1. Picture Seniors Health Services Presentation to Health Advisory Councils October 13, 2012 Cheryl Knight, Seniors Health Primary & Community Care cheryl.knight@albertahealthservices.ca

2. 2 Overview Who are we? What do we do? What do we see for the future?

3. 3 Who are we? We are the Provincial team responsible for developing health delivery strategy for continuing care services We are one of three parts of AHS: –Strategy –Operations –Strategic Clinical Networks

4. 4 What do we do? All ages and all diagnoses Continuing care and short term care services to older individuals and those living with chronic illness requiring assistance with health care needs –At home –In community day support and health programs –In congregate living spaces –In designated supportive living spaces –In long term care facilities –In community hospice spaces

5. 5 Philosophy Leads Strategy 90% of Albertans want to live in their own homes even when their needs require continuing care health services ASH Goal - support people to remain as healthy, active, and independent as their abilities allow Key foundational element of the AHS plan for continuing care

6. 6 The Continuing Care System Touching Albertans ALBERTA POPULATION - ANY GIVEN DAY –Home Care serves almost 68,000 unique individuals –Designated Supportive Living sites house and provide hospitality and health services to ~ 8,000 people –Long Term Care Facilities house and provide hospitality and health services to ~14,500 people –Day Programs provide support to ~ 2100 people –Community Hospice Beds provide end of life care to ~200 people

7. 7 Continuing Care is About Relationships No matter where provided, continuing care is a sensitive health service – it is intimate, personal, and longer standing than most health services Continuing care is provided through relationships – between Operators, AHS, and Government at all levels between Communities and Operators between Clients and Families and Friends and Management and Staff, Physicians, Community Pharmacists, and Volunteers

8. 8 Who provides continuing care? Continuing care services are provided by AHS –Directly –Fully owned subsidiaries (Capital Care Group and Carewest) Contracted Providers –Not for profit –For profit

9. 9 What can we expect of continuing care providers? All providers are: Partner with AHS to provide safe quality health care Accountable to the same Health Services and Accommodation Standards Audited in the same manner Funded under the same funding model for the service type

10. 10 Regulations & Standards Alberta Hospitals Act Alberta Nursing Home Act Alberta Public Health Act Regional Health Authorities Act Protection of Persons in Care Act Alberta Health Services Standards Alberta Accommodation Standards for Supportive Living and Facility Living environments Alberta Infection Control Standards Building and Fire Codes

11. 11 How do you get continuing care? All continuing care clients move through a “single point of access” process – one process across the province Any one can be referred to or refer themselves to a centralized point of contact – an intake office/offices in the Zone Home care staff member calls or visits and talks to the person about the need for health services When the right service is identified, the recommendation is discussed A CASE MANAGER may be assigned to someone to help during all the transitions through the health system Common assessment instruments – examine unique individual through a common set of questions – RAI tools

12. 12 Long Term Care Facilities Supportive Living with 24/7 Professional Nursing Supportive Living with 24/7 Health Care Aide help Assistance in Home Environments Living Options and Care

13. 13 Home Care Programs Provide services in the home to maintain health and safety –Personal care –Housekeeping –In-home respite for family caregivers Working toward standardizing what you can expect to receive from home care – hours of service; 24/7 access

14. 14 Home Care Programs Innovations –Paramedics are helping people connect to home care – 2000 referrals in one year –Nurses in the emergency room specifically to help people get home again with support – 3000 referrals in one year –Mobile x-ray machine – could prevent 1,300 ER visit –Taking the position of “home first” before any other living option is considered –Increasing spaces in Day Programs and Day Hospitals to serve an additional 500 people over the next 3 years –Increasing professional resources – case mangers

15. 15 Congregate Living Settings Designated Supportive Living To provide the appropriate care opportunity to individuals who require a congregate living setting but do not require a more intense care environment Facility Based Long Term Care To provide the appropriate intensive care services within a congregate living environment

16. 16 Supportive Living and LTC Provide degrees of health support in congregate settings –Respectful of person wishes and health goals –Address unmet needs and support the person to support themselves Working toward a standard service delivery model – types of care and hours of care

17. 17 Supportive Living and LTC Innovations –Creating supportive living environments – providing choice –Improving HCA competency –Creating LPN leadership –Creating new relationships between home care and congregate settings –More than 2000 spaces added to continuing care capacity in two years – goal is 5300 spaces

18. 18 System Level Activities

19. 19 Challenges in Service Delivery Proportion of Individuals over 65 years of age in last 50 years Statistics Canada, 2012

20. 20 Challenges in Service Delivery Supporting People to Live at Home People want to live close to home if not at home Older homes may not be “safe” – Simon Fraser studies Older communities or smaller communities may have inadequate infrastructure Building a community program of universal access/safety Adequate transportation

21. 21 Challenges in Service Delivery Enough of the Right Kinds of Spaces and Staff AHS expects by March 31, 2011, we’ll have added between 1,200 and 1,300 continuing care spaces Goal – 5300 spaces by 2015 Challenges: Capacity of owner/operators to meet shifting and increased service delivery demands Construction delays and costs Staffing availability and sustaining competency

22. 22 Staffing – Enough of the Right People Challenges exist at all levels –Registered Nurses –Licensed Practical Nurses –Health Care Aides AHS has a workforce planning group Initiative on Health Care Aide recruitment in continuing care continues; will expand to acute care

23. 23 Considering Care – Decision Challenges Coming to agreement – care is required Understanding of the person’s values, expectations, capacity, autonomy Understanding the personal support system Understanding the public support system –Community –Health services –Social support Philosophy of partnership

24. 24 Experience of Care We all do our best, challenges exist Attracting staff to this level of work Scheduling care around multiple individuals’ preferences Keeping everyone safe –environments (room size, equipment needs, dogs etc) –competency (training, performance evaluation) Maintaining an equal balance of authority/power – shared responsibility Providing medical services for disease or chronic conditions within the context of home

25. 25 So let’s talk What do you want from a continuing care system? What can we tell you to increase your confidence in the system? How do we make a social shift from institution to home; from paternalistic to partner? I am interested in your thoughts