1. Physician Assistants a Valuable Solution for Long-Term Care May 31, 2016 Chris Rhule, President, Canadian Association of Physician Assistants

2. Long-Term Care Seniors are entering long-term care homes (LTCH) when they are older, frailer, and in need of more medical and personal care than ever before The percentage of long-term care facilities with 100% of residents requiring Type III care or higher increased from 4% to 38% The mean annual mortality rate of residents went from 11% to 17% In BC, the number of people aged 65+ is estimated to grow from 730,500 in 2012 to 1,419,900 by 2036 With an average of 2.7 hours per resident per day (hprd), staffing levels in BC long-term care facilities are far below the minimum 4.1 hprd recommended by experts and researchers In BC approximately 1% of physicians specialize in geriatric medicine compared to 4.2 % in pediatrics. This discrepancy is alarming considering that BC seniors outnumber children in the province

3. Investment in LTC There is a strong case for more investment in long-term care (LTC) homes According to BC’s Ombudsperson, it can cost taxpayers up to 15% less to fund a care bed in LTC facilities compared to identical beds operated by regional health authorities If only 1000 more expensive care beds run by the health authorities were operated by LTC homes, it would save the health budget over $50M in the next 5 years – and not compromise the quality of care If additional staffing resources were allocated to LTC homes more seniors would be able to live in comfort and receive the care they need reducing the amount of hospital transfers and saving the government money

4. LTC The average compensation for physicians in Canada is $307, 482. At an average of $80, 000 for a PA per year this is more than three times the cost for the same services that could be provided by a PA onsite Our seniors need long-term care homes that are ready and capable of meeting their ever-increasing, complex health care needs and able to provide safe quality care when they expect and require it most It is important that LTC homes have the resources to treat patients with complex conditions that require medical, nursing and other expertise

5. PAs Can Help! Having a full-time PA in LTC homes can help improve the level of care to residents by: Increasing access to care and the level of service for patients Managing episodic or deteriorating health status in the LTC homes rather than in the hospital emergency department Providing services onsite such as intravenous therapy, wound care, post- operative care and other procedures traditionally requiring a trip to hospital Play an active role in preventative medicine and counselling

6. Scope of Practice Working in collaboration with physicians, PAs are trained to: Conduct medical histories and perform comprehensive physical examinations Complete admission and discharge procedures for hospital stays Preventative health counseling Prescribe medication in accordance with Medical Directives and provincial legislation Perform and interpret common laboratory, radiological, ECG, and other routine diagnostic procedures Order and interpret laboratory tests, X-ray, and other diagnostic investigations Assist the physician in developing and implementing a patient management plan Record progress notes in isolated and in-patient care settings Surgical Assists

7. Canadian Landscape 500 PAs practicing across Canada 4 CMA accredited PA programs 80 graduating students per year PAs practicing in MB, ON, NB and AB CAPA currently has over 700 members Strong public and physician support for the profession from the Royal College of Physicians and Surgeons, CMA, Doctors BC and the College of Physicians and Surgeons of BC

8. Role in the Healthcare System  PAs are capable of providing many of the same procedures and services as their supervising physicians  In primary care settings PAs are used for 75% of all visits without referral to physician level care  Further PAs manage up to 62% of all patients in emergency care environments  95% of Ontario physicians working with PAs said that the PA had increased their own efficiency in providing care

9. Impact on Seniors Care  Studies have found that the 30-day re-admission rate was reduced by 25% in patients receiving visits from PAs as part of a home care program  PAs in long-term care settings have been shown to decrease the hospital admission rates by 38% for seniors  Among those Canadians that have received care, more than nine in ten were satisfied and in BC specifically, 73% of participants support a greater role for PAs

10. Case Study Trillium Centre Care Community, Kingston, ON The PA has improved patient care and reduced hospital emergency admissions substantially With the addition of a PA to the team the emergency room admission rate was as low as 0% in 2014 compared to the provincial average published by CIHI of 13.0% The PA at Trillium has contributed to the team by performing: – Urgent medical and day to day assessments – Admissions – Annual physicals – Orders and interprets lab and imaging orders – Attends emergencies and is available on call – Works with specialists, mental health nurses and case managers to manage mental health concerns – Consults with patients and their families on disease prevention and health promotion activities – Minor procedures such as suturing and biopsies

11. Case Study Leacock Care Centre, Bob Rumball Home, Victoria Village, Muskoka Landing, Northern Ontario The introduction of a PA improved: Residents’ access to timely medical care Communication among families and the healthcare team Reduced transfers to ED - – Admission and annual physical examinations – Urgent medical assessments – Orders and interprets laboratory and imaging investigations – Performs minor procedures such as suturing, incision and drainage, wound packing and debridement and dressings

12. Case Study Deer Lodge Centre, Winnipeg, MB The introduction of a PA has contributed to: Earlier treatment of infectious processes Better patient outcomes Reduction in transfers to ED Better communication with family members – Provide a liaison between the primary care provider and nursing staff – Assessments and decision making – Physicals, joint injections, suturing of lacerations and skin biopsies – Medication reconciliation and quarterly medication reviews – Orders and interprets laboratory and imaging investigations – Provide referrals

13. Case Study St. Lawrence Medical Clinic, Cornwall, ON The introduction of a PA has contributed to: Reduction in the use of anti psychotic drugs from 65% to 21% Improved clinical assessments when determining transfers Augmented the level of clinical services available at the facility – Provided Quarterly Medication Reviews 111 residents – Help determine if residents cross over into a palliative stage and continue to follow them – Minor surgeries – Wound care (chronic and diabetic) – Admissions and discharges – Orders and interprets tests – Play a key role in managing mental health and acting as a conduit to psychiatry – See walk in patients at the clinic and does rounds at adjacent retiring home

14. Value PAs Can Provide Working alongside physicians and other health care professionals PAs: Decrease wait times and improve access to care for Canadians Enhance the quality of care being provided to patients in LTC homes Are a cost-effective solution to the health human resource challenges in Canada “PAs are a wonderful back up support to doctors. A PA can often cut emergency runs for patients in long term care, and their presence permits treatments to begin immediately.” Dr. Paul Coolican, St. Lawrence Medical Clinic, ON “PAs are here five days a week and it's made a huge difference. The staff really like it, families like it. I'm happy.” Dr. Jim Deacon, Trillium Centre Care Community, Kingston, ON “PAs can be an indispensable resource to a Primary Care Provider in the provision of both essential care and optimal care to patients and their families.” Dr Ian Maharaj, Deer Lodge Centre, Winnipeg, MB

15. Implementation Hurdles Lack of familiarity among staff with the PA role and responsibilities Acceptance PAs Funding/billing for PAs

16. Solutions Establish clear and comprehensive medical directives Ensure proper communication among caregivers and administrators Work with government/employers to establish funding models for PAs in LTC homes Show up everyday and provide exceptional care until the role is not only accepted but becomes invaluable to the LTC environment

17. Recommendations Introducing PAs into LTC homes is consistent with the BC Health’s Health Care Transformation Plan in delivering better care at the right time and would help to alleviate the health human resources challenges in long- term care A potential opportunity exists for CAPA to partner with patient groups to advocate for the introduction of PAs in the province to improve health outcomes in long-term care The result would be better care for BC’s seniors and a reduction in costs to the health system

18. Questions?