EXPANDING AND INNOVATING WITH LONG-TERM CARE HOMES AND SENIORS SERVICES IN RURAL ONTARIO - LISA LEVIN, CEO SHILPI MAJUMDER, PHD, DIRECTOR OF ...
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Expanding and Innovating with
Long-Term Care Homes and
Seniors Services in Rural Ontario
Lisa Levin, CEO
Shilpi Majumder, PhD,
Director of Public Policy
AdvantAge Ontario
> AdvantAge Ontario is the trusted voice for senior care
> We represent community-based, not-for-profit organizations dedicated to
supporting the best possible aging experience. Our members include
municipal, charitable and
not-for-profit agencies
> The association and our members have
been advancing senior care for 100 years!
Page 2
Today’s Presentation >Seniors’ Care Context >Challenges >Solutions >Municipal Homes Provide value >The Rural Context >Wellington Terrace
Seniors’ Care Context:
Challenges
Page 7
Increased Acuity
>Increased acuity of seniors in community (including supportive
housing, retirement homes, and various other seniors housing options)
>Seniors being admitted to LTC are older and have increased acuity
>LTC homes admit residents with higher MAPLe scores than before –
this trickles down into community as well
>2 out of 3 residents in Ontario’s LTC homes have been diagnosed with
dementia, while 90% have some form of cognitive impairment
>Increased incidences of responsive behaviours
Page 8
Wait List Challenges
> 54,835 senior households in Ontario were on
waiting lists for social housing in 2015 and
waited an average of 4.4 years
> Over 34,000 people may wait up to 400 days
for an LTC bed
> Wait lists are projected to reach 48,000 by
2021
> 142 days - average time to placement in LTC
as of Oct 2018
Page 9
Health Human Resource Challenges > Existing long term care homes cannot find enough staff like PSWs and nurses. > Northern, rural and remote communities face major challenges recruiting and retaining qualified staff to meet seniors’ needs. > Staff shortages lead to increased staff stress and burnout and impacts the quality of care provided to residents > A survey of PSWs found that 79% were dissatisfied with their jobs and 39% of those that were reported staffing issues as the reason > 63% of those who have left the field say that burnout is the key reason
Solutions
Page 7
Solutions – HHR Strategy > An average of 4 hours of care per resident, per day would help to both maintain high quality care and improve working conditions for staff > Recruitment and appropriate training of staff to work in seniors’ care settings is key to addressing shortages > Allowing on-the-job training, facilitating more placements in LTC homes, and offering support for continuous training and skills upgrading are recommended > Reducing unnecessary regulations that take workers away from front-line care would help to improve care and working conditions > We recommend that the government develop a long-term, integrated health human resources strategy that begins with capacity planning.
Solutions - Dementia care > High levels of resident acuity, multiple chronic conditions, dementia-related responsive behaviours, makes it difficult to provide quality care, in the face of serious HHR shortages > A different way of thinking, recognizing the basic emotional and social needs of seniors, can improve lives for tens of thousands of people across Ontario. > Unique care models like Butterfly, Green House and Eden Alternative are transforming the way we think about seniors’ care. > Seniors’ campuses allow better use of tax dollars, stronger communication between care professionals, and smoother transitions as needs grow.
Examples – Emotional Care
> Malton Village – Butterfly Approach
> Grandview Lodge – Montessori and Butterfly
> Bruyére – Cluster Living
Page 11Example – Campus of Care Model
> Campuses of Care provide innovative solutions for older adults and
caregivers wishing to age-in-place in their communities
> Campuses include:
• Range of seniors’ housing options, including Long Term Care
• Community services
• Wellness programs and Seniors’ Active Living Centres
> AdvantAge Ontario co-funded a CIHR Impact Fellow, Dr. Frances Morton-
Chang and partnered with University of Toronto to conduct research on
campuses of care
> Benefits include independence, well-being, reduced social isolation and
reduced hospital and LTC admissions
Page 12Solutions – Age in Place
> Municipal homes partner with various
other community organizations
> Many municipalities are beginning to
offer a continuum of integrated
services to seniors in a campus of care
> Municipalities are building age-friendly
communities to support
seniors aging in place
Photo: Corporation of the County of Simcoe, Georgian Village
Page 13Our plan
> In our 2019 pre-budget submission we’ve taken
our front-line experience and put together a plan
for how, working with government, we can solve
hallway health care.
> At a glance, our recommendations support four
critical goals:
> More people for the front lines
> Thinking about care in new ways
> Ending hallway health care
> Reducing over-regulationMunicipal Homes
Provide Value
Page 11History of the Municipal Role in LTC
>Municipalities have long played an
essential role in the delivery of care
>Municipalities have been part of our
association since inception
>Currently, 17% of all long term care homes in
Ontario are municipally owned
>Our members include 88 municipal LTC homes
Page 16Municipal Long Term Care Provides Value
> Care closer to home
> Care for everyone
> High quality care
> Innovative and integrated care for seniors
> Strong communities
> Good jobs and economic benefits
> A strong voice for seniors
Page 17High Quality Care
> Municipal homes belong to the not-for-profit sector
> Rigorous systematic reviews have shown that NFP homes consistently
excel on a range of quality measures:
• More hours of care (20-25 minutes more of direct care)
• Higher staff-skill mix
• Lower staff turnover
• Lower restraint use
• 25% lower risk of hospital admissions (1 year after admission)
• 10% lower risk of mortality (1 year after admission)
• 8% lower risk of pressure ulcers
> Our data also shows that NFP homes are often the provider of choice
Page 18The Rural Context
Page 11The Rural Context - Challenges > Geographically remote and isolated, low population density > Long travel times for services not locally available > Weather extremes and lack of public transportation impact access to care > Often high density of elderly, Aboriginal and other distinct populations (such as francophone, migrant workers, etc.) > High burden of chronic disease > May have high prevalence of mental illness, alcohol/substance abuse > Limited health service options > Limited health care provider availability > HHR shortages are even more pronounced Source: Multi-Sector Rural Health Hub Advisory Committee (January 2015). Rural Health Hubs Framework for Ontario. Retrieved from https://www.oha.com/Documents/Rural%20Health%20Hub%20Framework%20Ontario.pdf
Development in Rural Areas
> Currently, over 30,000 B, C, and upgraded D beds in about 300 homes remain to
be redeveloped by 2025, in order to meet the current design standards
> In addition, 6,000 new beds have been allocated across the province to create
additional spaces for long term care home residents by 2022
> Challenges for rural homes to develop/redevelop:
> Smaller homes; fixed costs
> Being able to staff a larger home
> Construction costs are higher due to remote access
> Lack of IT support
> Need to support their specific populations such as Francophone and
Indigenous
> Difficulty fundraisingSolution: Collaboration and Rural Hubs
Vision
The creation of rural health
hubs will encourage and
enable local health care and
social service providers such
as hospitals, health centres
and physicians in rural
communities to work
together to create a rural
health hub tailored to their
local community’s needs in a
way that enhances seamless,
sustainable service
integration and the effective
delivery of person-centred,
equitable, high-quality,
timely health care, whether it
is delivered locally or
referred to a regional
partner.
Source: Multi-Sector Rural Health Hub Advisory Committee (January 2015). Rural Health Hubs Framework for Ontario. Retrieved from
https://www.oha.com/Documents/Rural%20Health%20Hub%20Framework%20Ontario.pdfRural Hubs
> “Rural Health Hubs will allow local health and social service providers,
through formal agreements and partnerships, and on-going community
consultation, to improve the coordination and effectiveness of care for a
defined population and/or geographic area. Each rural health hub will
be locally defined and tailored to the community.”
> To be successful, hubs should:
> build on existing collaborations
> develop a local, evidence-based and equity-informed Community
Health Plan
> Engage with all providers and the community meaningfully
throughout the process
Source: Multi-Sector Rural Health Hub Advisory Committee (January 2015). Rural Health Hubs Framework for Ontario. Retrieved from
https://www.oha.com/Documents/Rural%20Health%20Hub%20Framework%20Ontario.pdfWellington Terrace Laura Holtom, Administrator
Resident’s Experience People are drawn to live in a rural municipal LTC Home because: > Close proximity to their home of origin > Sense of pride in living in a home where the community has contributed to the standard of care > Likely to know other residents living in the home > Likely their care givers are familiar to them from their community > Programmes and services are geared to what brings them pleasure
Employee Experience People are drawn to work in rural municipal home: > Employees like to work in the community they live in > Municipal homes are known for being service oriented > Municipal homes offer competitive wages and benefits and provide stability to employees, residents and their families > Workers with a rural background bring a good work ethic, and motivation drawn from core values
Challenges for Rural Homes Health Human Resources: Challenges: > PSW shortage through out the sector = smaller candidate pool to draw from > Millennials not interested in working shift work > Difficult for local people to access post secondary schools in urban centers > Inadequate childcare in rural settings Solutions in County of Wellington: > ‘Grow your own’ strategies > Proving flexibility in work place > Partnerships with local high school and post secondary > Local day care
Challenges for Rural Homes Resident Care Challenges: > Access to services > Transportation is limited > Level of expertise in rural areas is limited. Solutions in Wellington County: > Telemedicine technology > Utilizing in-house expertise and service oriented approach to care > Capacity building > Relationship building with partners
Rural Challenges Rural Challenge: > Aging Population > Health care pressures > Distance from loved one living in LTC Solutions: > Exploring the possibility of a Continuum of Care development on our property adjacent to Wellington Terrace
Questions? Shilpi Majumder: smajumder@advantageontario.ca Lisa Levin: llevin@advantageontario.ca Laura Holtom: laurah@wellington.ca AdvantAge Ontario 7050 Weston Road, Suite 700 Woodbridge, ON L4L 8G7 T: 905-851-8821 Twitter.com/advantageont www.advantageontario.ca
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