3 Continuing Care for Seniors and Others A continuum of care requires integration across health care sectors and services We recognize that this continuum can include the pillars of home care, respite care, long-term care, and palliative care Our focus: An aging population with multiple and complex needs An integrated system of continuing care can determine the appropriate place and level of care required, particularly for seniors
4 Integration Across the Health Care Continuum for Seniors Source: Hollander, M.J. and M.J. Prince, Organizing healthcare delivery systems for persons with ongoing care needs and their families: A best practices framework. Healthcare Quarterly, 2008. 11(1): p. 42-52. Hollander and Princes’ framework depicts an integrated system of care across various sectors and at multiple levels, linked through case management.
5 Focus on Home Care for Seniors The 2004 Ten Year Plan focused on home care for short- term post-acute, mental health, and palliative care Health Council Report (April 2012): To inform Canadians of the challenges in home care for seniors and family caregivers, using RAI-HC data analyses We profile innovative practices that integrate home care across the continuum of care
6 Seniors need support to age at home Most seniors (93%) live at home and want to remain at home (CIHI, 2011), but will need support from home care and family caregivers to remain at home Many seniors waiting in hospitals for long-term care facility placement, can return home if appropriate supports are put in place Home care can delay entrance into LTC, lead to cost savings in hospitals and a better quality of life for seniors
7 Home care services for seniors vary across Canada
8 Impact of High Needs Clients on Family Caregivers At least 30% of home care clients have high or very high needs As needs of home care clients increase, hours of care provided by family caregivers increase, considerably, but hours of home care increase very little As a consequence, family caregivers of these high needs clients are becoming distressed
9 Family caregivers provide the majority of care received Source: RAI-HC 2.0 (2010 data for the Yukon, the Northern Health Authority in British Columbia, and Ontario; 2007 data for Nova Scotia and the Winnipeg Regional Health Authority.)
10 Home Care vs. LTC Spending in OECD Countries
11 Lessons from Denmark In 1987, Denmark stopped building new long-term care facilities and focused legislation and resources on developing home care and assisted living options Health and social care services for seniors are integrated and coordinated through case management, interdisciplinary teams, cross setting care, and common training programs Denmark’s home care programs have been shown to be cost- effective substitutes for long-term care facilities Preventive home visits for seniors are provided to all citizens over 75 years
12 Integrated continuing care in Canada: PRISMA The PRISMA model in Quebec is based on six elements: coordination of organizations and services; a single point of entry case management an individualized service plan a standardized assessment; and electronic records Since 2005, all public hospitals, long-term care facilities and home care agencies in Quebec have been merged under single organizations within a region facilitating the implementation of the PRISMA model
13 Health Council’s View Continuing care is a cornerstone of high-performing health care systems and needs to be integrated We need to ensure the pillars are strengthened to facilitate integration Current areas to be addressed: Appropriate balance of spending in LTC, home care and other continuing care Appropriate training and wages for continuing care workforce
14 The Challenge Ahead: Strengthening Continuing Care Expand what’s working: Draw on innovative practices in Canada and abroad Assess needs: inter-RAI assessments are available across sectors and provide a standard tool to assess needs, integrate services, collect comparable data, and evaluate outcomes Set targets: Concrete targets and goals facilitate progress
15 The Challenge Ahead: Strengthening Continuing Care Shift resources appropriately: Funding should follow the patient, based on needs Work together: Collaboration within and across sectors and involving Canadians and their families in their care will help to maintain their quality of life
16 Seniors in need, Caregivers in Distress: What are the home care priorities for seniors in Canada? (April) Health Council Presentation at Canadian InterRAI Conference (May 7-10) Progress Report 2012 (June) Please visit our website: www.healthcouncilcanada.ca More to come…
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