Community First Strategic Aim - Seniors

On September 26th, at their Open Board Meeting, staff presented the Board of the Central East LHIN Seniors - pngwith the PROPOSED Strategic Aims for the 2013-16 Integrated Health Service Plan (IHSP).  With an overall theme of “Community First – Help Central East LHIN residents spend more time in their homes and their communities”, four aims have been proposed. 

One of the aims is focussed on Seniors and proposes that, by working together as a system, we can reduce the demand for long-term care so that seniors spend 320,000 more days at home in their communities by 2016.

This aim was developed with the support of the LHIN's Regional Specialized Geriatric Services (RSGS) Entity, which is comprised of leaders from a broad cross section of local health service providers and two local seniors' representatives.

Randy Filinski, one of the two seniors' reps offered a potential scenario that could be realized if the system works together to achieve the proposed Seniors Aim.

Mrs H, age 90, was found in a confused state in the lobby of her condo. She was taken to emergency and diagnosed with a stroke; she was admitted overnight for further tests. Since the Emergency Room was busy, she waited 36 hours in the hallway and became de-conditioned. After being moved to a floor, she fell and broke her hip in the middle of the night. This required surgery, but that was delayed for 48 hours due to other priorities. During her eventual surgery, there were complications, and after four days in the ICU and recovery, she passed away.

"More Days at Home" scenario:

Mrs H is referred to a RSGS/GAIN clinic at 90 because of "frailty issues".  Even with a health plan, she experiences the stroke but rather than wait in emergency, her record goes with her where she is intercepted by a Geriatric Emergency Management (GEM) nurse or immediately is treated with an updated plan considering her health and stroke.  She is probably kept in a specialized geriatric floor where the staff is aware of safety concerns (vision, frailty) and is appropriately sent home with services to be implemented by the CCAC/caregiver.
What do the extra days at home provide? 

Over the next 365 days, although under caregiver care and help with community services, she experiences her grandson's engagement and marriage, her granddaughter's newborn, a second granddaughter's first home purchase and has the usual Christmas family festivities with the complete family.  She also plays another 30-40 bridge games with her friends and hits the casino at least twice.  She is absolutely aware of her frailty and stroke issues but accepts these knowing that at some point, she will need to go to a care facility or a place outside of her home.
So, "more days at home" means much more than just surviving with services as she has experienced life all around her.  It is not just a matter of "keeping people alive" but giving them the "choice" to live and experience. 
As Randy says, this is simply one example of changing the story and there are thousands of stories to change.

Let us know what you think

Please click HERE to access the LHIN's IHSP page and provide your feedback on the PROPOSED Strategic Aims.  CF LogoAt the Central East LHIN, our mission is to lead the creation of an integrated sustainable healthcare system that ensures better health, better care, better value for money. 

Your feedback and support will help us all achieve that mission.