Home First - Helping People Stay in their own Homes

When Marguerite Crottie’s 90-year old mother started ‘seeing things’ and was exhibiting some strange behaviours, she was brought to The Scarborough Hospital’s Emergency Department.

“They knew something wasn’t quite right, and she was admitted,” Marguerite recalls of that harried time on June 14. “That’s when I first heard about Home First. A very nice social worker told me about it, and I thought it was a good idea.” 

Home First - TSH
Thanks to Home First, 90-year-old Selena Waddell, left, is able to remain in her home and still receive enhanced care, relieving some of the burden from her daughter, Marguerite Crottie (right). The arrangement was facilitated by Scott Wisner, centre, a social worker at The Scarborough Hospital.

Home First is part of the Central East LHIN’s ‘Aging at Home’ strategy, and is a philosophy that helps patients transition from the hospital back to their homes. By working with patients and their families, TSH, the Central East Community Care Access Centre (CCAC) and Transcare match services to patients to help them stay in their own homes.

“When a patient comes into the hospital, we begin our discussions around discharge planning – how we are going to get them home as safely as possible,” explains Sari Greenwood, Patient Care Manager for the Social Work Department. “Each patient is assessed by the interdisciplinary team, including our community partners, in a discharge support meeting.”

From there, they may receive individualized support services depending on their healthcare needs, such as home care, meals, friendly visitors and light housekeeping.

“The partnership we have developed with the CCAC and Transcare is really collaborative, where we work together to match the right package of services with the patient and their family so that they can go home.” 

For Marguerite and her mother, Selina Waddell, that meant enhanced hours from the three hours a week they were already receiving, to 14 hours a week.

“This means I can get some respite, go on health appointments, and I know Mom is being cared for while I’m away from the house,” says Marguerite, who is 63 and starting to feel the effects of caregiver burn-out.

Scott Wisner is the Social Worker who looked after Marguerite and Selina.

“Home First is about helping patients who no longer require the acute care services of the hospital return home to maximize their quality of life in the community,” Scott explains. “The idea is to do our best to support this person and get them home once their acute needs clear up a bit.”

The Home First philosophy has made it easier for Social Workers like Scott to do their jobs better, especially since he’s working closely with CCAC case managers who attend rounds with Scott every day to discuss each case individually.

“You want to help these patients, and you recognize they’re struggling at home. But with sources so limited in the community, your hands are tied about what you can do for them,” he explains. “Home First makes it easier in situations where the family wants the patient back in their home environment, and are happy to receive the extra help available to them.”

For Marguerite, who is dealing with some health issues of her own right now, Home First has allowed her to continue to look after her mother in her own home, while still having the chance for respite, knowing Selina is well cared-for while she’s doing errands.

The strategy has also helped improve the working relationship between TSH and CCAC.

“We’re working together, supporting one another, particularly around complex and complicated discharges,” Sari adds. “Communication and collaboration with our community partners are improving so that past barriers to discharge are breaking down and we’re getting patients home quicker.”

Submitted by Cindy Woods, Communications Officer, The Scarborough Hospital