Sub-Acute Capacity Planning Presentation to the. Champlain LHIN Board of Directors

Transcription

1 ub-acute Capacity Planning Presentation to the Champlain LHIN Board of Directors Dr. haun McGuire, Co-chair, ub-acute Capacity Planning Executive teering Committee Cameron Love, Co-chair, ub-acute Capacity Planning Executive teering Committee April 25, 2018

2 What is ub-acute Care? ub Acute ervices include: All rehabilitation, complex medical management, convalescent and sub-acute palliative care beds. All publicly-funded community restorative care services. These services benefit patients such as stroke survivors, those with acquired brain injuries, amputees and older people who have become deconditioned following illness or injury. 2

3 Current Distribution of ub-acute Beds in Champlain LHIN Type of ub-acute Care # of beds General Rehabilitation (including transitional care) 106 Geriatric Rehabilitation 54 Complex Medical Management 517 troke Rehabilitation 41 pecialized Rehabilitation 54 ub-acute Palliative Care 31 Convalescent Care 76 TOTAL 879 3

4 The Case for Change The olution: make better use of existing beds Provide more rehabilitation beds Invest in appropriate community based resources Provide adequate in home rehabilitation Increase alternatives to Long Term Care 4

5 ub-acute Capacity Planning tructure Acute Care In-Patient Rehabilitative Care Alliance Definitions ub-acute Care Community Rehabilitation Activation / Restoration hort-term Medical Mgmt Long-Term Medical Mgmt Palliative ub-acute Capacity Executive teering Committee easonal urge Work Group Rehabilitation Network of Champlain Convalescent Care Work Group - TBD Complex Medical Management Work Group Champlain Hospice Palliative Care Network troke Work Group Long-Term Ventilation Work Group In-Patient Palliative Care Work Group pecialized Rehab Work Group General & Geriatric Rehab Work Group Coordinated Access Work Group -to be created Financial Impact Work Group * Ch LHIN to develop plan for additional LTC capacity 5

6 Planning Principles Clinical Work Groups Patient-centered: the model should be patient centered with care and services aligned with identified patient needs. Geographic location of services: patients should be able to obtain services as close to home as feasible. Evidence based: the model must be based on the Rehabilitation Care Alliance (RCA) Framework and embrace best practices in clinical care and service delivery. Efficient: the model and program distribution will be driven by quality, efficiency and effectiveness. ervices should model and reflect the highest quality attainable within existing resources. Comprehensive Coordinated Model: the model should consider how the parts of the system can work together in new ways to ensure transitions are improved and patients are getting the best available care and services they require. Connected and Accountable: the model should create and embrace a LHIN wide strategy and integrated approach where everyone is responsible to one another and to the patient. Focused on early identification and prevention: it is recognized that maintenance of function is important, and therefore the model should incorporate means of mitigating future demand for subacute services by investing in prevention and maintenance activities. 6

7 Key Recommendations For Action Convert a minimum of 43 complex medical management, 28 general rehabilitation and 14 transitional care beds to specialized, stroke and geriatric rehabilitation beds. Test the impact of increased intensity of rehabilitation by offering therapy 7 days per week and increasing daily hours of therapy Increase availability of out-patient and in-home rehabilitation to reduce use of in-patient beds through the creation of integrated hubs of service in 3 geographic locations Add community based housing supports to expedite discharges out of subacute care Make better use of existing sub-acute beds by standardizing care: reducing length of stay, standardizing admission criteria, coordinating access to beds 7

8 Proposed Bed Repurposing to Meet ervice Requirements 8

9 Proposed Integrated Rehabilitation Hubs (ambulatory care) Integrated rehabilitation Hub Model, Benefits: Integrated Community Efficient use of resources grouping Clinical rehabilitationilitation Programs across CLHINHubs Equitable access to community programs, (ICRH): care closer pecialized to home. toke, Day Increased availability of ambulatory services, Hospitals, such as Community day hospitals troke and outpatient care across the region in select locations as well as in-home sites provision options ICRH with pecialized Co-location, and perhaps co-provision of services, ideally led by the organizations that deliver stroke and other rehabilitation more specialized rehabilitation in each geographic area. atellite site (ICRH): may Hubs accountable to provide guidance, standard have one processes or a combination and training of to programs and staff dispersed throughout services the LHIN Leveraged by use of tele health and other technologies East West Central Total total cost $ 1,408,761 $ 1,337,788 $ 7,022,897 $ 9,769,446 already invested $ 280,000 $ 426,000 $ 99,974 $ 805,974 to be invested $ 1,128,761 $ 911,788 $ 6,922,923 $ 8,963,472

10 Community Based ervices Increase Assisted Living ervices regionally Improve non-urgent transportation in rural areas Provide supportive housing options for high respiratory needs population Augment ocial Work and Rapid Response Nurses in Ottawa Increase interventions to support seniors 10

11 Additional Considerations ub-acute Executive teering Committee has recommended: Moving 6 in-patient stroke rehabilitation beds from Hôpital Glengarry and District Hospital (HGDH) to Cornwall Community Hospital(CCH) Moving 4 complex medical management beds from Winchester and District Hospital (WDH) to other hospitals. Co-locating stroke rehabilitation in Ottawa with the acute stroke unit at the Ottawa Hospital. LHIN staff is recommending we consider in future years once other elements of the sub-acute plan have been actioned. 11

12 ummary of Required Investments All Recommendations year one (prorated) total project costs Inpatient Total $ 1.1M $ 6.3M Integrated Hubs Total $ 504K Community Programs Total $ 87K $ 6.4M total $ 1.7 M $ 12.7M Future Considerations - pending pilots and further assessment Integrated Hubs $ 8.9M Resource intensity 120 min $ 1.9M additional stroke beds $ 468K $ 1.7M 7 day per week rehabilitation $ 791K $ 4.4M total $ 1.2M $ 16.9M total costs $2.9M $ 29.6M * one time costs $ 608K Total projected costs estimates will be funded with a combination of existing and new funds, further detailed costing is required. * Potential total costs assuming all services are required at the level planned. + $1,150,000 already committed to Community Programs ($250,000 to High Respiratory Needs and $900,000 to Assisted Living ervices) 12

13 Implementation Plan year one (F2018/19) Type Of rehabilitation Recommendations Year 1 Converting Inpatient Capacity troke rehabilitation + five (5) beds at Bruyere Continuing Care Consider adding an additional six (6) troke rehabilitation beds based on need troke rehabilitation Intensity of ninety (90) minutes pecialized rehabilitation Acquired Brain Injury (ABI) + four (4) beds The Rehabilitation Centre Integrated rehabilitation Hubs Community Programs One Time Costs pecialized rehabilitation (ABI) seven day per week rehabilitation Community troke rehabilitation Renfrew County, Prescott-Russell, plan for Greater Ottawa *High Respiratory Needs *Assisted Living ervices see below Total Costs Work Groups: Integrated Hubs, Medical Models, Coordinated Access, Evaluation Framework, Phases of repurposing beds Network: Complex Medical Management Ambulatory troke Care Bruyere Continuing Care Total One Time 13

14 Next teps: June 27, 2018 CLHIN Board approves proposed integration decision(s) to be submitted for community consultation July-August, 2018 Community consultation related to integration decision(s) Amendments/Revisions TBD (eptember/october) LHIN Board issues final integration decision(s) 14

15 The Resolution: Whereas the LHIN staff and Executive teering Committee have: Reviewed the ub-acute Capacity Plan recommendations and finds them to be aligned with LHIN priorities, based on the best available data, evidence and methodologies, vetted by local experts and that there has been significant engagement with providers in developing the future state of sub-acute services. Whereas the LHIN Board of Directors: Endorsed the ub-acute Report on May 25, 2016 and requested that an implementation plan to fulfill its recommendations be developed. Be it resolved that The Champlain LHIN Board of Directors approves: The overall direction of this implementation plan The execution of Year 1 (F2018/19) of the staged Implementation plan, conditional on the availability of sufficient operational resources. 15

16 Discussion & Questions 16