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Long Term Care Administration

Class Agenda

Thursday, February 12, 2009News and ViewsHome and Community CareBreakPresentation GradesMental Health Services

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Old friends, old friends,Sat on their parkbench like bookendsA newspaper blown through the grassFalls on the round toesOf the high shoes of the old friends

Old friends, winter companions, the old menLost in their overcoats, waiting for the sunsetThe sounds of the city sifting through treesSettles like dust on the shoulders of the old friends

Can you imagine us years from today,Sharing a parkbench quietlyHow terribly strange to be seventy

Old friends, memory brushes the same years,Silently sharing the same fears

Old Friends

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Simon and Garfunkel

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Home and Community Care

February 15, 2007

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Home and Community CareDefinitions

Home Care Publicly funded programs and services that

people with functional limitations access to remain at home.

Community-Based Services Range of supportive services such as meals

on wheels, transportation, homemaker services, enabling people to remain in the community.

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Home and Community Care

Community CareEncompasses home care and

community based services, includes support provided by family and friends, volunteers and, occasionally facility based care.

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Three Models of Home Care

Acute Care Substitution ModelProvides services to people who

otherwise would be admitted to or remain in acute care facilities.

Long Term Care Substitution ModelProvides home care services for those

who would otherwise require placement in a long term care facility.

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Three Models of Home Care…

Maintenance Preventative ModelProvides support and services to people

with health and functional deficits.Its goal is to maintain their independence

and prevent health and functional breakdowns and eventually institutionalization.

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Home Care Program

Home Care Teams made up of nurses, physiotherapists, occupational therapists, case managers and nutritionists work together to support people in the community. They work out of the six Community Health Areas providing supportive services to clients in their homes, clinics and other settings. Services include:

Pain management Wound care Palliative care Home IV Mobility, endurance and strength training Assessment for Home Support

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Home Care Program

Home Support Home Support consists of a range of support

options designed to meet the assessed health needs of clients for personal care, safety, prevention of health decline and end of life care. Home Support also assists in enabling safe discharge from hospital. Currently, Vancouver Community is working with five agencies to provide home support services to Vancouver residents.

Personal Care includes: grooming and hygiene, bath assistance, assistance with mobility lifts and transfers, assistance with medications, nutritional assistance and family and caregiver respite.

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Home Care Program

Caregiver Support Program The Caregiver Support program offers the

following programs and services to support family and friend caregivers:

Education Series and workshops Support groups Telephone support Information and referral to healthcare and

community resources Annual caregiver forum Caregiver Times quarterly newsletter. All services

are free.

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Home Care Programs

Adult Day Centres Adult Day Centres (ADC) provide a range of health,

social stimulation and therapeutic recreational programs in support group settings. Clients attend ADC for:

Caregiver & family respite Waiting residential placement Health status monitoring Medication support & monitoring Targeted therapeutic activities Access to health education

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Home Care Programs

Home Hospice Program The Vancouver Home Hospice Program

provides hospice palliative care to people in their home setting. Hospice palliative care refers to the physical, emotional, social and spiritual care with the goal of providing comfort and improving quality of life for those persons who are living with or dying from advanced illness. This active compassionate care is based on a commitment to the whole person respecting personal, cultural and faith values, beliefs and practices.

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Home Care Programs

Home Hospice Program, cont… In collaboration with the individual and their

family/caregivers, hospice palliative care services are provided by an interdisciplinary team including:

Family physician Community health nurses Community PT/OT Palliative care physicians Nurse clinician Social work consultant Spiritual care consultant Coordinator of volunteers Hospice volunteers

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Home Care Program

Meal ProgramsMeal Programs assist clients to maintain

or improve their health by supplementing their present diet wit hot, nourishing meals. The main types of service are Meals-on-Wheels, Wheels-to-Meals, and Congregate Meals.

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Home Care Program

Short Term Assessment and Treatment Centre

Short Term Assessment and Treatment (STAT) Centre (VGH) has both an inpatient unit and a day hospital whose main function is to provide assessment of the frail elderly. The unit has a strong focus on research, education and holistic geriatric care.

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Home Care Programs

Transitional Care Transitional Care is provided for individuals

requiring more time for recovery after an acute care episode in order to return to their home. Client needs are less than in acute care but more than residential care. Programs & activities are rehabilitation based and focus on assisting clients in regaining their functioning & abilities.

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Home Care Programs

Shop-By-Phone Shop By Phone covers the entire city with the

exception of the west-end and provides a volunteer-run grocery shopping service for those people unable to get out to do their own shopping. Registrants must live within the boundaries of the service; have no friends, family or neighbours to assist with groceries; be homebound; suffer from a chronic illness (mental, physical, addiction); have a short-term disability or have no transportation to assist with groceries.

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Private-Public Role in Home Care

Three Distinctions

1. Delivery – service provider organization public or private.

2. Financing – Publicly or private financed.

3. Allocation – degree to which government controls delivery system.

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Private-Public Role in Home Care

Example1. Whether the service should be provided, to

whom, how much is needed.2. Recipient pays directly or indirectly.3. Who will provide the service.

Note In some cases the system is publicly financed

and private provided.

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Private-Public Role in Home Care

Four Models of Home Care Delivery

1.Public-provider model where single entry functions, professional nursing services and home support services are delivered by public employees.

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Private-Public Role in Home Care

Four Models of Home Care Delivery

2. The public-professional and private home support model where single entry functions and all professional services are provided by public employees.

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Private-Public Role in Home Care

Four Models of Home Care Delivery

3.The mixed public-private model, where single entry functions, plus some professional services, are delivered by public employees, some nursing and all home support are contracted out depending on the region of the province.

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Private-Public Role in Home Care

Four Models of Home Care Delivery

4. The contracted model where single entry is provided by public employees and professional and home support employees are contracted out.

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Providers of Home Care

Traditional Formal Caregivers Service delivery personnel typically employed

by government-funded, for-profit or not-for-profit agencies.

Independent Formal Caregivers and Personal Assistants

Service delivery personnel who register with an employment agency who are employed on a casual or permanent basis by users of their service

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Providers of Home Care

Volunteer CaregiversTypical unwaged service deliverers

working with a volunteer or nonprofit agency.

Informal CaregiverFamily and friends of the person

receiving care.

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Emerging Issues in Home Care

The increasing medicalization of home and community care.

A national home and community care approach.

Role of technology.Public-Private Mix in Home CareFuture Availability of Human Resources.

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Other Emerging Issues

Available Data.Regionalization.Rural Urban Differences.Supportive Housing.Role of Research