1. Long Term Care Administration Agenda Thursday, September 16, 2010 1. News Stories 2. Study of Aging 3. BC Ministry of Health 4. Coffee Break 5. History and Evolution of Long Term Care 6. Group Presentation Prep Time

2. History and Evolution of Long- Term Care Long Term Care Administration September 16, 2010

3. History and Evolution of Long Term Care

4. Gerontology is the study of aging. It is to be distinguished from geriatrics, which is the study of the diseases of the aging (medical studies). Gerontology covers the social, psychological and biological aspects of aging. Gerontology includes these and other endeavors: studying physical, mental, and social changes in people as they age. investigating the effects of our aging population on society. applying this knowledge to policies and programs. As a result of the multidisciplinary focus of gerontology, professionals from several fields call themselves "gerontologists".

5. History of Evolution of Long Term Care The term "gerontology" was introduced in 1903 by Elie Metchnikoff, a Nobel laureate and professor at the Pasteur Institute of Paris. In North America, the emergence of gerontology as a scientific movement can be traced to a small group of leaders who, in the mid-1930s, recognized that the health of the American population was undergoing a change from domination by infectious diseases to chronic diseases. The Gerontological Society of America was founded in 1945, and the International Association of Gerontology about five years later.

6. History and Evolution of Long Term Care Earliest References to the Aging Process? King Solomon Ecclesistes Chapter 12 1 Remember then thy Creator in the days of thy youth, before the evil days come, and the years draw nigh, when thou shalt say: 'I have no pleasure in them'; 2 Before the sun, and the light, and the moon, and the stars, are darkened, and the clouds return after the rain; 3 In the day when the keepers of the house shall tremble, and the strong men shall bow themselves, and the grinders cease because they are few, and those that look out shall be darkened in the windows,

7. History and Evolution of Long Term Care 4 And the doors shall be shut in the street, when the sound of the grinding is low; and one shall start up at the voice of a bird, and all the daughters of music shall be brought low; 5 Also when they shall be afraid of that which is high, and terrors shall be in the way; and the almond-tree shall blossom, and the grasshopper shall drag itself along, and the caperberry shall fail; because man goeth to his long home, and the mourners go about the streets; 6 Before the silver cord is snapped asunder, and the golden bowl is shattered, and the pitcher is broken at the fountain, and the wheel falleth shattered, into the pit;

18. BC Ministry of Health

19. Ministry of Health

21. 2006 Budget Spending

22. Ministry of Health Budget 2006 More than $100 million over three years for operating costs associated with government's commitment to add 5,000 new residential care, assisted living, and supportive housing beds with home support by December 2008. This builds on the $75 million in each of 2005/06 and 2006/07 that was provided in the September Update to strengthen and modernise the full range of health care services for seniors, including purchasing temporary residential care and assisted living beds, increasing home support hours, enhanced adult day care, falls prevention, palliative care, health promotion programs, and acquisition of specialised equipment.

23. BC Ministry of Health Our mission is to guide and enhance the province's health services to ensure British Columbians are supported in their efforts to maintain and improve their health. The Ministry of Health works together with BC’s health authorities to provide quality, appropriate and timely health services to British Columbians. The ministry sets province-wide goals, standards and performance agreements for health service delivery by the health authorities.

24. Home and Community Care Home and community care services provide a range of health care and support services for eligible residents who have acute, chronic, palliative or rehabilitative health care needs. These services are designed to complement and supplement, but not replace, the efforts of individuals to care for themselves with the assistance of family, friends and community.

25. Home and Community Care, cont… In-home services, for eligible clients, include home care nursing, rehabilitation, home support and palliative care. Community-based services include adult day programs, meal programs, as well as assisted living, residential care services and hospice care. Case management services are provided in both the home and community.

26. Home and Community Care Services support clients to remain independent and in their own homes for as long as possible; provide services at home to clients who would otherwise require admission to hospital or would stay longer in hospital; provide assisted living and residential care services to clients who can no longer be supported in their homes; and provide services that support people who are nearing the end of their life, and their families, at home or in a hospice.

27. Home and Community Care Philosophy home and community care services will promote the well-being, dignity and independence of clients; palliative care services will provide the best possible quality of life for people nearing the end of their life and their families; clients and their families should have the information required to make their own decisions about lifestyle and care; and clients have the right to make their own care decisions.

28. Community Care Services Home Support Choice in Supports for Independent Livingin Supports for Independent Living Home Care Nursing and Community Rehabilitation Adult Day Centres Caregiver Relief/Respite Assisted Living Residential Care Group Homes Family Care Homes

29. Community Care Services Home Support Home support services are designed to help clients remain independent and in their own home as long as possible. Home support provides personal assistance with daily activities, such as bathing, dressing, grooming and light household tasks that help to maintain a safe and supportive home. If home support assistance is recommended, a case manager will help the client determine the assistance that will best suit their needs and will make the necessary arrangements.

30. Community Care Services Choice in Supports for Independent Living (CSIL) Choice in Supports for Independent Living (CSIL) is an alternative for eligible home support clients. CSIL was developed to give British Columbians with daily personal care needs more flexibility in managing their home support services. CSIL is a "self-managed model of care". Clients receive funds directly for the purchase of home support services. They assume full responsibility for the management, co-ordination and financial accountability of their services, including recruiting, hiring, training, scheduling and supervising home support workers.

31. Community Care Services Choice in Supports for Independent Living (CSIL) Who is Eligible for CSIL? Eligible clients: require daily personal assistance; have the ability to direct all aspects of their care or have a client support group to do so; and have demonstrated the ability to manage care services.

32. Community Care Services Choice in Supports for Community Independent Living (CSIL) Getting Help Managing CSIL Services Seniors and people with disabilities who are unable, or not always able, to direct their own care can obtain CSIL funding through the formation of a client support group. What is a Client Support Group? A client support group consists of five people who have registered as a non- profit society for the purpose of managing support services on behalf of a CSIL client. Family members, friends, neighbours, an advocate, family physician or others may be members of the client support group. The client support group takes on all the responsibilities of an employer. CSIL funds go directly to the group to purchase home support services on behalf of their client.

33. Community Care Services Choice in Supports for Independent Living (CSIL) Payment to Family Members Home and community care recognizes that families have the primary responsibility of caring for and assisting family members. Families remain the most important source of support for clients. CSIL clients have greater flexibility in their care options and the opportunity to pay some family members as caregivers. Family members who do not live with the client, such as siblings, aunts or cousins, may be eligible. Although family members who do live with clients are not usually eligible, some exceptions may be made.

34. Community Care Services Home Care Nursing and Community Rehabilitation Home care nursing and community rehabilitation are professional services, delivered to clients in the community by registered nurses and rehabilitation therapists. Nursing care is available on a non- emergency basis for British Columbians requiring acute, chronic, palliative or rehabilitative support. Rehabilitation therapists can also provide assessment and treatment to ensure a client's home is suitably arranged for their needs and safety.

35. Community Care Services Adult Day Centres Adult day programs assist seniors and adults with disabilities to continue to live in their own homes by providing supportive group programs and activities that assist with daily activities or give clients a chance to be more involved in their community.

36. Community Care Services Adult Day Centres Activities vary with each centre. They may include: personal care services, such as bathing programs and administering medications; therapeutic recreation and social activities; caregiver respite, education and support; and in some centres, meals and transportation may also be provided or arranged.

37. Community Car Services Adult Day Centres

38. Community Care Services Adult Day Centres

43. Clients may attend an adult day program in addition to receiving other services, such as Meals-on-Wheels and home support. Many programs are connected with residential care facilities, while others operate independently.

44. Crossreach Adult Day Centre Crossreach is a non-profit society, located in Vancouver, British Columbia, that provides services to seniors. Crossreach operates an adult day centre which provides a safe setting, social interaction and other programs for seniors able to remain at home alone during the day or who would otherwise be deprived of contact with others, and also provides respite for caregivers. We are committed to supporting the independent living of seniors and improving their lifestyle, so that seniors can age in place for as long as they are able to. We are located at 3348 West Broadway, in our own building, which was specifically designed for adults. We provide a smoke-free environment in bright, spacious and wheelchair accessible premises. We have a commercial kitchen in which our professional chef prepares healthy, nutritionally-balanced snacks and meals. Our dining facility can seat up to 60 people, and can be booked for private events. Membership in Crossreach is available to anyone for an annual fee of $25. Senior members who are clients of Crossreach pay an annual fee of $10.

45. Crossreach Adult Day Centre How Clients are Selected To be eligible to participate in Crossreach as a client, you must be 65 plus live in the West Point Grey area of Vancouver (including Kitsilano, Kerrisdale, Dunbar and Point Grey) be referred to us (either by a doctor, family member or referring agency) meet with a representative of the Vancouver Coastal Health Authority, who will assess your needs and determine if our services will be of benefit be issued a long-term care number by the Health Authority, and meet with our client co-ordinators in your home Our client co-ordinator is happy to help you and your family to obtain an appointment with the appropriate referring agency.

46. Crossreach Adult Day Centre Crossreach is open for clients from Monday to Friday each week. A typical day at Crossreach includes a morning snack, exercises and music, a healthy hot lunch, crafts and games, outings to parks, and other activities designed to entertain, stimulate and engage our seniors. Crossreach is authorized to provide its services by the provincial Ministry of Health, through the Vancouver Coastal Health Authority, from which we receive funds for operations. To supplement the funds received from the Health Authority, we charge a small "daily fee" to our clients to cover part of the costs of the meals and activities. We also organize fund-raising events during the year and raise funds from donations and legacies, memberships, rentals of our premises, catering services, family dinners and partnerships with business.

47. Crossreach Adult Day Centre A Day At Crossreach 8:30 a.m. We phone you to ask if you are joining us today 9:30 - 10:00 am Handi-dart arrives to collect you (Handi-dart charges a small fee) 10:30 a.m. Arrive at Crossreach and enjoy a fresh muffin and coffee or tea 11:00 a.m. Morning Session: exercises, yoga, music therapy Noon Enjoy a fresh healthy hot lunch prepared by our chef 1:30 p.m. Afternoon activities: crafts or games, discussion groups, perhaps an outing in our 18-passenger bus to a local pub, park or Wal-Mart 3:00 p.m.Handi-dart takes you home

48. Crossreach Adult Day Centre Nutrition Program and Menu We have a commercial kitchen and a professional chef. Morning Snack - the morning snack is usually coffee or tea, along with a freshly baked muffin, scone or other delight. Noon Meal - our lunches are designed mainly for our clients who are spending the day with us. However, we welcome family and friends of our seniors. The cost of the lunch for clients is covered by the daily fee. The lunch is nutritionally balanced, and consists of soup, a hot entree and a dessert. There is always water, coffee, tea and juice. Afternoon Nutrition Break - on days when we offer afternoon activities at Crossreach, we provide afternoon coffee, tea or juice. On occasion one of our staff or clients will contribute baked goods for our afternoon break!

49. Community Care Services Caregiver Relief/Respite Many people receiving home and community care services are assisted by non-professional caregivers, often a friend or family member. Respite care can give the caregiver temporary relief from the emotional and physical demands of caring for a friend or family member. It gives caregivers the opportunity to join in community activities, while renewing their energies so they may continue to provide quality care.

50. Community Care Services Caregiver Relief/Respite Respite may take the form of a service in the client's home. Or, the client may be admitted, on a short-term basis, to a residential care facility, hospice or other community care setting. Caregivers may also take a break while the client attends an adult day centre or is receiving home support services.

51. Community Care Services Assisted Living Assisted living residences provide housing, hospitality services and personalized assistance services for adults who can live independently but require regular assistance with daily activities, usually because of age, illness or disabilities. Support services promote occupants' independence, while involving family and friends in their care. Assisted living residences combine building features and services that enable people to remain in their community as long as they are able to self-direct their own care. They maximize independence, while promoting choice, self-direction and dignity.

52. Community Care Services Assisted Living Housing Assisted living residences can range from a highrise apartment complex to a private home. Units can vary from one room to private, self-contained apartments. Residences may be located on their own or housed with other residential options, such as supportive housing (for people with lower care needs) or residential care.

53. Community Care Services Assisted Living Building History2006 Suites56 one-bedroom suites Onsite Amenities Dining room Library Computer Stations Social Lounge

54. Community Care Services Assisted Living Health Care Personal Care Services will be provided. Emergency Response24-hour emergency on-call system is provided in each suite. Mount Saint Josephs Hospital is a ten-minute drive from Clarendon Court. A pharmacy, along with medical and dental offices is located in the mall across the street.

55. Community Care Services Assisted Living Services Hospitality services consist of: meals; housekeeping; laundry; social and recreational opportunities; and a 24-hour response system. Personal assistance services may include assistance with tasks like bathing, grooming, dressing and mobility. Other specific nursing and rehabilitation tasks, such as assistance with medication, may be delegated by a health care professional to personal assistance staff.

56. Community Care Services Assisted Living Moving In Publicly-funded assisted living residences are available to seniors and people with disabilities who: are able to make informed decisions about their daily activities and personal assistance services; and are able to communicate and be understood by personal assistance staff or by a spouse living with them who can communicate with staff on their behalf; and are able to use an emergency response system and take direction in an emergency, such as a fire.

57. Community Care Services Assisted Living Moving Out A client is required to move out of assisted living if: they are no longer able to self-direct their own care; or their behavior jeopardizes their or others' safety and well-being; or they are not complying with the terms of their occupancy (or residency) agreement. If a client's care needs can no longer be met in an assisted living residence, they may be eligible to move into a residential care facility or will be helped to locate other appropriate accommodation and services.

58. Community Care Services Assisted Living Health and Safety Under the Community Care and Assisted Living Act, all assisted living residences must be registered with the assisted living Registrar. The Registrar ensures assisted living residences provide services to residents in a manner that does not jeopardize their health and safety.

59. Community Care Services Residential Care Facility Care Residential care facilities provide 24-hour professional nursing care and supervision in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes. Residential care services include: an assisted meal service; medication supervision; personal assistance with daily activities, such as bathing, dressing or grooming; and a planned program of social and recreational activities.

60. Community Care Services Residential Care

64. TYPICAL Menu Breakfast Hot or Cold Cereals Compote of Fruit Full English Breakfast with Toast and Preserves Fruit Yogurt Choice of Juices Lunch Chef’s Best Soup Prime Rib with Au Jus Baked Potatoes Broccoli Dinner Rolls Assorted Dessert Tray Choice of Beverage Dinner Chef’s Best Soup Chef’s Salad Plate with Dinner Roll Herb Roasted Chicken with O’Brien Potatoes Macaroni & Cheese Assorted Desert Tray Choice of Beverage

65. Community Care Services Typical Day Activities 10:00 am Morning Munchies 11:00 am Sit and Fit Exercise 1:00 pm Baking Memories 2:00 pm Name that Tune 3:00 pm Kitchen Kaboodle 4:00 pm Game Room 7:00 pm Fireside Chat

66. Community Care Services Residential Care Moving to a Care Facility British Columbia's residential access policy ensures seniors and people with disabilities with the highest need and urgency have priority for the first available, appropriate care facility bed. Clients who have been assessed as needing facility care are expected to take the first room that becomes available. Once in residential care, clients may request a transfer to a preferred care facility when there is an opening. It is wise to plan ahead for a move to residential care. Clients are encouraged to ask their family and friends to help them prepare for their move. When a room does become available, they will be asked to move in fairly quickly - usually within 48 hours.

67. Community Care Services Residential Care What Clients Should Know Before They Move Moving to a residential care facility may not be easy, especially for seniors or people with disabilities who are moving from their own home. Taking the time to learn about the services that are offered in the facility, the costs and policies will ease the transition and make the move less stressful. Here are some questions clients may want to ask their case manager before they move: Can they take their own furniture into the care facility? What are the visiting times? What are the facilities' practices regarding belongings, pets and mail? What kind of clothing should they bring? Can outings and overnight stays be arranged?

68. Community Care Services Group Homes Group homes are private residences that enable adults with disabilities to live as independently as possible in the community. They offer an important service to residents because they provide short- and long-term living arrangements, affordable and safe housing, skills training, peer support and counselling. Many British Columbia communities have group homes, which are generally operated by non-profit societies. Homes range from single family dwellings to apartment complexes and usually accommodate four to six residents.

69. Community Care Services Family Care Homes Family care homes are single family residences that provide supportive accommodation for up to two clients. Family care homes can be an alternative to a care facility for some individuals. What are They Like? Family care homes offer a home-like atmosphere, nutritious meals and housekeeping services, along with any required assistance with daily living activities, such as bathing, grooming and dressing. Although family care homes are available throughout the province, they are more numerous in rural areas where their availability allows clients to remain in their own communities.

70. Community Care Services Family Care Homes Who Uses Family Care Homes? Family care homes are for seniors and people with disabilities who: require a more individualized approach to their care than is available in a residential care facility; or have an immediate need for residential care and are unable to find other suitable alternatives; or find the care environment at a residential care facility is not compatible with their religious, ethnic or cultural background or lifestyle; or need short-term assistance upon leaving hospital but are not ready to return to living in their own home.

71. Community Care Services Family Care Homes

72. Community Care Services Family Group Homes FolkStone Family Care Home Locations “At a FolkStone Home everyone knows your name...you become part of the family." FolkStone Homes provide a safe atmosphere where the quality of life and the desire for independence are balanced with the needed assistance. Burnaby Coquitlam Delta Ladner Langley Maple Ridge New Westminister North Vancouver Port Moody Richmond Surrey Vancouver White Rock

73. Home and Community Care Case Management and Care Co-ordination Case managers act as co-ordinators to help clients obtain home and community care services. They determine the nature, intensity and duration of services that would best meet clients' needs and arrange their services. The case manager will stay in touch with the client to arrange care services and make any adjustments necessary in the event their care needs change.

74. History and Evolution of Long Term Care Continuum of Care “The coordination or management of care within the myriad components of the health care system to ensure the provision of the right services, in the right place, at the right time.”

75. History and Evolution of Long Term Care Case Management “Case Managers act as coordinators of care and advocates to help ensure that the care plan proceeds smoothly and the elderly person’s care needs are properly met in a timely way.”

76. History and Evolution of Long Term Care Three Phases in the Development of Long Term Care Services First Phase Social Disinterest Family and Charitable Assistance From Colonialism to 1960s

77. History and Evolution of Long Term Care Elizabethan Poor Law of 1601 Required local parishes in England to provide for persons who could not support themselves because of age, poverty and infirmity. Public taxes funded the Almshouses. Elderly, Sick or Disabled

78. History and Evolution of Long Term Care 1866 Legislation passed in Ontario municipalities to set up houses of industry for: Poor persons who could not support themselves. Persons who can look after themselves. Persons who did not make an honest living. Persons who spend time and money in public houses, to the neglect of any lawful cause. Persons of low IQ below 20.

79. History and Evolution of Long Term Care

81. History of Evolution of Long Term Care Three Phases in the Development of Long Term Care Services Second Phase Benevolent Paternalism Institutional and Professional Focus/Control over decision making Protect life and improve quality of life by various means From the 1960s and tapering off into the current period

82. History and Evolution of Long Term Care Saskatchewan Premier Tommy Douglas implemented North America’s first universal hospital insurance plan in 1947.

83. History and Evolution of Long Term Care National Health Care Funding 1948 National Health Grants, construction of hospitals. 1957 Hospital Insurance and Diagnostic Services Act, 60% of hospital services funded by federal government. 1966 Medical Care Act, 50% medical care expenses funded by federal government.

84. History and Evolution of Long Term Care Three Phases in the Development of Long Term Care Services Third Phase Dependent adult treated as an adult rather than a child Uncertainty over degree of implementation of this phase From recent to past to the current period

85. History and Evolution of Long Term Care The Canada Health Act 1984 (Medicare) Public Administration Comprehensiveness Universality Portability Accessibility

86. History and Evolution of Long Term Care Established Programs Financing (EPF) Act Injection of federal cash for long term care services in 1977. Residential care facilities: public, proprietary and charitable, nursing homes, homes for the aged, personal care homes. Increase of long term care beds in hospitals.

87. History and Evolution of Long Term Care Regionalization (1980s – 1990s) Cost Containment Improved health outcomes Increased flexibility and responsiveness of care Better integration and coordination of services

88. History and Evolution of Long Term Care Closer to Home – Seaton Report, BC Royal Commission on Health Care and Costs Examine the structure, organization, management and mandate of the current health care system to ensure continued high quality, access and affordability.