1. Transforming Innovations Into Quality Home Care Experiences BC Care Providers Conference Panel Discussion Transforming Innovations Into Quality Home Care Experiences May 25, 2015

2. Role of innovation 2 independence in tasks of daily living cognition and memory education and employment computer access communication and social interaction therapy, exercise and recreation mobility Well Being/Quality of Life

3. Settings for innovation 3 @Home @hospital @ Residential Care To promote: Quality of life Prolong Functioning at Home Alternative methods of care Capacity of caregiver Greater options for service providers To promote: Rapid Assessment Rapid Stabilisation Rapid transfer Alternative methods of care To promote: Quality of Life Alternative methods of care Enhanced Capacity Enhanced Safety Progression of Need Health systems world-wide - including BC’s - face extraordinary challenges that require rethinking the models under which the systems are delivered. This includes exploring targeted innovative practices and strategies as well as the need to adopt innovative tools to help maximize system resources and improve patient outcomes

4. Benefits of Technology 4 Benefit to Person, Family and Caregivers Benefit to SystemBenefit to Service Providers Increased choice, safety, independence and sense of control Improved quality of life Maintenance of ability to remain at home Reduced burden placed on caregivers Improved support for people with long-term health conditions Enhancing mental health resilience and protective factors Potential to arrest progression of diabetes/dementia More timely, cost effective intervention reduced acute hospital admissions more timely acute hospital discharge planning Delay in need for residential and nursing home care Improved ability to redistribute spending on services Re-purpose of nursing resources Consistent scheduling Real time monitoring of health status Reduced travel requirements Greater networking capacity between Nurse, Physician and Patient and Carer. Alternative options to more costly and intrusive interventions – e.g. physical, pharmaceutical and environmental constraints, remote tracking devices etc.. Targeted innovative technologies benefit the person, family, system and service providers:

5. CanAssist’s Innovative practices Mandate: To improve the independence and quality of life of people of all ages and representing the full spectrum of disabilities by developing innovative, customized technologies where there are gaps in existing services. 5

6. Phone-in Monitoring System allows caregiver to leave home and remotely check on client’s activity a few sensors placed in home monitor activity uses existing phone line (no internet access required) requires no special equipment or subscriptions caregiver calls to receive automated information reduces caregiver burnout and increases client’s ability to stay home longer 6

7. designed to discourage wandering at night small screen mounted in bedroom reinforces when it is night time screen on door to outside turns on when approached (motion detector) uses personalized text or video messages to redirect individual 7 Wandering Deterrent System

8. My Things App helps people with dementia explore personally meaningful music and photos entertains, sparks memories, encourages conversation, reduces resistance to care designed for those in care facility

9. Lift for Manual Wheelchair customized lift for easily transporting chair into vehicle improvements made to existing commercial products improves safety for older spouse and other caregivers

10. Simplified DVD Player enables clients to control DVDs easily and independently system can store a large DVD collection electronically controlled by a large single button (in this example, mounted the inside bed, allowing client to skip between videos) additional videos can easily be added to the collection simply by inserting a DVD 10

11. Categories of adapted technologies for adults Simple environmental controls Easy-to-use household tools and devices Simple memory aids Easy-to-use phones Apps for scheduling and completing tasks Home safety devices 11

12. Remote Monitoring, Patient Coaching and Virtual Care Innovation for a Healthier Tomorrow Improving Outcomes and Reducing Costs

13. Leverage technology to capture vitals and health information while connecting with patients when care workers are not there Using wireless technology to connect patients living with chronic disease(s) to a Registered Nurse who monitors their vital signs remotely Provides assessment of vital signs, information about managing their chronic condition, medication compliance and adjustments to their care plan Service is operated from We Care's Monitoring Centre in- house Monitoring Centre

14. Provides remote monitoring of vital signs (one nurse, approx. 100 clients) Family physician provides target range for vital signs We Care’s eHealth RN monitors results daily: Vital Signs Measured: Features: Check-In, Surveys & Patient Reminders Video Conferencing Supporting Virtual Visits Telehealth Dashboard for Staff Supporting 200+ Bluetooth Connected Wellness & Medical Devices Schedule Visibility & Requests Configurable Monitoring Flow Blood Pressure PulseBlood Glucose WeightPulse Oxygen Mood

15. Client We Care Nurse Family physician Referral Family caregiver ADDED FEATURE: PATIENT AND FAMILY PORTAL Patient, Family and Care Giver Access Leads to Improved Outcomes While enhancing a Patient-Centered approach Care Team Profiles and information Progress Reports Visibility to Care Plan Education content Health and Wellness Video Conferencing and Chat Navigational Support We Care Nurse ambassador for communication across the health team: Intake/discharge reports to family physician Communication on client progress to referral Support and health updates to family caregiver Scheduled coaching with client, ongoing support and health updates

16.  Current Algorithms are predicting 72% of adverse effect (re-admissions, ER visits, fall)  50% fewer false positives than alerts based on simple vital sign thresholds

17. # falls # of clients w/hospital admission # of times admitted Length of stay (days) Cost of stay Pre Re-Act52425.5208.5$110,794 On program476.542.5$22,482 % Difference-20%-71%-75%-80% Represents $289,015 in savings across 106 clients *Based on costs of $138 per ER visit and $532 per nightly medical hospital bed **Data captured from 33 intake questionnaires and on program questionnaires from a subset of randomly selected clients serviced in 2013 and 2014 (raw data in supplemental excel)

18.  For 100 clients NOT on THE SYSTEM:  would require weekly nursing visit (approx. $65/visit) and 2 medication reminders a day (approx. $27 a visit).  The annual cost of delivery service exceeds $2 million  Our current servicing costs including equipment represents a fraction of this cost  Better use of a Professional Caregivers time could be spent with high need patients and help reduce wait times and hospital to home waitlists

19. Pre- ReactOn ProgramComparison Experienced Visit to Hospital Experienced a Fall Experienced Visit to Hospital Experienced a Fall Change in Visits Change in Falls Clients with 2 chronic conditions 8231-63%-50% Clients with 3+ chronic conditions 16343-75%0% n=33 Correlation between number of chronic conditions and incidence of events Dramatic decrease in hospital visits across both groups after being on the program

20. *Based on 21 of previous 33 surveyed clients (could not interview remaining due to death, no response, other) **Some increase in client events expected subsequent to discharge off program and end of nurse monitoring *** 2 post Re-Act hospital visits due to pneumonia not necessarily linked to chronic condition

21. Understanding medication, taking on timeSTDEV Confident and knowledgeable in managing my diseaseSTDEV Vital Signs: Knowledge of normal rangeSTDEV Knowledge of community resourcesSTDEV Pre Re-Act 8.52.56.82.17.22.36.92.3 On program 9.31.09.31.48.21.58.41.5 % Difference 10.2% 37.2% 14.3% 22.3%  n=33  Increase in confidence and understanding across all goal categories while on the program  Greatest increase seen in disease management  STDEV decreased across responses

22. The future of home care will be 24/7 access to a registered nurse on demand Patient-facing tablet application  used directly by the patient (RPM-style deployment)  used by a PSW while with a patient (Virtual Visit-style deployment or in a delegated authority/task model)  Family Caregiver support on demand  Patient support on demand  Video conferencing capability  Machine learning algorithms computing probability of negative events

23. Family Portal Access to certain aspects of their patient information can be exposed to their family, loved ones, or extended care teams. Patient Record The secure patient record allows a care worker to access important information about a patient. The information displayed is configurable and can be easily extended. TeleHealth Portal The TeleHealth portal features a set of functionally targeted at helping a care worker in a TeleHealth call centre manage the care for scores of patients. It can also be used by nurses in a call centre to conduct virtual visits with a PSW on-site with the patient

24. BC Care Providers Association Annual Conference 2015 Epsilon™ Powered Innovation in Home Care Technology

25. Bayshore’s Epsilon™ platform Technology and process ecosystem working seamlessly to provide personalized, borderless care 1.Point of care data collection 2.Point of care decision support 3.Real-time data sharing and collaboration 4.Better care. Lower cost.

27. Bayshore’s Epsilon™ platform

28. Epsilon™ Core Services Advanced collection of critical data at the point of care Evidence-based, best practice guidelines to get the best possible outcome for clients In-home remote monitoring devices and self-care

29. Epsilon™ Core Services Critical information – available to those that need it – quickly and reliably Advanced Virtual Clinic –Virtual Care Room –Virtual Waiting Room –Adhoc virtual visits –Online questionnaires –Wellness Education

30. Epsilon™ Core Services Automated provider reporting –System to system integration to deliver critical data as soon as it is created Curated information portals –Customized, relevant content and analysis –Access, continuity of care, outcomes, client satisfaction … all information available 24x7

31. Epsilon™ Core Services Driving efficiency in operations – to enable technology investments Integrated referral management system –Easy to connect –Quick referral acceptance Advanced employee tools to allow self-management and schedule coordination