Overview of Elder Care and Long Term Care Issues Date: September, 2013 Presentation to: GNAO By: Sheila Bauer, Administrator Peter D. Clark LTC Centre

Agenda Global context Ministry of Health and Long Term Care Directions Champlain Local Health Integration Network Strategic Directions Elders -- who are we talking about? Data, profiles Where is care provided – what is LTC like? What are the challenges and opportunities? What we have learned? Where are we going?

Why Population Aging Matters “We are aging—not just as individuals or communities but as a world. In 2006, almost 500 million people worldwide were 65 and older. By 2030, that total is projected to increase to 1 billion—1 in every 8 of the earth’s inhabitants. Significantly, the most rapid increases in the 65- and-older population are occurring in developing countries, which will see a jump of 140 percent by 2030”. (National Institute on Aging, 2007)

Global context Population trends An aging population Increasing life expectancy Rising number of the oldest old Growing burden of non-communicable diseases (people are living longer with chronic diseases such as diabetes, cardiovascular disease, arthritis, cerebral vascular accident, Parkinson's disease, cancer, mental health illness, Alzheimer's and other related dementias)

Global context continued Aging and population decline Changing family structure Shifting patterns of work and retirement Evolving social insurance systems Emerging economic trends Why Population Matters: A Global Perspective, National Institute on Aging U.S. Dept. Of State 2007

Global Perspective

Worldwide Share of Deaths, by Cause

Chronic Disease Healthy aging can delay and minimize the severity of chronic diseases and disabilities in later life, thus saving health care costs and reducing long-term care needs (Laditka, 2001). Chronic diseases account for an enormous human and economic burden in Canada. The prevalence increases with age and is highest among older people in vulnerable communities (e.g., Aboriginal and economically disadvantaged groups) (Public Health Agency of Canada (PHAC), 2005a).

Canadian Context 2011 Census data: People over the age of 65 surged to over 5 million between growing 14.1% Note this is more than double the 5.9% increase of the population as a whole People aged grew 29.1% between median age in Canada 40.6 years (oldest ever); it was 39.5 in 2006 and 33.5 years 1991 (20 years ago). Dr. Sinha said 14.6% of Ontarians are 65 and older, yet account for nearly half of all health and social care spending

Alzheimer’s Disease Alzheimer Society of Canada – 2012 the number of Canadians living with cognitive impairment, including dementia, 747,000 and projected to double to 1.4 million by So what? The combined direct (medical) and indirect (lost earnings)- cost of dementia total is $33 billion per year. By $293 billion annually

Alzheimer’s Continued Pressures on families – 2011, families spent $444 million unpaid hours per year. In 2040 – devoting 1.2 billion unpaid hours per year. A quarter of all family caregivers are seniors themselves (1/3 older than 75 creating a situation where we have the elderly caring for each other)

Funding Allocation by Sector ( ) Base Allocation Note in millions 20 Hospitals $1,700, % 61 LTC Homes $310,439 (13%) 1 CCAC $189, % 36 CMH $64, % 11 CHC (including satellites) $52, % 83 CSS $50, %

Provincial Action Plan Priorities and LHIN System Imperatives

Champlain LHIN Priorities Strategies for an integrated system Build a strong foundation of integrated primary, home and community care Improve coordination and transitions of care Increase coordination and integration of services among hospitals. Not population based, where do seniors fit?

MoHLTC Priorities Ontario’s Action Plan for Health Care Keeping Ontario Healthy Faster access to Stronger Family Health Care Right care, right place, right time KOH – diabetes, obesity, mental health FA – Healthcare Connects RCRPRT – CHC, CCAC Focus on seniors, not direct policy

Who are we talking about in LTC? Demographics: average age, range of ages in LTC, gender, culture, languages, co-morbidities Resident assessment instrument (RAI)- Minimum Data Set (MDS) scales CPS, ABS, CHESS, CMI trends Creates a picture of increased complexity partnered, increased care needs and specialization

Data How long does someone wait? Is that too long? Why? Median number of days to long-term care home placement Provincial median for January-March 2011: 113 days Provincial median for January-March 2010: 112 days Waitlists -- too long for some, yet others are not ready

PDC – Age Ranges

Length of Stay

Case Mix Index

Aggressive Behaviour Scale (ABS)

Depression Rating Scale (DRS)

What do people want/need? Stay in their own home Is there a price point? At any cost? Continuum of care and housing needs Affordable assisted living Instrumental activities of daily living (IADL) support ADL support 24 hour supervision required in many cases

What is LTC like Funding model profit and for-profit homes Legislation - programs Much care is provided by PSWs 24 RN on-site Recreation and leisure – programming (stratification of ages, different degrees of capacity, different interests) Specialized units (few)

What is long term care like? Legislation = individualized care Staffing requires routines – need to find a balance Elderly requires patience, time, expediency, respect, CARING throughout ADLs Nursing rehabilitation program Education and knowledge transfer Expertise – access

What do we mean by care of the elderly in LTC? Is it different than care of anyone at any age? Yes and no Values are the same Application is different, elderly people are different Significant deterioration can occur and hard to recover Changes in senses, changes in muscle mass, changes in bone mass, changes in hormone levels Medically complex, frail seniors Rehabilitation, medicine, psychiatry

What do we mean by care of the elderly in LTC? Primary reason why LTC is considered – dementia and/or incontinence Complex treatment plans Urinary tract infections Pressure ulcers Falls Restraints (physical and chemical) Responsive behaviours

What do we mean by care of the elderly in LTC? Bladder and bowl management Skin and wound management Peripherally inserted central catheters (PICC) Feeding tubes and pumps Pain pumps Assistive devices Ambulation devices

What do we mean by care of the elderly in LTC? Infection prevention and management Memory challenges Plethora of co-morbidities and associated care requirements Extremely complex care in specific cases

Challenges Funding (flexibilities and physio changes) Staffing ratios Programs Human resource challenges Retention and Recruitment Education, knowledge transfer Fear Salaries

Challenges continued Prescriptive legislation Image – complaints, action lines, annual inspections, critical incidents, media, health partners Resident profiles Family expectations (LTC fees) Health partner expectations Ministry expectations Primary care coverage with consultants prn Accountabilities

LTC Opportunities To make a difference To share our expertise To collaborate with health care partners To re-vitalize its image To be an important part of the continuum of care Supportive environments Self-care in choices and actions To be a choice

What we have learned Staffing levels Education and knowledge transfer People providing most of the direct care have minimal education Very few challenges are unique to long term care but LTC is treated differently and challenges are exacerbated Care is complicated Service delivery model Important, necessary part of the health care system

Where are we going? Advocacy Specialized units (younger adults) Incidence trending Profiles Increase in prevalence of residents with responsive behaviours Community presence Care of the elderly +

The Challenge The evidence compels us to build on existing opportunities, to put in place interventions that are known to be effective, and to show leadership by supporting innovative approaches. Experience provides us with some models and successful interventions that can be replicated in different settings. Opportunities to build on existing strategies in aging and healthy living that are already underway in most provincial/territorial, federal and local jurisdictions....sometimes we want to do it our way

Ending Comment Seniors make a significant contribution to the richness of Canadian life and to the economy. Older people provide a wealth of experience, knowledge, continuity, support and love to younger generations. The unpaid work of seniors makes a major contribution to their families and communities. Some 69 percent of older Canadians provide one or more types of assistance to spouses, children, grandchildren, friends and neighbours (National Advisory Council on Aging (NACA), 2001).

Ending Comment Can we agree that it is time for a new vision on healthy aging — a vision that: Values and supports the contributions of older people; Celebrates diversity, refutes ageism and reduces inequities: and Provides age-friendly environments and opportunities for older Canadians to make healthy choices, which will enhance their independence and quality of life.....regardless of whether you live in your own home or LTC?

The clock is ticking……… 38