Challenges and Changes in Home Care Presentation March 6-7 2009

1. Challenges and Changes
in Homecare
British Columbia Association of Geriatric
Care Physicians Conference
www.bcgeriatrics.ca
Maylene Fong & Heather Wright
March 6th, 2009
1
Outline
• Accessing Services
• Key structure – who’s who
• Services provided in Vancouver Community
Homecare
• Hospice Program
• Challenges
• Community Resources
– Internet
2
Community Health Areas
Three Bridges CHA#1
North CHA#2 (includes Pender Site)
Evergreen CHA#3
Pacific Spirit CHA#4
Raven Song CHA#5
South CHA#6

2. Vancouver Community:
Demographics
• Housing affordability
• Population:
625,000
average- $750,000
• Life expectancy:
• Single parent families 17%
79 year + (F>M)
63 % low income
• Unemployment
• Some age groups
4.3 % (Oct.2006)
increasing:
• English 2nd Lang:
5 – 9 year olds
40%
80 years +
• Visible minorities:
50%
Vancouver Community
Model Populations
Served
Complex
28%
Chronic
Unstable
ry
Treatment
n ju
re
s/I
Ca
es
Chronic Stable 62 %
lln
eI
di c
ut
is o
Secondary Prevention
Ac
Ep
Well at
Risk
6.2%
Well
Prevention & Promotion
Core Functions
Homecare/Case Management
Team Objectives
1. To deliver homecare (eg. nursing, occupational
therapy, physiotherapy, etc.) and case management
services to better meet the needs of our clients
2. To provide more chronic disease management in the
community setting through self-management
strategies, groups, heath centre-based services
3. To develop formal partnerships between community
health staff & community family physicians

3. Home Care Services
• For clients who are home bound
• Access number 604-263-7377
– Central Intake
– Transitional Services Team (TST)
• Provides link from acute care to community
services
• Multidisciplinary Home Care Team
• Nurses, physiotherapist, occupational therapist,
case manager & nutritionist
7
Home Care Structure - CHC
8
Services Provided
• Discipline and team assessments
• Wound care
• Medication management
• Chronic disease management
• Home IV
• Rehabilitation assessment
• Assessment for home support
9

4. Client Assessment
• Functional, health and
mental status
• Risk taking behaviours
• Social & environmental
conditions
Determining Priority of Visit
• Priority 1A: Intolerable Risk
• Visit within 12 hours (same day service)
• high probability of immediate negative outcome if not seen within 12 hours
• Priority 1B: Intolerable Risk
• Visit/Intervention within 12-24 hrs
• high probability of immediate negative outcome if not seen
within 24 hours
• Priority 2: Tolerable Risk
• Visit/Intervention within 48hrs
• high probability of negative outcome or secondary
complications to health, safety of client/family if situation
persists over 48 hrs.
Determining Priority of Visit
• Priority 3: Tolerable Risk
• Visit/Intervention within 1 week
• high probability of negative outcome or secondary complications will occur if
situation persists over 1 week
• Priority 4: Tolerable Risk
• Visit/Intervention within 2 weeks
• moderate probability of negative outcome or secondary
complications will occur if situation persists up to 2 weeks.
• Priority 5: Tolerable Risk
• Visit/Intervention after 2 weeks
• low probability of negative outcome or secondary
complications will occur if situation persists after 2 weeks.

5. Home Support Services
• Based on client need, • Utilize family and community
functional status, goals resources first
of intervention AND
client’s right to make
informed choices
• Maximizes ability for
self care
• Equitable distribution to all
clients
Home Support Service Areas
• Personal care
• Safety maintenance
• Linen and laundry
• Nutritional services/meals
• Respite
Short term hours
• To support
discharge from
hospital and acute
illness recovery

6. Convalescent care
• To support
temporary reduction
in physical function
and tolerance
Palliative care
• To support end of
life clients
– Prognosis < 6
months AND
– Palliative
performance
measure of 50% or
less
Long term care hours
• To support long
term clients with
chronic illness and
disability

7. Home Hospice Program
• Hospice Consult Team
– Interdisciplinary Team
– Supports and supplements GP care
• Assist clients to die at home if they wish
• Provides symptom management
• Supports end of life
• For more information, please call the
Home Hospice Program at 604-742-4010.
19
Ambulatory Clinics
• Each CHC has an ambulatory clinic
• Services include:
– Wound management
– Medication Management
– IV infusions
– Rehabilitation Assessment
• Referrals are through intake, TST,
physician and self referrals
20
Community Resources Links
• Adult Day Care Centres
• STAT Centre (Short Term Assessment & Treatment)
• Meal Programs and Shop by phone
• Home Oxygen Programs
• Caregiver Support Program
• HealthLink
21

8. Challenges Impacting Home
Care Services
• Aging Population
• Movement of acute care services to
community
• Early discharges from hospitals
• Ageing workforce
– Decreasing available staff
22
Challenges
• Adult Guardianship legislation
– First responders
• Clients with many co morbidities
• Complex medication management
• Costs – back to client
• Increasing acuity from hospital
• Electronic Documentation
• Complex medical technology i.e. pumps
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Chronic Disease Prevention &
Management Programs
• Healthy Living Program
• Focus on population Health, screening and CDSM
– Community Pulmonary Rehabilitation
Program
• Kerrisdale community centre
• Exercise and Education Program
– VC Diabetes Education Centre
• Taught in Chinese (2 day workshop with 6 month
follow-up)
24

9. Emerging Practices
• GP Partnerships
– Pacific Spirit
– Raven Song
• Chronic Disease Initiatives in Primary
Care
• Frail Elderly Initiative
– Development of standard care plan,
assessments to support Frail Elderly
25
Questions?
26
www.vch.ca
• http://www.vch.ca/facilities/community/vancouver.htm
• http://www.vch.ca/community/home_and_community_care.htm