Long Term Care Administration

1
Long Term Care Administration

• Agenda
• Thursday, September 16, 2010
• News Stories
• Study of Aging
• BC Ministry of Health
• Coffee Break
• History and Evolution of Long Term Care
• Group Presentation Prep Time

2
History and Evolution of Long-Term Care

• Long Term Care Administration
• September 16, 2010

3
History and Evolution of Long Term Care
4
History and Evolution of Long Term Care

• Gerontology is the study of aging. It is to be
  distinguished from geriatrics, which is the study
  of the diseases of the aging (medical studies).
  Gerontology covers the social, psychological and
  biological aspects of aging.
• Gerontology includes these and other endeavors
• studying physical, mental, and social changes in
  people as they age.
• investigating the effects of our aging population
  on society.
• applying this knowledge to policies and programs.
  
• As a result of the multidisciplinary focus of
  gerontology, professionals from several fields
  call themselves "gerontologists".

5
History of Evolution of Long Term Care

• The term "gerontology" was introduced in 1903 by
  Elie Metchnikoff, a Nobel laureate and professor
  at the Pasteur Institute of Paris.
• In North America, the emergence of gerontology as
  a scientific movement can be traced to a small
  group of leaders who, in the mid-1930s,
  recognized that the health of the American
  population was undergoing a change from
  domination by infectious diseases to chronic
  diseases.
• The Gerontological Society of America was founded
  in 1945, and the International Association of
  Gerontology about five years later.

6
History and Evolution of Long Term Care

• Earliest References to the Aging Process?
• King Solomon
• Ecclesistes Chapter 12
• 1 Remember then thy Creator in the days of thy
  youth, before the evil days come, and the years
  draw nigh, when thou shalt say 'I have no
  pleasure in them'
• 2 Before the sun, and the light, and the moon,
  and the stars, are darkened, and the clouds
  return after the rain
• 3 In the day when the keepers of the house shall
  tremble, and the strong men shall bow themselves,
  and the grinders cease because they are few, and
  those that look out shall be darkened in the
  windows,

7
History and Evolution of Long Term Care

• 4 And the doors shall be shut in the street, when
  the sound of the grinding is low and one shall
  start up at the voice of a bird, and all the
  daughters of music shall be brought low
• 5 Also when they shall be afraid of that which is
  high, and terrors shall be in the way and the
  almond-tree shall blossom, and the grasshopper
  shall drag itself along, and the caperberry shall
  fail because man goeth to his long home, and the
  mourners go about the streets
• 6 Before the silver cord is snapped asunder, and
  the golden bowl is shattered, and the pitcher is
  broken at the fountain, and the wheel falleth
  shattered, into the pit

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
BC Ministry of Health
19
Ministry of Health
20
Ministry of Health
21
Ministry of Health

• 2006 Budget Spending

22
Ministry of Health

• Budget 2006
• More than 100 million over three years for
  operating costs associated with government's
  commitment to add 5,000 new residential care,
  assisted living, and supportive housing beds with
  home support by December 2008.
• This builds on the 75 million in each of 2005/06
  and 2006/07 that was provided in the
  September Update to strengthen and modernise the
  full range of health care services for seniors,
  including purchasing temporary residential care
  and assisted living beds, increasing home support
  hours, enhanced adult day care, falls prevention,
  palliative care, health promotion programs, and
  acquisition of specialised equipment.

23
BC Ministry of Health

• Our mission is to guide and enhance the
  province's health services to ensure British
  Columbians are supported in their efforts to
  maintain and improve their health.
• The Ministry of Health works together with BCs
  health authorities to provide quality,
  appropriate and timely health services to British
  Columbians. 
• The ministry sets province-wide goals, standards
  and performance agreements for health service
  delivery by the health authorities. 

24
Home and Community Care

• Home and community care services provide a range
  of health care and support services for eligible
  residents who have acute, chronic, palliative or
  rehabilitative health care needs.
• These services are designed to complement and
  supplement, but not replace, the efforts of
  individuals to care for themselves with the
  assistance of family, friends and community.

25
Home and Community Care, cont

• In-home services, for eligible clients, include
  home care nursing, rehabilitation, home support
  and palliative care.
• Community-based services include adult day
  programs, meal programs, as well as assisted
  living, residential care services and hospice
  care.
• Case management services are provided in both the
  home and community.

26
Home and Community Care Services

• support clients to remain independent and in
  their own homes for as long as possible
• provide services at home to clients who would
  otherwise require admission to hospital or would
  stay longer in hospital
• provide assisted living and residential care
  services to clients who can no longer be
  supported in their homes and
• provide services that support people who are
  nearing the end of their life, and their
  families, at home or in a hospice.

27
Home and Community CarePhilosophy

• home and community care services will promote the
  well-being, dignity and independence of clients
• palliative care services will provide the best
  possible quality of life for people nearing the
  end of their life and their families
• clients and their families should have the
  information required to make their own decisions
  about lifestyle and care and
• clients have the right to make their own care
  decisions.

28
Community Care Services

• Home Support
• Choice in Supports for Independent Living
• Home Care Nursing and Community Rehabilitation
• Adult Day Centres
• Caregiver Relief/Respite
• Assisted Living
• Residential Care
• Group Homes
• Family Care Homes

29
Community Care ServicesHome Support

• Home support services are designed to help
  clients remain independent and in their own home
  as long as possible. Home support provides
  personal assistance with daily activities, such
  as bathing, dressing, grooming and light
  household tasks that help to maintain a safe and
  supportive home.
• If home support assistance is recommended, a case
  manager will help the client determine the
  assistance that will best suit their needs and
  will make the necessary arrangements.

30
Community Care ServicesChoice in Supports for
Independent Living (CSIL)

• Choice in Supports for Independent Living (CSIL)
  is an alternative for eligible home support
  clients. CSIL was developed to give British
  Columbians with daily personal care needs more
  flexibility in managing their home support
  services.
• CSIL is a "self-managed model of care". Clients
  receive funds directly for the purchase of home
  support services. They assume full responsibility
  for the management, co-ordination and financial
  accountability of their services, including
  recruiting, hiring, training, scheduling and
  supervising home support workers.

31
Community Care ServicesChoice in Supports for
Independent Living (CSIL)

• Who is Eligible for CSIL?Eligible clients
• require daily personal assistance
• have the ability to direct all aspects of their
  care or have a client support group to do so and
  
• have demonstrated the ability to manage care
  services.

32
Community Care ServicesChoice in Supports for
Community Independent Living (CSIL)

• Getting Help Managing CSIL ServicesSeniors and
  people with disabilities who are unable, or not
  always able, to direct their own care can obtain
  CSIL funding through the formation of a client
  support group.What is a Client Support
  Group?A client support group consists of five
  people who have registered as a non-profit
  society for the purpose of managing support
  services on behalf of a CSIL client. Family
  members, friends, neighbours, an advocate, family
  physician or others may be members of the client
  support group.The client support group takes on
  all the responsibilities of an employer. CSIL
  funds go directly to the group to purchase home
  support services on behalf of their client.

33
Community Care ServicesChoice in Supports for
Independent Living (CSIL)

• Payment to Family MembersHome and community
  care recognizes that families have the primary
  responsibility of caring for and assisting family
  members. Families remain the most important
  source of support for clients.CSIL clients have
  greater flexibility in their care options and the
  opportunity to pay some family members as
  caregivers. Family members who do not live with
  the client, such as siblings, aunts or cousins,
  may be eligible. Although family members who do
  live with clients are not usually eligible, some
  exceptions may be made.

34
Community Care ServicesHome Care Nursing and
Community Rehabilitation

• Home care nursing and community rehabilitation
  are professional services, delivered to clients
  in the community by registered nurses and
  rehabilitation therapists. Nursing care is
  available on a non-emergency basis for British
  Columbians requiring acute, chronic, palliative
  or rehabilitative support. Rehabilitation
  therapists can also provide assessment and
  treatment to ensure a client's home is suitably
  arranged for their needs and safety.

35
Community Care ServicesAdult Day Centres

• Adult day programs assist seniors and adults
  with disabilities to continue to live in their
  own homes by providing supportive group programs
  and activities that assist with daily activities
  or give clients a chance to be more involved in
  their community.

36
Community Care ServicesAdult Day Centres

• Activities vary with each centre. They may
  include
• personal care services, such as bathing programs
  and administering medications
• therapeutic recreation and social activities
• caregiver respite, education and support and
• in some centres, meals and transportation may
  also be provided or arranged.

37
Community Car ServicesAdult Day Centres
38
Community Care ServicesAdult Day Centres
39
Community Care ServicesAdult Day Centres
40
Community Care ServicesAdult Day Centres
41
Community Care ServicesAdult Day Centres
42
Community Care ServicesAdult Day Centres
43
Community Care ServicesAdult Day Centres

• Clients may attend an adult day program in
  addition to receiving other services, such as
  Meals-on-Wheels and home support. Many programs
  are connected with residential care facilities,
  while others operate independently.

44
Crossreach Adult Day Centre

• Crossreach is a non-profit society, located in
  Vancouver, British Columbia, that provides
  services to seniors.
• Crossreach operates an adult day centre which
  provides a safe setting, social interaction and
  other programs for seniors able to remain at home
  alone during the day or who would otherwise be
  deprived of contact with others, and also
  provides respite for caregivers. We are committed
  to supporting the independent living of seniors
  and improving their lifestyle, so that seniors
  can age in place for as long as they are able
  to.
• We are located at 3348 West Broadway, in our own
  building, which was specifically designed for
  adults. We provide a smoke-free environment in
  bright, spacious and wheelchair accessible
  premises. We have a commercial kitchen in which
  our professional chef prepares healthy,
  nutritionally-balanced snacks and meals. Our
  dining facility can seat up to 60 people, and can
  be booked for private events.
• Membership in Crossreach is available to anyone
  for an annual fee of 25. Senior members who are
  clients of Crossreach pay an annual fee of 10.

45
Crossreach Adult Day Centre

• How Clients are Selected
• To be eligible to participate in Crossreach as a
  client, you must
•  be 65 plus live in the West Point Grey area
  of Vancouver (including Kitsilano, Kerrisdale,
  Dunbar and Point Grey) be referred to us
  (either by a doctor, family member or referring
  agency) meet with a representative of the
  Vancouver Coastal Health Authority, who will
  assess your needs and determine if our services
  will be of benefit be issued a long-term care
  number by the Health Authority, and meet with
  our client co-ordinators in your home
• Our client co-ordinator is happy to help you and
  your family to obtain an appointment with the
  appropriate referring agency.

46
Crossreach Adult Day Centre

• Crossreach is open for clients from Monday to
  Friday each week. A typical day at Crossreach
  includes a morning snack, exercises and music, a
  healthy hot lunch, crafts and games, outings to
  parks, and other activities designed to
  entertain, stimulate and engage our seniors.
• Crossreach is authorized to provide its services
  by the provincial Ministry of Health, through the
  Vancouver Coastal Health Authority, from which we
  receive funds for operations.
• To supplement the funds received from the Health
  Authority, we charge a small "daily fee" to our
  clients to cover part of the costs of the meals
  and activities. We also organize fund-raising
  events during the year and raise funds from
  donations and legacies, memberships, rentals of
  our premises, catering services, family dinners
  and partnerships with business.

47
Crossreach Adult Day Centre

• A Day At Crossreach
• 830 a.m. We phone you to ask if you are joining
  us today
• 930 - 1000 am Handi-dart arrives to collect you
  (Handi-dart charges a small fee)
• 1030 a.m. Arrive at Crossreach and enjoy a fresh
  muffin and coffee or tea
• 1100 a.m. Morning Session exercises, yoga,
  music therapy
• Noon Enjoy a fresh healthy hot lunch prepared by
  our chef
• 130 p.m. Afternoon activities crafts or games,
  discussion groups, perhaps an outing in our
  18-passenger bus to a local pub, park or Wal-Mart
• 300 p.m.Handi-dart takes you home 

48
Crossreach Adult Day Centre

• Nutrition Program and Menu
• We have a commercial kitchen and a professional
  chef.
• Morning Snack - the morning snack is usually
  coffee or tea, along with a freshly baked muffin,
  scone or other delight.
• Noon Meal - our lunches are designed mainly for
  our clients who are spending the day with us.
  However, we welcome family and friends of our
  seniors. The cost of the lunch for clients is
  covered by the daily fee. The lunch is
  nutritionally balanced, and consists of soup, a
  hot entree and a dessert. There is always water,
  coffee, tea and juice.
• Afternoon Nutrition Break - on days when we offer
  afternoon activities at Crossreach, we provide
  afternoon coffee, tea or juice. On occasion one
  of our staff or clients will contribute baked
  goods for our afternoon break!

49
Community Care ServicesCaregiver Relief/Respite

• Many people receiving home and community care
  services are assisted by non-professional
  caregivers, often a friend or family member.
• Respite care can give the caregiver temporary
  relief from the emotional and physical demands of
  caring for a friend or family member.
• It gives caregivers the opportunity to join in
  community activities, while renewing their
  energies so they may continue to provide quality
  care.

50
Community Care ServicesCaregiver Relief/Respite

• Respite may take the form of a service in the
  client's home. Or, the client may be admitted, on
  a short-term basis, to a residential care
  facility, hospice or other community care
  setting. Caregivers may also take a break while
  the client attends an adult day centre or is
  receiving home support services.

51
Community Care ServicesAssisted Living

• Assisted living residences provide housing,
  hospitality services and personalized assistance
  services for adults who can live independently
  but require regular assistance with daily
  activities, usually because of age, illness or
  disabilities. Support services promote occupants'
  independence, while involving family and friends
  in their care.Assisted living residences
  combine building features and services that
  enable people to remain in their community as
  long as they are able to self-direct their own
  care. They maximize independence, while promoting
  choice, self-direction and dignity.

52
Community Care ServicesAssisted Living

• HousingAssisted living residences can range
  from a highrise apartment complex to a private
  home. Units can vary from one room to private,
  self-contained apartments. Residences may be
  located on their own or housed with other
  residential options, such as supportive housing
  (for people with lower care needs) or residential
  care.

53
Community Care Services Assisted Living

• Building History2006
• Suites56 one-bedroom suites
• Onsite Amenities
• Dining room
• Library
• Computer Stations
• Social Lounge

54
Community Care ServicesAssisted Living

• Health Care
• Personal Care Services will be provided.
• Emergency Response24-hour emergency on-call
  system is provided in each suite. Mount Saint
  Josephs Hospital is a ten-minute drive from
  Clarendon Court.
• A pharmacy, along with medical and dental
  offices is located in the mall across the street.

55
Community Care ServicesAssisted Living

• ServicesHospitality services consist of
• meals
• housekeeping
• laundry
• social and recreational opportunities and
• a 24-hour response system.
• Personal assistance services may include
  assistance with tasks like bathing, grooming,
  dressing and mobility.Other specific nursing
  and rehabilitation tasks, such as assistance with
  medication, may be delegated by a health care
  professional to personal assistance staff.

56
Community Care ServicesAssisted Living

• Moving InPublicly-funded assisted living
  residences are available to seniors and people
  with disabilities who
• are able to make informed decisions about their
  daily activities and personal assistance
  services and
• are able to communicate and be understood by
  personal assistance staff or by a spouse living
  with them who can communicate with staff on their
  behalf and
• are able to use an emergency response system and
  take direction in an emergency, such as a fire.

57
Community Care Services Assisted Living

• Moving OutA client is required to move out of
  assisted living if
• they are no longer able to self-direct their own
  care or
• their behavior jeopardizes their or others'
  safety and well-being or
• they are not complying with the terms of their
  occupancy (or residency) agreement.
• If a client's care needs can no longer be met in
  an assisted living residence, they may be
  eligible to move into a residential care facility
  or will be helped to locate other appropriate
  accommodation and services.

58
Community Care Services Assisted Living

• Health and SafetyUnder the Community Care and
  Assisted Living Act, all assisted living
  residences must be registered with the assisted
  living Registrar. The Registrar ensures assisted
  living residences provide services to residents
  in a manner that does not jeopardize their health
  and safety.

59
Community Care ServicesResidential Care

• Facility CareResidential care facilities
  provide 24-hour professional nursing care and
  supervision in a protective, supportive
  environment for people who have complex care
  needs and can no longer be cared for in their own
  homes. Residential care services include
• an assisted meal service
• medication supervision
• personal assistance with daily activities, such
  as bathing, dressing or grooming and
• a planned program of social and recreational
  activities.

60
Community Care ServicesResidential Care
61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
Community Care ServicesResidential Care

• TYPICAL Menu
• BreakfastHot or Cold CerealsCompote of
  FruitFull English Breakfast with Toast and
  PreservesFruit YogurtChoice of Juices
• LunchChefs Best SoupPrime Rib with Au
  JusBaked PotatoesBroccoliDinner RollsAssorted
  Dessert TrayChoice of Beverage
• DinnerChefs Best SoupChefs Salad Plate with
  Dinner RollHerb Roasted Chicken with OBrien
  PotatoesMacaroni CheeseAssorted Desert
  TrayChoice of Beverage

65
Community Care ServicesTypical Day Activities

• 1000 am            Morning Munchies 1100 am
             Sit and Fit Exercise100
  pm              Baking Memories200 pm
               Name that Tune300 pm             
  Kitchen Kaboodle400 pm              Game
  Room700 pm              Fireside Chat

66
Community Care Services Residential Care

• Moving to a Care FacilityBritish Columbia's
  residential access policy ensures seniors and
  people with disabilities with the highest need
  and urgency have priority for the first
  available, appropriate care facility
  bed.Clients who have been assessed as needing
  facility care are expected to take the first room
  that becomes available. Once in residential care,
  clients may request a transfer to a preferred
  care facility when there is an opening.It is
  wise to plan ahead for a move to residential
  care. Clients are encouraged to ask their family
  and friends to help them prepare for their move.
  When a room does become available, they will be
  asked to move in fairly quickly - usually within
  48 hours.

67
Community Care ServicesResidential Care

• What Clients Should Know Before They MoveMoving
  to a residential care facility may not be easy,
  especially for seniors or people with
  disabilities who are moving from their own home.
  Taking the time to learn about the services that
  are offered in the facility, the costs and
  policies will ease the transition and make the
  move less stressful. Here are some questions
  clients may want to ask their case manager before
  they move
• Can they take their own furniture into the care
  facility?
• What are the visiting times?
• What are the facilities' practices regarding
  belongings, pets and mail?
• What kind of clothing should they bring?
• Can outings and overnight stays be arranged?

68
Community Care ServicesGroup Homes

• Group homes are private residences that enable
  adults with disabilities to live as independently
  as possible in the community. They offer an
  important service to residents because they
  provide short- and long-term living arrangements,
  affordable and safe housing, skills training,
  peer support and counselling. Many British
  Columbia communities have group homes, which are
  generally operated by non-profit societies. Homes
  range from single family dwellings to apartment
  complexes and usually accommodate four to six
  residents.

69
Community Care ServicesFamily Care Homes

• Family care homes are single family residences
  that provide supportive accommodation for up to
  two clients. Family care homes can be an
  alternative to a care facility for some
  individuals.What are They Like?Family care
  homes offer a home-like atmosphere, nutritious
  meals and housekeeping services, along with any
  required assistance with daily living activities,
  such as bathing, grooming and dressing.Although
  family care homes are available throughout the
  province, they are more numerous in rural areas
  where their availability allows clients to remain
  in their own communities.

70
Community Care ServicesFamily Care Homes

• Who Uses Family Care Homes?Family care homes
  are for seniors and people with disabilities who
  
• require a more individualized approach to their
  care than is available in a residential care
  facility or
• have an immediate need for residential care and
  are unable to find other suitable alternatives
  or
• find the care environment at a residential care
  facility is not compatible with their religious,
  ethnic or cultural background or lifestyle or
• need short-term assistance upon leaving hospital
  but are not ready to return to living in their
  own home.

71
Community Care ServicesFamily Care Homes
72
Community Care ServicesFamily Group Homes

• FolkStone Family Care Home Locations
• At a FolkStone Home everyone knows your
  name...you become part of the family." FolkStone
  Homes provide a safe atmosphere where the quality
  of life and the desire for independence are
  balanced with the needed assistance.
• Burnaby Coquitlam Delta Ladner
  Langley Maple Ridge New Westminister
• North Vancouver Port Moody Richmond
  Surrey Vancouver White Rock

73
Home and Community Care

• Case Management and Care Co-ordination
• Case managers act as co-ordinators to help
  clients obtain home and community care services.
  They determine the nature, intensity and duration
  of services that would best meet clients' needs
  and arrange their services.The case manager
  will stay in touch with the client to arrange
  care services and make any adjustments necessary
  in the event their care needs change.

74
History and Evolution of Long Term Care

• Continuum of Care
• The coordination or management of care within
  the myriad components of the health care system
  to ensure the provision of the right services, in
  the right place, at the right time.

75
History and Evolution of Long Term Care

• Case Management
• Case Managers act as coordinators of care and
  advocates to help ensure that the care plan
  proceeds smoothly and the elderly persons care
  needs are properly met in a timely way.

76
History and Evolution of Long Term Care

• Three Phases in the Development of Long Term Care
  Services
• First Phase
• Social Disinterest
• Family and Charitable Assistance
• From Colonialism to 1960s

77
History and Evolution of Long Term Care

• Elizabethan Poor Law of 1601
• Required local parishes in England to provide for
  persons who could not support themselves because
  of age, poverty and infirmity.
• Public taxes funded the Almshouses.
• Elderly, Sick or Disabled

78
History and Evolution of Long Term Care

• 1866 Legislation passed in Ontario
• municipalities to set up houses of industry for
• Poor persons who could not support themselves.
• Persons who can look after themselves.
• Persons who did not make an honest living.
• Persons who spend time and money in public
  houses, to the neglect of any lawful cause.
• Persons of low IQ below 20.

79
History and Evolution of Long Term Care
80
History and Evolution of Long Term Care
81
History of Evolution of Long Term Care

• Three Phases in the Development of Long Term Care
  Services
• Second Phase
• Benevolent Paternalism
• Institutional and Professional Focus/Control over
  decision making
• Protect life and improve quality of life by
  various means
• From the 1960s and tapering off into the current
  period

82
History and Evolution of Long Term Care

• Saskatchewan Premier Tommy Douglas implemented
  North Americas first universal hospital
  insurance plan in 1947.

83
History and Evolution of Long Term Care

• National Health Care Funding
• 1948 National Health Grants, construction of
  hospitals.
• 1957 Hospital Insurance and Diagnostic Services
  Act, 60 of hospital services funded by federal
  government.
• 1966 Medical Care Act, 50 medical care expenses
  funded by federal government.

84
History and Evolution of Long Term Care

• Three Phases in the Development of Long Term Care
  Services
• Third Phase
• Dependent adult treated as an adult rather than a
  child
• Uncertainty over degree of implementation of this
  phase
• From recent to past to the current period

85
History and Evolution of Long Term Care

• The Canada Health Act 1984 (Medicare)
• Public Administration
• Comprehensiveness
• Universality
• Portability
• Accessibility

86
History and Evolution of Long Term Care

• Established Programs Financing (EPF) Act
• Injection of federal cash for long term care
  services in 1977.
• Residential care facilities public, proprietary
  and charitable, nursing homes, homes for the
  aged, personal care homes.
• Increase of long term care beds in hospitals.

87
History and Evolution of Long Term Care

• Regionalization (1980s 1990s)
• Cost Containment
• Improved health outcomes
• Increased flexibility and responsiveness of care
• Better integration and coordination of services

88
History and Evolution of Long Term Care

• Closer to Home Seaton Report, BC
• Royal Commission on Health Care and Costs
• Examine the structure, organization, management
  and mandate of the current health care system to
  ensure continued high quality, access and
  affordability.