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INTEGRATED MODELS FOR DELIVERING CARE TO FRAIL SENIORS

INTEGRATED CARE ADVOCACY

Advocacy group determined to make integrated community-based home support care a major priority in the next provincial election. Endorsed by Council of Senior Citizens Organization (COSCO), Jewish Seniors Alliance (JSA), BC Retired Teachers Association


Food for Thought

The Integrated Models for Delivering Care to Frail Seniors workshop was held at the Unitarian Church on Wednesday, the morning of October 3, 2012, sponsored by the Jewish Seniors Alliance, Canadian Centre for Policy Alternatives, Remaining LIght, and Integrated Care Advocacy. Approximately 80 people attended the session.

The panel consisted of four people who had direct experience in organizing and delivering more integrated and comprehensive care to frail elders in their communities. They described what works and why. Anne Chisholm, Director of Community & Residential Services from the Northern Regional Health Authority spoke about working closely with the community and flexibly tailoring the services to the needs expressed by the community. Shannon Berg, Executive Director of Home and Community Care, Vancouver Coastal Regional Health Authority spoke about the present on-going research being done by the health authority to overcome existing obstacles to integrating comprehensive care. Dr. John Sloan talked about a project called, Home Vive, funded by Vancouver Coastal, which provides 24/7 medical care, including physicians, nurses, and other disciplines such as physio, occupational,and nutritional services. He elaborated on the need to keep frail elders with multiple chronic conditions in their homes, providing comfort and quality of life to the senior. Michele Jessop, Manager of Choice Day Programs in Edmonton Alberta described a very comprehensive program that has been in existence for many years. It consists of a day care program offering socialization, two meals a day, and transportation as well as a full medical clinic for those who might need the services of a doctor, nurse, pharmacy oversight, and rehabilitation.

They also provide in home services and outreach to social isolates. Gloria Levi, coordinator of Integrated Care Advocacy, was the moderator. She urged people to advocate for more integrated comprehensive community based care and to make it a priority issue in the next provincial election. It was a very well informed and participatory audience.

The workshop made an indelible impression on all those attending and many attendees responded enthusiastically.

Many thanks to the sponsors and staff who made this workshop possible.

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What Do We Mean by “Integrated Care”

Integrated care means a one-stop shop for accessing care. An integrated, non-fragmented system, will assist a smooth transition to higher levels of care, such as residential care when and if needed. We are talking about care which can be delivered in the community to the home of the elder in his/her community setting. Home care empowers people to live independently in the own homes, with dignity as long as possible. This care will not be narrowly defined as only medical care. It will involve an array of services that are preventative and therapeutic measures such as homemaker services, etc. and support for the family care-giver.

Accessibility is the first step. The first contact into the system may be the family physician or the case manager at the local health unit, usually a nurse but not necessarily. The key contact who will open doors is the case manager. The elder must know how to contact his/her local case manager. This should be advertised as widely as possible: doctors’ offices, community centres, health units, seniors’ organizations, etc., not just through a telephone number or a website I A case manager is a person who is able to do a comprehensive functional assessment of the physical, social, emotional, and psychological needs of the elder. This manager will be up-to-­date and aware of the broad range of services that is potentially available for that elder. The guiding principle of the case manager is to listen carefully to the needs of the elder and allocate the most appropriate care required by that elder.

The broad range of services that may be available to the elder must include doctor’s home visits 24/7, if and when necessary, plus additional services, such as physiotherapy/occupational therapy, nursing, dental and optical. Equally as important, it must include broad-based preventative services, such as, cooking, cleaning, laundry, shopping, transportation, possibly yard work if necessary, and socialization programs, etc.

The focus on broad based community services to elders in their homes requires the raising of standards, training, and supervision for home health aides, drivers, recreational workers, volunteers, etc. Professionals will recognize the vital role that family members play in the care of their elders. A new social contract will be created between the health professionals, elders, and their families. This relationship will empower elders and/or families to have full participation in the decision-making process about necessary services. To do this, elders and their families need to be fully informed of all pertinent facts.

Present situation blocking effective integrated care: There is a shortage of case managers. A minimal bUdget is set aside for community supportive services. There are harsh restrictions on non-medical services and they have been severely cut-back. The present focus within regional health units is on strictly medical care with acute care gobbling up the major share of the budget.

For integrated care to work, with the focus on increased community based services to the elder living at home, there must be a reallocation of dollars I We have to stop being penny-wise and pound-foolish. This may require a three year transitional period. This reallocation may result in re-thinking our fee-for-service form of payment to doctors. Some home-based services may require subsidized patient payment on a sliding scale.

ACTION ONE COULD TAKE:

Write to your MLA, the Minister of Health, the Critic for Seniors Affairs, letters to the editor of The Vancouver Sun, the Province, you local neighbourhood newspaper. All or any of the above.

Inform them about your desire and need for more community-based home care and for a more integrated system of delivery of that service. For any questions, suggestions or follow-up:

Gloria Levi, coordinator of ICA (Integrated Care Advocacy)
Tel: 604-873-0078
goldielevi@gmail.com

Click here to download Choice Program Fact Sheet (Alberta Health Service) – presented at the Seminar

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