Environmental Scan 2011
Ontario Shores requested to assume lead in developing environmental scan of psychogeriatric services in CELHIN Common belief suggested variety of services but services have never been fully identified or articulated As regional provider, Ontario Shores pleased to assume lead on project that may result in better system coordination
Purpose, Scope and Methodology Seniors demographics in Central East LHIN Specialized Geriatric Services findings Psychogeriatric Services findings Key challenges Promising practices Summary
To complete an environmental scan of specialized geriatric and psychogeriatric services available within and in close proximity to the Central East LHIN. Get a big picture scope of how services are organized and delivered to meet the needs of the frail elderly Determine what and where health funded specialized geriatric programs/services are currently Determine what and where health funded psychogeriatric programs/services are currently delivered in the Central East LHIN
Does not include hospital or community services and supports for seniors who do not fit the definition of frail elderly with complex medical needs Does not include mental health hospital or community services and supports for seniors who do not fit the definition of frail elderly with complex mental health needs
Key informant interviews with 25 people (February to April 2011) Stakeholder consultations (March 2011) Peterborough Ajax
Specialized Geriatric Services (SGS) Frail elderly in combination with complex and interrelated biomedical, psychological, social, functional and environmental needs. SGS provide a range of services to support older individuals with chronic and complex conditions; including specialized geriatric assessment, consultation, short-term treatment, rehabilitation, and short-term specialty case management.
Psychogeriatric Services Psychiatry of the elderly is a branch of psychiatry and forms part of the multidisciplinary delivery of mental health care to older people. The specialty provides assessment and treatment for elderly persons with challenging behavioural issues or complex mental health problems and their consequences; particularly mood and anxiety disorders, the dementias, the psychoses of old age and substance abuse.
High risk frail seniors with behavioural issues and/or mental illness Specialized Geriatric Services designing a coordinated system to meet the needs of high risk frail seniors including specialized geriatric services and senior-friendly hospitals Psychogeriatric Services conducting an environmental scan of available psychogeriatric services in CE LHIN
8 public hospitals operating on 14 sites Campbellford Memorial Hospital Haliburton Highlands Health Services Corporation (Haliburton, Minden) Northumberland Hills Hospital (Cobourg) Peterborough Regional Health Centre Ross Memorial Hospital (Lindsay) Rouge Valley Health System (Ajax, Scarborough) The Scarborough Hospital (2 sites) Lakeridge Health (Oshawa, Bowmanville, Port Perry, Whitby reopened) 1 psychiatric hospital Ontario Shores Centre for Mental Health Sciences (Whitby) +1 private hospital treating people with drug and alcohol addictions
Inpatient Acute Geriatric Medical Unit/Acute Care of the Elderly (ACE) Lakeridge Health Corporation Oshawa site Peterborough Regional Hospital Corporation The Scarborough Hospital both sites (in operation for 10 years)
Geriatric Rehabilitation Units/Geriatric Assessment and Treatment Unit (non-acute) RVHS has Geriatric and Treatment Unit Lakeridge Health GARU (Whitby site) TSH accesses Geriatric Rehab Unit at Providence Healthcare through formal agreement with on-site Patient Flo Coordinator at TSH re: intake and admission to Providence (outside CE LHIN) Ross Memorial Hospital GERI unit; ONLY hospital with an Inpatient Geriatric Consultation team (fiscal funding) Northumberland Hills Hospital - restorative care beds
Geriatric Emergency Management (GEM) GEM professionals available in ER at all Central East LHIN hospital sites except Haliburton Highlands and Campbellford Memorial Clinical Nurse Specialists Assess and identify at risk elderly in ER and initiate appropriate treatment Varying hours of availability and # FTEs; usually coverage during business hours only
Geriatric Assessment and Intervention Network GAIN Outpatient Clinics Lakeridge Health (Oshawa) TSH (at General campus but supports both sites) PRHC RVHS (Scarborough) Other SGS Geriatric Assessment: Brock Community Health Centre community assessments in-home and in clinic by NP with back-up from RGP Geriatrician through OTN Lakeridge Health ONLY Geriatric Day Hospital
Geriatric Outpatient Clinics Memory Clinics: Peterborough Dr. J. Ingram (private clinic) Durham Ontario Shores (in partnership with University Health Network) Scarborough Dr. J. Lessard (private clinic) Scarborough - RVHS Dr. J. Peto Multispecialty assessment dedicated to the early diagnosis and treatment of dementia lead by Geriatrician TSH (both sites) Specialized Geriatric Outpatient Clinics RVHS 2 clinics in Scarborough Clinics lead by Geriatrician to provide assessment and intervention; referrals from hospital and directly from community
Geriatric Outreach Teams NPSTAT Nurse Practitioners Supporting Teams Averting Transfers 3 Teams: The Scarborough Hospital Village of Taunton Mills (Whitby) CCAC offices Peterborough, Northumberland, Haliburton Work with Long Term care homes to reduce avoidable hospital visits and can also help facilitate earlier discharges back to LTCH There are NO Geriatric Outreach Teams that serve people in-home in the community in the CE LHIN.
Inpatient Scarborough: TSH has 8-10 psychogeriatric beds on mental health unit (Birchmount site) Geriatric Psychiatrists/Psychogeriatricians: PRHC, Ross Memorial, TSH, RVHS
Seniors Memory Disorders Unit Serves seniors with dementia who have challenging behaviours Referrals mainly from LTCHs; ALOS 3 months Seniors Mental Health Unit Assessment, treatment planning for seniors with serious mental illness; may be medically complex but must be medically stable ALOS 2-4 months Referrals from LTCHs, hospitals, community
Ontario Shores - Prompt Care (Urgent Care) Clinic largely serves OS discharged clients; 4% seniors in 2010 OS Mood Clinic for Seniors (assessment, medical management, therapy for severe depression meet 2Xper month) have set up Outpatient Clinics in 12 LTCHs with Psychiatrist and Community Nurse Clinician on specific days of the week for consultation and case reviews TSH: mainly community referrals, some hospital follow/up PRHC PASE 7 satellite rural clinics in shared space with community mental health agencies, CHCs, LTCHs Ross Memorial Hospital: offers psychotherapy groups (depression and anxiety) for older adults
Psychogeriatric Assessment Services for the Elderly (PASE): serves LTCHs and community residents in Peterborough, Haliburton, Northumberland and community only in City of Kawartha Lakes Community Care Durham: Psychogeriatric Community Support Program (PCSP): serves Durham in partnership with Ontario Shores and CMHA Durham TSH: serves residents of LTCHs in Scarborough RVHS: serves residents of LTCHs in Scarborough Ross Memorial Hospital: Older Adults Program (inpatient and outpatient team) in partnership with CMHA Kawartha for hospital outpatients in City of Kawartha Lakes
Ontario Shores serves Durham and City of Kawartha Lakes 2 FTE TSH - member of Psychogeriatric Outreach Team serves Scarborough 2 FTE (one at each site) PASE serves Peterborough, Northumberland, Haliburton 1.7 FTE PRCs provide education, consultation and support on dementia care to health care staff primarily in long-term care facilities, also offer to community service agencies There are 68 LTCHs (9,572 beds) there is one Behavioural Response Unit site (15 beds) at Bendale Acres LTCH in Scarborough; others (?)
Ageism and discrimination Fragmentation and inequitable access Services in some areas and not others; no single point of entry, don t know where/what services are available, services are far from home No standardized assessments, protocols, treatment approaches = confusing and frustrating
Lack of coordination Within organizations medicine and mental health work in isolation; seniors treated as separate Between organizations there is limited communication or sharing; no intensive long term case management Lack of specialized resources Only three Geriatricians working in CE LHIN No geriatric outreach teams One day hospital Lack of family physicians Lack of supportive housing or residential treatment setings
Interdisciplinary teams and knowledge transfer Inpatient programs to stop the functional loss and deconditioning experienced by frail elderly in the hospital Use of technology (e.g. OTN, remote monitoring) Early identification and linkages with primary care Development of Regional Model for SGS
Two essential elements to build upon the efforts of existing services to improve access, navigation and integration across the continuum of care: 1. Core components must be evenly present and accessible throughout the LHIN 2. Services must be regionally coordinated to ensure seniors can move easily across core components as their needs change.
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