1. LHIN Home and Community Care Funded Respiratory Therapy Services Dave Jones, BSc. , RRT

2. Discussion Agenda Background The Progression The Real Why
CCAC’s (now LHIN’s) funding RT’s
Moving Forward

3. A little ground work…
Health care providers and patients have recognized a gap in the community for the care of people requiring support for their complex respiratory needs for many years
Small pockets around the province that figured out how to provide the clinical care and support for these people
Largely unfunded meaning not sustainable
Relying on the goodwill of RT’s and their employers

4. A little more groundwork…
The expectations and demands continue to rise for options of care at home
Technology continues to improve that supports people with increasingly complex needs outside of the hospitals
The pressures continue to rise to transfer people out of the hospital to free up that bed for someone else requiring hospital care.

5. Chronic Ventilation Strategy Task Force
Final Report 2006
One of the key recommendations:
“That the MOHLTC and, in due course, the LHINs, improve the support provided for ventilator-dependant clients living in the community by: Providing and funding additional services for ventilator-dependant clients living in the home. These additional services would include Respiratory Therapists’ services. These services could be delivered through CCACs or a hospital-based service”. (MOHLTC, 2006)
Plus some others including strong support for ADP and VEP

6. Provision of Community Services Regulation O. Reg 386/99
Revised in 2009 to allow CCAC’s to contract Respiratory Therapy Services in the community for clients who are:
“ventilator-dependent, have artificial airways or be receiving home oxygen services under the Assistive Devices Program”
CCAC’s adopted a scope of practice for RT’s that was very inclusive allowing RT’s to use their competencies
There was no mandate to provide RT services or financial resources created to do that, but the door was opened.

7. Optimizing Respiratory Therapy Services: A Continuum of Care From Hospital to Home
The Health Force Ontario funded project of the College of Respiratory Therapists of Ontario
Many contributors to this project across the province
Goal was to use the competencies of RT’s in the community to provide care for people requiring mechanical ventilation and airway management outside of the hospital.
The target was to safely transition people to and have them remain in their homes.
18 month project- October March 2010

8. Optimizing Respiratory Therapy Services
Key findings
Successful transitions home
Improved quality of life
Decreased unplanned hospital visits
Increased job satisfaction
Cost savings to healthcare system
Community costs about $1000 per day
Community hospital about $2000 per day
Academic Hospital about $3800 per day
One example from project demonstrated savings of about $ over almost one year.
Improved access to ICU beds

9. The Story, The Real Why

10. Looks great….highly complex care needs.

11. And now…

12. CCAC’s Starting the trend
North Simcoe Muskoka became an early adopter
SouthEast followed in 2012
SouthWest adopted RT services in 2014
Central West and Mississauga Halton contract RT services as well.
All adopting similar models with some regional variations.

13. Populations being served
All age groups
Invasive ventilation
Non-Invasive Ventilation
Includes Lung Recruitment
Tracheostomies/ Laryngectomies
Complex home oxygen
Ideally medically stable
Exclusions- cannot make it safe, no caregivers

14. LHIN Considerations Very small effect on overall budget
Not in place to duplicate services
Goal is always to have the right person, with the right skills providing the best care
RT’s are not replacing shift nursing
24/7 service is essential
RT’s provide direct clinical care
RT’s provide education for all caregivers and build capacity in the whole care team.

15. Involvement in the Process
Varies greatly with each person
Starts at the discharge planning stage for inpatients
Caregiver training can start in hospital in coordination with the hospital team
Varies with resources, comfort and frequency of discharges of this population
SW LHIN has a great core team at LHSC, support other centres in the area, seamless handoffs to continue training
Outpatients
Includes pre-planned session to urgent same day set-ups following clinic visits
May include initiation at home
Establish goals and interventions to support a safe transition home and ongoing.

16. Caregiver Education and Support
Building capacity in regulated health professionals to be comfortable with technology and care needs
Supporting unregulated care providers in routine care needs and planning for managing exceptions.
Supporting family members to gain confidence in caring for client
Repeat training required as needs change, caregivers change, people return from leaves
Must be flexible to offer training when people are available and care is needed
Training late evenings to meet overnight staff

17. Clinical Support Changing tracheostomy tubes
Extra support with airway clearance during respiratory infections
Assisting with transports
Data downloads
Parameter adjustments
Ventilator weaning
Speaking valve trials
Acclimatization to CoughAssist, non-invasive ventilation
Clinical assessment to report to MRP and rest of clinical team

18. Where do we go now?
Continue to grow within LHIN’s that are using RT services now
Increased familiarization with the service across the broader team
Increased need to care for clients
Increased respect for specialized skills
Additional LHIN’s to implement RT services
Need strong advocates
Use the examples that exist in other LHIN’s
Continue to build a reproducible model that focuses on the patient first

19. Your Partner in an Integrated Health System Chronic Disease Management • End of Life Care • Complex Respiratory Care