The Convalescent Care Program: Flexing the Muscle of Long-Term Care

By Julie Pereira and Kristine Heckman. Julie Pereira, Reg. OT, is the Coordinator and Kristine Heckman,Reg. PT, is Area Manager, LifeMark Eldercare. They can be reached at 1-877-317-8111; for details see www.lifemark.ca. To learn more about the supportive care program, contact your local Community Care Access Centre. (Reprinted with permission from Long Term Care, December 2007, p. 36)

March 2008- While the immediate intervention for an acute medical event or illness in Canada is to remain in hospital, there is now a more cost-effective and arguably a more appropriate environment in which some individuals can recover. Located in a number of long-term care homes across Ontario , the Ministry of Health and Long-Term Care provides additional funding for designated convalescent beds. These beds provide both the therapeutic resources and the gift of time to those who otherwise would be waiting in an acute care setting for a rehab bed. It offers an opportunity for individuals to recuperate in their own community and at a considerably lower cost to the province compared to an acute care setting. (The United States has been using a similar rehabilitation/long-term care model for years through skilled nursing facilities. This program clearly illustrates the ability of the long-term care industry to deliver goal-oriented, interdisciplinary, rehabilitative care to clients.)

Some individuals, particularly older adults, are compromised in their ability to live independently after an acute medical event or as the result of the progression of a chronic illness. A convalescent care bed is intended to help an individual rebuild strength, reduce the need for assistance and reinforce independence through rehabilitation. The focus is on maximizing people's activities of daily living with the goal of reintegration into the community.

Participants who benefit from this program are those who are motivated to return to independent living, have the ability to relearn skills, are medically stable enough to participate in a daily rehabilitation program, and have attainable and well-defined rehabilitation and health goals with a discharge plan back home or to a rehabilitation facility.

Although all convalescent care beds are located in long-term care homes, the individual is not considered a long-term care resident. The utilization of long-term care beds is part of a provincial government initiative to occupy beds outside of the hospital setting. Individuals are considered candidates for the program whether they are a patient in a hospital or are living in the community. People admitted from the community usually experience some medical condition that does not require hospitalization but affects their ability to manage independently. Others are admitted following a hospitalization (eg, surgical procedure, stroke or general deconditioning) and may no longer require acute care services but are not yet able to return home.

Applications to the convalescent care program are made through the local Community Care Access Centre. An applicant has a choice of three supportive care programs. Wait lists can vary depending on the jurisdiction in which the convalescent care beds exist. On acceptance into the convalescent care program, participants are assessed by an interdisciplinary health care team that includes a dietician, nurse, occupational therapist, physician, physiotherapist and social worker. The team, in collaboration with the client and family, develops a specific and realistic plan of care to meet the individual's medical, social and functional goals.

The client may also work with a rehabilitation assistant(s) and personal support workers when participating in his or her therapeutic interventions. The client engages in daily rehabilitative therapy, including strengthening exercises, performance of household tasks (meal preparation, laundry), transfers (tub, toilet, bed) and training on the use of mobility aids if needed (walker, wheelchair). The focus is on restoring physical stamina, increasing mobility and maximizing independence in all regular activities.

The maximum stay of a client in a supportive care bed is 90 days, but on average, the length of stay is closer to 30 to 45 days. Consequently, it is imperative that a discharge plan be developed as soon as a client is admitted into the program.

Prior to discharge, the health care team ensures the client is well prepared to return home. Often, the team will set up a pre-discharge home assessment, determine the need for any mobility or adaptive equipment (walker, wheelchair, assistive devices in the home) and provide links to other community resources. In preparation for discharge, clients will often participate in an overnight trial in their home before being fully discharged from the program. This helps to gauge their readiness to return home and to identify unforeseen issues or concerns that may not have arisen during their stay.

The cost of a convalescent care stay includes a private room with a bathroom, three meals and snacks, education sessions for the client and family, rehabilitation therapy, medical and nursing services, and the use of mobility and therapy equipment. Services such as television, phone and transportation to and from medical appointments are the client's responsibility. If the individual requires a mobility device on a permanent basis, the occupational therapist or physiotherapist will complete an assessment and apply for provincial funding through the Assistive Devices Program to purchase the appropriate aid.

The convalescent care program illustrates the presence of highly skilled, integrated health care teams working in long-term care. These designated beds have allowed the sector to ‘flex its rehabilitation muscle' and demonstrate its capacity to deliver more complex care than what has traditionally been required of us. The sector has the expertise to respond to changes in the health care needs of both the residents of Ontario and new care initiatives implemented by the Ministry of Health and Long-Term Care. Long-term care has once again proven itself to be an accomplished and integral part of the health care continuum in Ontario.

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