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Envisioning Long-Term Care

International study under way

A York University professor is leading an international study seeking to deliver practical solutions to the challenges within long-term residential care.

Dr. Pat Armstrong, a distinguished research professor of sociology at York University, Toronto, leads the seven-year study called Re-Imagining Long-Term Residential Care. She has co-authored numerous books on health policy, including They Deserve Better: The Long-Term Care Experience in Canada and Scandinavia.

This major collaborative project includes researchers in five Canadian provinces, along with researchers in the United States, Germany, Norway, Sweden, and the United Kingdom. Its partners are from workers’ unions, employer associations, and community organizations that represent older people.

The research is organized around four central themes:

• Approaches to care

• Work organization

• Accountability

• Financing and ownership

The first two years of the project (April 2010-April 2012) focused on data collection and publishing articles based on the data. Articles are available at www.yorku.ca/reltc. The project is supported by the Social Sciences and Humanities Research Council of Canada.

An expert panel weighs in

In 2010 the Ontario Long Term Care Association  (OLTCA) commissioned the Conference Board of Canada to investigate the innovation potential of Ontario long-term care homes. Then, the OLTCA convened a panel of experts to address several areas ripe for innovation.

The result was Why not now? a five-year strategy published this year by the expert panel, co-chaired by William Dillane, President, The Response Group, and Dr. William Reichman, President and CEO of Baycrest.

The panel envisions long-term care homes as hubs of innovation that work closely with hospitals, ensuring accessibility, and handling all sorts of short-term, long-term, and cyclical care.

To get there, highly integrated care teams would require new roles and a different mix of skills. Staffing models would have to be developed to allow the same service providers to provide care in and out of hospital.

“The goal of every home should be a committed and competent medical staff that works together as a team to assure easy accessibility at all times,” the report states.

Whatever form it takes, change will inevitably come, as Ontario prepares to nearly triple its number of elderly citizens during the next two decades. The current system shows many signs of being overburdened. Close to 24,000 Ontarians currently await long-term care placement, and too many are taking up hospital beds while they wait.

Here are some of the expert panel recommendations.

• A nurse practitioner in every long term care home

• A significant increase in the proportion of LTC nurses with advanced or specialized training, particularly in areas such as behaviours and pain and symptom management

• Creation of a long-term care medical specialty similar to the AMDA Certified Medical Director in Long Term Care program

• Coverage of LTC facilities as a fixed responsibility of capitated primary care

• Development of alternate LTC physician and nurse practitioner reimbursement models which provide incentives for mentoring LTC staff and students and achieving key care outcomes targets such as reducing hospital transfers

• All self-regulated professions work to full scope of practice, which includes delegation of acts to other health professionals and unregulated staff

• Development of clinical pathways to enable RPNs to support RNs with feeding tubes, PICC lines, tracheostomy and ileostomy care and IV therapy

• Increasing the number of LTCH staff certified in blood transfusions, peripherally inserted central catheters (PICCs), and transportation of blood products and staff with advanced training in dealing with surgical site infections, acute change of condition, end of life care, behaviour management and mental health and addictions

• Creation of new PSW roles (e.g., PSW Care Coordinator, Medication Aide, Caregiver Coach) that enable nursing staff to focus on clinical care and leadership rather than routine tasks that can be safely delegated

• Creation of new categories of workers (e.g., transitional care aides, universal worker) to keep care teams to a reasonable size and improve continuity and consistency of care

• Strengthening of LTC educator roles

• Creation of a multidisciplinary LTC team core competencies task force to examine the composition, skill set and level of interdisciplinary integration required to support the delivery of safe, high-quality care in skilled nursing centres and other models of care delivery

• A comprehensive review and updates to college and university curricula to better prepare front-line workers for the emerging long-term care environment

• Service-based funding that considers optimal staffing mix for different groups of residents, along with outcomes of care

• A “Release 5 Million Hours to Care” campaign should be launched to encourage nurses, PSWs, pharmacists, therapists, physicians, housekeeping staff, maintenance workers, and dietary staff to eliminate unnecessary or routine administrative tasks and redirect the time to improving care and strengthening relationships with residents and families