Long Term Care Administration Thursday, January 29, 2009 Class Agenda 1. Class Presentation 2. Case Example 3. Users of Long Term Care 4. Break 5. Challenges for LTC Management 6. Prep Time for Presentations

What a drag it is getting older… Doctor please, some more of these Outside the door, she took four more What a drag it is getting old Life's just much too hard today, I hear every mother say The pursuit of happiness just seems a bore And if you take more of those, you will get an overdose No more running for the shelter of a mother's little helper They just helped you on your way, through your busy dying day Rock Songs about Aging

Long Term Care Administration Users and Challenges of the Long Term Care System

Users of the Long Term Care System

The Gerharts  Reuniting Seniors – Closer to Home  For Mary & Emery Gerhart, Adanac Park Lodge is so close to home it is as though they are having a family reunion.  For the couple who were married on August 22, 1936, 2006 marks the seventieth anniversary of their wedding.  In the past 70 years Vancouver has changed dramatically.  Back in 1936 Mary Gerhart recalls purchasing their home in East Vancouver near Adanac Park for $1,200.  The price was a lot of money for the Gerharts at the time, but they managed to scrape it up.  Mary created a large vegetable garden at the side of the house and Emery got some chickens so they could have fresh eggs every day.

The Gerharts  For more than seventy years, the couple has been the best of friends, and it was with a heavy heart that Mary had to grapple with the idea that due to the effects of Emery’s dementia, she could not longer care for him at home and she reluctantly agreed to have Emery placed in a residential care facility in the Fall of  Over the years, the couple has shared many joys and many heartaches with the most difficult set back being the death of their sons Roy in 1974 and Bruce in 1997, but through it all their love and friendship remained strong.  Having to be apart for the past five years has been another of the most difficult passages of all.

The Gerharts  Mary stayed in the house during the first four years after Emery moved into Adanac Park Lodge.  It was a difficult time for her to live alone, after all she had never lived alone and since the age of 17 she had lived with Emery, the love of her life.  Living alone in the house became too much for Mary and she moved to an assisted living facility in January of  That too was hard, but she tried her best to cope.

The Gerharts  After seventy years of marriage, the Gerharts were reunited at Adanac Park Lodge.  In a written history from Audrey Raines, one of the Gerharts daughters, she expressed her many thanks and gratitude…”the family wants to thank the hard work and advocacy by a wonderful woman from the Fraser Health Authority, [the case manager] Eleanor Allan.  In addition, the family wants to thank Vancouver Coastal Health and the healthcare professionals at Adanac Park Lodge.  Because of all these people, mom and dad were reunited again.”  Now in the final sunset of their lives, they are together once again - to give comfort to one another.  It is a love that has survived and flourished and an example of which to be proud.  Both daughters are very grateful that they have this chance to be together again for their parents.  This is a great example of the health care system working well with very positive results.

The Gerharts Today

Users of Long Term Care Consumers – It does take a village  Independent to care needs.  Receives a service provides another  Neighbours: frail elder, living next door is a mom and a preschooler – neighbours support each other.  Community services are an extension of such neighbouring.  Retain power of decision making.

Users of Long Term Care Clients  Less independent to care needs.  Use services based on a multidimensional assessment.  Formal system controls delivery of services and care.  Informal system retain control over daily living activities.

Users of Long Term Care Residents  Lack of informal supports to be cared for safely in the community.  24/7 supervision, care, safe, secure, protective living environment.  Ethnocultural & geographic specific.  Limited control over surroundings.

User of Long Term Care Patients  Physical, mental illness, long-stay.  Med. complex, heavy, tech dependent and conditions may change over time – discharged to home of LTC Facility.  Limited choice food and clothing.  Regionalization: movement of funds from acute care to long term care and community care.

Demographics of Long Term Care Users

Users of Long Term Care Needs and Expectations  Based on assessed needs.  Older, frailer, sicker, chronic care.  Longer life = functional disability.  Need to support informal caregivers  Baby boomers will want larger collective solutions to long term care services needs

Users of Long Term Care Major Concerns  Caregivers consume health care.  Women caregivers, low wages, no family support networks, friends.  Substantial personal investment in time and money.  Multitude of issues impact on users

Users of Long Term Care  93-year-old former fitness instructor and physical education teacher died in November  He helped popularize basketball in Britain.  Basil "Joe“, died of pneumonia at a hospital in England, about a week after he was injured during a fall at his home.  His Australian-born wife of 59 years, Eva, died of heart failure in  He is survived by two sons Mick and Chris

Users of Long Term Care

Challenges for LTC Management  Aging of the population.  Shortage of LTC beds & wait lists.  Mergers, conversions and closures.  No new construction of facilities.  Acute care hospital stays reduced.  Frail, medically complex illnesses.  Home and community alternatives to institutional care.

Challenges for LTC Management 1 Projecting populations and their health status 2 Providing support for supporters 3 Discovering innovation in LTC 4 Working for an aging society 5 Financing LTC in the future

Challenges for LTC Management Projecting Populations and Their Health Status 1 % people at various stages of health unpredictable. 2 Cognitive impairments first than physical health problems, for some the impairments are intertwined.

Challenges for LTC Management Projecting Populations and Their Health Status 3 Not all impairments are degenerative in progression. 4 92% 65+ females are active 85% 75+ females are active 60% 85+ females are active 50% 95+ females are active

Challenges of LTC Management Projecting Populations and Their Health Status 5 Activity level does not drop after 95 6 Men are more active to the end, at advanced age in particular.  60% 95+ men are active  50% 95+ women are active

Challenges for LTC Management Providing Support for Supporters  Family caregivers provide the most important role.  Caregivers do not have social or recreational outlets.  Challenge – create effective care plans for both client and supporters.

Challenge for LTC Management Discovering Innovations in LTC  Single point of entry – one stop shopping for a full range of services  Case management  Increase in choices & care settings.  Innovation funds dedicated for pilot and demonstration projects.

Challenges for LTC Management Home Care Programs  Core of community-based services.  Demonstrate cost effectiveness.  Expand services SW, OT, PT.  Focus on problem-solving with volunteers, self-help groups and professionals to show case home care – effective, satisfied customers

Challenges for LTC Management Respite Care  Evidenced caregiver recuperation  Link respite to the continuum.  Caregiver assessment is needed.  Need to educate public about the benefit and availability of respite care services.

Challenges of LTC Management Alternate Care Delivery Options  Home Adaptations – grab bars  Flex Housing – widened hallways  Garden Units – intergenerational  Group Homes – Facility in a home  Assisted Living – LTC alternative  Supportive Housing – High end  Adult Day Care – Seniors Centre +

Challenge of LTC Management LTC Centres Challenges  Accreditation – public confidence  Priority admissions suitable facility  Qualitative social balanced with quantitative functional impairment  Removing production line aspects  Strive to improve quality of life

Challenge of LTC Management LTC Centre Challenges  Effective recruitment, caring people  Help workers feel that there work is important  Develop a fair funding model  Encourage recruitment of young people into LTC

Challenges for LTC Management Evidenced Based Classification System  MDS – Minimum Data Set  RAI – Resident Assessment Instrument  RUGs- Resource Utilization Groups  CIHI – Canadian Institute of Health Information

Challenges for LTC Management Professional Issues in LTC  More autonomy, variety, career satisfaction in community-based  Emphasis curriculum on cognitive process  Management training HR & Finance  Professional incentives  Merge community and facility cultures

Challenge for LTC Management Frontline Providers of LTC  Help lower paid staff feel important  Respect and value non-prof. staff  Create career ladders non-prof staff  Create an atmosphere where staff are motivated to treat residents as individuals like their own family and friends in an efficient manner

Challenge of LTC Management Unions and Management  Unions want assurance from management that the overall number of positions will not be reduced and that workloads will not increase.  Nursing union has cast a suspicious eye on delegation of regulated nursing functions.

Challenge of LTC Management Financing LTC for the Future  The costs of long term care should not come as an unpleasant surprise that causes financial distress for individuals and their families.  Long term care is a normal risk of living and growing old.

Challenges of LTC Management Protection Against Catastrophic Costs  As long as public health insurance remains in place, there is room for both public and private long term care facilities and programs, especially with the use of assessment tools that review the needs in an impartial manner.

Challenge of LTC Management Creating a Balance Between Informal, Home Care and Institutional LTC 1. Seniors wish to age in their home. 2. Home care preserves independence, delaying admission to LTC facility and assists in early discharge from hospital. 3. Positive attitudes toward home care

Challenge of LTC Management Can the Continuum be Sustained?  Expand cost effective home care and adult day care programs and reduce residential beds.  Expand short stay, supportive housing, respite care & innovative LTC programs at the expense of residential beds.

Challenge of LTC Management Can the Continuum be Sustained?  Reverse the trend toward reducing eligible contributions to RRSPs to discourage the dipping into savings before retirement.  Encourage people to save for retirement.

Challenge of LTC Management Can the Continuum be Sustained  Bring about a national debate defining what belongs in the universal and comprehensive basket of long term care services and which, if any, services may be offered at varying levels of quality and price.