice Allows More Healthcare Dollars to be Used for Acute Care Services Cost of Residential Hospice is $300/day. Cost of Residential Hospice is $300/day. Cost of Acute Care Hospital Beds is $800 - $1,000 per day. Cost of Acute Care Hospital Beds is $800 - $1,000 per day. Residential Hospice is cost-effective care. Residential Hospice is cost-effective care.

Residential Hospice Provides timely access to comprehensive hospice palliative care services Right care at the right time by the right providers Right care at the right time by the right providers Setting of Choice - non-institutional care Setting of Choice - non-institutional care

Government Priorities 1. Access 2. Wait times – “NB Wait Times Worst” – Telegraph Journal, Wed. Oct. 25/06 3. Cost containment 4. Sustainability Residential Hospice is part of the solution! Residential Hospice is part of the solution!

Win-Win-Win-Win-Win Government - Right Care (Access), Right Time (Wait Times), Right Providers (Sustainability and Cost Containment) Government - Right Care (Access), Right Time (Wait Times), Right Providers (Sustainability and Cost Containment) Hospital – Increased access to acute care beds Hospital – Increased access to acute care beds Patients – Setting of Choice (non-institutional) Patients – Setting of Choice (non-institutional) Families - Support when needed Families - Support when needed Hospice – Deliver on our Mission & Vision Hospice – Deliver on our Mission & Vision

Residential Hospice Care in a Home-Like Environment Small, not institutional – 6-10 beds Small, not institutional – 6-10 beds Privacy ensured Privacy ensured 24 hour access for family members 24 hour access for family members Atmosphere supportive, preserves dignity, neither hastens nor postpones death, encourages communication, fosters hope Atmosphere supportive, preserves dignity, neither hastens nor postpones death, encourages communication, fosters hope Ontario Residential Hospice Standards Ontario Residential Hospice Standards

For people who do not require the expensive and highly medical/technical care in an acute care hospital. For people who do not require the expensive and highly medical/technical care in an acute care hospital. Because typical wait times for admission to continuing care (NH or SCH) from acute care can be months – longer than most palliative pts will live Because typical wait times for admission to continuing care (NH or SCH) from acute care can be months – longer than most palliative pts will live Because people often require 24-hour medical care in a safe environment in the last month of life and families need to be loved ones, not caregivers Because people often require 24-hour medical care in a safe environment in the last month of life and families need to be loved ones, not caregivers Residential Hospice Compassionate, Cost- Effective Quality Care

Carpenter House – Burlington, Ontario Established May

Vernon Hospice, Vernon, British Columbia

Residential Hospice Capital Costs Ontario Hospice Association $1 million to $1.3 for a 7,000 square foot 10-bed residence $1 million to $1.3 for a 7,000 square foot 10-bed residence Based on average costs of $140 per square foot and includes all soft costs (levies, site study and legal costs), furniture, fixtures and equipment, architect fees and project management costs) Based on average costs of $140 per square foot and includes all soft costs (levies, site study and legal costs), furniture, fixtures and equipment, architect fees and project management costs)

Residential Hospice Annual Operations - $800, FTE Medical Director 0.20 FTE Medical Director 1 FTE Nurse Coordinator 1 FTE Nurse Coordinator 1 FTE Administration Coordinator 1 FTE Administration Coordinator RN’s, LPN’s, PSW’s RN’s, LPN’s, PSW’s 1 FTE Housekeeper/Maintenance 1 FTE Housekeeper/Maintenance 0.50 FTE Cook 0.50 FTE Cook Utilities, Repairs, Taxes, Fees, Telecomm. Utilities, Repairs, Taxes, Fees, Telecomm. Supplies, Food Supplies, Food

Nursing Care:1 Nurse Manager Day Shift1 RN 1 LPN 1 PSW Evening Shift1 RN 1 LPN Night Shift1 RN 1 PSW Nursing Coverage

People admitted under the care of their family physician – responsible for 24-hour medical coverage People admitted under the care of their family physician – responsible for 24-hour medical coverage FP has access to 0.20 FTE Hospice Medical Director (hired and paid by Hospice) for consultation, support and overseeing care FP has access to 0.20 FTE Hospice Medical Director (hired and paid by Hospice) for consultation, support and overseeing care Physician Coverage

Ontario Government - October 2005 Commitment to $$$ 30 Residential Hospices Commitment to $$$ 30 Residential Hospices Funding based on 10-bed model Funding based on 10-bed model $580,000 annually for nursing & personal support services $580,000 annually for nursing & personal support services Investment is delivering on their healthcare priorities – health, reduced wait times, increased access Investment is delivering on their healthcare priorities – health, reduced wait times, increased access

Hospice and NB Government Cost Share Proposal Government funds 70% ($200/day) = $580,000/year in funding Government funds 70% ($200/day) = $580,000/year in funding Hospice funds 30% ($100/day) = $220,000/year through fundraising, donations Hospice funds 30% ($100/day) = $220,000/year through fundraising, donations

Hospice of Greater Saint John, Inc. Independent, non-profit community charity established in 1983 Independent, non-profit community charity established in 1983 Governed by 16-member Board of Directors Governed by 16-member Board of Directors 170 Volunteers 170 Volunteers 3 FTE Staff 3 FTE Staff Annual Budget $270, % funded by donations, fundraising Annual Budget $270, % funded by donations, fundraising Member of the HPC Team, working in collaboration with medical services (2002 Norms) Member of the HPC Team, working in collaboration with medical services (2002 Norms) Provide comprehensive non-medical support services to over 600 people annually Provide comprehensive non-medical support services to over 600 people annually

Our Track Record Largest, most well developed community Hospice organization in NB and Atlantic Canada Largest, most well developed community Hospice organization in NB and Atlantic Canada Member of Health Canada’s National HPC Strategy for 5 years Member of Health Canada’s National HPC Strategy for 5 years Winner of Canadian Donner Services to Seniors Award for non-profit excellence in 2004 and 2005 – Finalist for 2006 Winner of Canadian Donner Services to Seniors Award for non-profit excellence in 2004 and 2005 – Finalist for 2006 Co-Founders of AHSC’s new HPC Outreach Program Co-Founders of AHSC’s new HPC Outreach Program Established Hospice services in Sussex area – giving Region 2 full Hospice services Established Hospice services in Sussex area – giving Region 2 full Hospice services Established First Hospice House in Atlantic Canada Established First Hospice House in Atlantic Canada

Why a Hospice House? Establish a community identity Establish a community identity Space for program expansion Space for program expansion Space to permit us to pursue a Residential Hospice Space to permit us to pursue a Residential Hospice

August 22, 2006 – “Ottawa to Address Wait Times” – Telegraph Journal Federal Health Minister, Hon. Tony Clement announces new money for innovative pilot projects in Atlantic Canada that address wait times Federal Health Minister, Hon. Tony Clement announces new money for innovative pilot projects in Atlantic Canada that address wait times Our Residential Hospice Plan can be that innovative pilot project for NB Our Residential Hospice Plan can be that innovative pilot project for NB

Making it Happen Five years, seven site visits Research done, business case complete 1. Present the Residential Hospice Plan to Federal Health Minister for full funding in the amount of $800,000 for a two-year pilot project and secure $300,000 in seed funding to ready for operations 2. Provide capital funding in the amount of $800,000 for space renovations 3. Agree to a 70/30 cost-share funding arrangement post the successful evaluation of the pilot project

The Standard of Care We Create in our Communities Will Be The Standard of Care We Receive