Spring 2011: Central East LHIN Options paper developed

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1 Glenna Raymond, Chair, RSGS Governance Authority Victoria van Hemert, RSGS Executive Director 1

2 Spring 2011: Central East LHIN Options paper developed Called for new entity to oversee and improve the coordination and delivery of specialized geriatric services in the Central East region A Governance Authority for the RSGS would be directly accountable to the Central East LHIN Board of Directors (LOU) and would function under a shared governance model 2

3 Fall 2011: Northumberland Hills Hospital selected as host organization to provide back-office supports Funding sources include Central East LHIN & contributions from hospitals and Community Care Access Centre January 2012: Majority of Governance Authority members selected 15-members; comprised of senior administrative leaders from Central East Health Service Providers, clinicians and community representatives; ex-officio representation from Central East LHIN & RGP of Toronto 3

4 Regional Specialized Geriatric Services (RSGS) will provide leadership in the creation of a regional system of integrated specialized geriatric services for frail seniors including: System planning; Recommendations regarding priorities for system enhancement and resources; Monitoring of performance outcomes; Advocacy; Communication; and Education for Specialized Geriatric Service providers. 4

5 Vision: Best health experience for frail seniors in the Central East LHIN Mission: To create a high quality, integrated, personcentred system of care that supports the best quality of life for frail seniors and their caregivers * These were noted as provisional in order to guide the Governance Authority s activities until the completion of the RSGS s strategic plan 5

6 RSGS became operational in July 2012; Primary focus of activities has been directed to strengthening and coordinating current specialized geriatric services: Geriatric Emergency Medicine (GEM); Geriatric Assessment & Intervention Network (GAIN); NPSTAT (Nurse-Practitioners Supporting Teams Averting Transfers); and Behavioural Supports Ontario (BSO). Additional activities have included building the entity/infrastructure development Developed key policies to guide the work of the Governance Authority and hired staff (~3.5 FTEs); Developed 2012/13 workplan for submission to Central East LHIN 6

7 Developed a strategic aim for frail seniors for submission to the Central East LHIN Integrated Health Service Plan : In progress: By 2016, reduce the demand for long-term care resulting in 320,000 more days at home in the community. Needs-assessment & capacity analysis of specialized geriatric services; Identify performance standards for SGS providers for 2013/14 and make recommendations to the Central East LHIN; Re-vision GEM-GAIN along a screening/assessment/intervention continuum; Develop an RSGS organizational/multi-year strategic plan; and Develop and implement a communications, community engagement and branding strategy/plan. 7

8 Start-up of a new entity Where are we going (mission)? How will we get there (strategies)? Role clarification and relationship to LHIN, LHIN-funded providers, other providers. What is our blueprint for action (work plan)? Creating an inclusive engagement strategy (LHIN geography, number of stakeholders). How do we know if we are on track (evaluation)? Many system-level changes in progress Ontario Seniors Strategy; Health Links; and Hospital and CCAC funding models. 8

9 Safe There is variation in the quality of care as measured by rates of adverse events and near-misses Effective Information is lacking to evaluate whether those who could benefit are receiving services, and viceversa Gap between best practices knowledge and application Patient-Centred The patient s voice/experience has not traditionally been solicited in health system design; feedback has relied on satisfaction measures Timely ALC long-stay awaiting LTC placement Eligibility criteria and wait lists for home care services Efficient The current system is uncoordinated; difficult to navigate Equitable There is variation in access to care as measured by wait times for service, geographic distance to service, awareness of service 9

10 For example, for acute care hospitals: Principles Goals Proposed Standards Expected Patientrelated outcomes Equity: Those who most need SGS are identified and prioritized to receive them* *Accred. Canada standard To ensure that those with frailtyrelated conditions are identified and care is planned accordingly Comprehensive geriatric assessment available 24/7 (virtual/functional GEM capacity) Fewer avoidable returns to ED/ avoidable admissions Safety: Avoid injury or preventable adverse events To reduce functional decline during hospital admission To reduce hospital-acquired delirium* *Accred.Canada standard Align with SFH Action Priorities: Across hospital departments: Implement interprofessional early mobilization protocols to optimize physical function Implement interprofessional delirium screening, prevention and management protocols to optimize cognitive function Less functional decline in hospital with more discharges home Fewer deliriumassociated complications 10

11 Recommendations Released January 8, 2013 Seven (7) month consultation exercise, including: Nine (9) Ministries LHIN-funded and non-lhin-funded health service providers (2500 representatives) 5000 questionnaires and 800 structured interviews with caregivers 13 Areas of Focus, including recognition of the broader determinants of health (income supports to low and moderate income seniors, development of housing alternatives to longterm care, transportation systems, access to primary care, etc.) and some specialized geriatric services (e.g. NPSTAT, BSO) 11

12 Recommendation MOHLTC should at least maintain its commitment to increase home and community sector funding by 4% for this current year and the next two years... MOHLTC in collaboration with LHINs and local municipal EMS programs should explore the development and expansion of community paramedicine programs MOHLTC in partnership with LHINs should continue to promote the adoption of Senior Friendly Hospital principles MOHLTC should continue to work with Health Quality Ontario to expedite the implementation of the care transitions standards and processes RSGS Role RSGS to provide advice to the Central East LHIN regarding funding priorities Link to GEM-GAIN continuum of screening and assessment Reflected in development of performance standards for hospitals Opportunity exists to expand application of principles to other locations where people seek care Has been identified as future work for RSGS in helping to strengthen and coordinate services 12

13 Recommendation MOHLTC should undertake the development of an evidence-informed capacity planning process to meet the needs of current and future eligible LTC populations MOHLTC should develop new LTC home service models to maximize capacity, including: short-stay respite and convalescent care programs in LTC enabling LTC homes to provide higher levels of care to individuals with complex care needs MOHLTC should support mechanisms to maximize the knowledge and skills of LTC home staff with additional training RSGS Role Will be addressed through the Service Needs/Capacity Analysis project underway These needs were identified by RSGS in its IHSP advice to the CE LHIN Ongoing through BSO implementation 13

14 Recommendation MOHLTC should enhance the utilization of Nurse-Led Outreach Teams (NLOT/NP- STAT) to effectively meet the needs of patients with more complex conditions RSGS Role Ongoing through NPSTAT Opportunity to expand coverage to all 68 homes in Central East MOHLTC, in collaboration with the Ministry of Training, Colleges & Universities, should support the preparedness of all future health and social care providers to meet the evolving care needs of older Ontarians MOHLTC and LHINs should require that health, social and community service providers streamline their assessment and referral processes Aligned with GAIN Interprofessional Fellowship initiative Future RSGS role in education to be addressed in Strategic Planning exercise Has been identified as future work for RSGS in helping to strengthen and coordinate services Needs to be linked to other e-health strategies (e.g. Integrated Assessment Record) 14

15 Recommendation MOHLTC should support its LHINs to leverage partnerships and successes of their Behavioural Supports Ontario initiatives to help define what core community geriatric mental health and addictions services need to be funded and delivered RSGS Opportunity Explore, define, and coordinate both overlaps and gaps between specialized geriatric services and specialized psychogeriatric services, including mobile outreach/crisis teams, Psychogeriatric Resource Consultants, etc. MOHLTC should improve the awareness of services and supports available to unpaid caregivers with improved single points of access MOHLTC should encourage the standardization of services and supports offered through the Alzheimer Society s First Link program System navigation needs have been identified beyond unpaid caregivers RSGS role in system navigation to be addressed in Strategic Planning exercise The opportunity to strengthen and coordinate services for people with dementia and their families is broader than First Link and core to RSGS s mandate 15

16 Recommendation MOHLTC and its LHINs should establish a provincial working group of geriatricians, care of the elderly family physicians and specialist nurses, allied health professionals, and others to help develop a common provincial vision for the delivery of geriatric services and a prioritization plan to guide local staff and funding of care models as resources become available MOHLTC should require each LHIN to: Appoint a member of its executive team to oversee the implementation of the Seniors Strategy Establish a steering committee with a broad base of representation to help discuss and plan opportunities to further develop and implement services for older Ontarians in their regions RSGS Opportunity RSGS to pursue membership on new provincial working group To be effective, RSGS needs to be highly focused on meeting the needs of frail seniors, but be closely connected to broader system activities/strategies 16

17 Whereas the Central East LHIN called for a new entity to oversee and improve the coordination and delivery of specialized geriatric services in the Central East region (the Central East Regional Specialized Geriatric Services entity or RSGS ); Whereas the Governance Authority for the RSGS is directly accountable to the Central East LHIN Board of Directors via a Letter of Understanding; Be it resolved that the Central East LHIN Board of Directors approve the Letter of Understanding with the Governance Authority of the RSGS, accepts the first annual report of the RSGS and acknowledges the work completed to date. 17