Long Term Care Administration Thursday, January 29, 2009 Class Agenda 1. Class Presentation 2. Case Example 3. Users of Long Term Care 4. Break 5. Challenges.

Long Term Care AdministrationThursday, January 29, 2009

Class Agenda1. Class Presentation2. Case Example3. Users of Long Term Care4. Break5. Challenges for LTC Management6. Prep Time for Presentations

What a drag it is getting older…

Doctor please, some more of theseOutside the door, she took four moreWhat a drag it is getting old

Life's just much too hard today,I hear every mother sayThe pursuit of happiness just seems a boreAnd if you take more of those, you will get an overdoseNo more running for the shelter of a mother's little helperThey just helped you on your way, through your busy dying day

Rock Songs about Aging

Long Term Care Administration

Users and Challenges of the Long Term Care System

Users of the Long Term Care System

The Gerharts

Reuniting Seniors – Closer to Home For Mary & Emery Gerhart, Adanac Park Lodge is so close to

home it is as though they are having a family reunion.  For the couple who were married on August 22, 1936, 2006

marks the seventieth anniversary of their wedding. In the past 70 years Vancouver has changed dramatically. Back in 1936 Mary Gerhart recalls purchasing their home in

East Vancouver near Adanac Park for $1,200.  The price was a lot of money for the Gerharts at the time, but

they managed to scrape it up.  Mary created a large vegetable garden at the side of the

house and Emery got some chickens so they could have fresh eggs every day.  

The Gerharts

For more than seventy years, the couple has been the best of friends, and it was with a heavy heart that Mary had to grapple with the idea that due to the effects of Emery’s dementia, she could not longer care for him at home and she reluctantly agreed to have Emery placed in a residential care facility in the Fall of 2001.

Over the years, the couple has shared many joys and many heartaches with the most difficult set back being the death of their sons Roy in 1974 and Bruce in 1997, but through it all their love and friendship remained strong.

Having to be apart for the past five years has been another of the most difficult passages of all.

The Gerharts

Mary stayed in the house during the first four years after Emery moved into Adanac Park Lodge. 

It was a difficult time for her to live alone, after all she had never lived alone and since the age of 17 she had lived with Emery, the love of her life. 

Living alone in the house became too much for Mary and she moved to an assisted living facility in January of 2006.

That too was hard, but she tried her best to cope.

The Gerharts

After seventy years of marriage, the Gerharts were reunited at Adanac Park Lodge.

In a written history from Audrey Raines, one of the Gerharts daughters, she expressed her many thanks and gratitude…”the family wants to thank the hard work and advocacy by a wonderful woman from the Fraser Health Authority, [the case manager] Eleanor Allan. 

In addition, the family wants to thank Vancouver Coastal Health and the healthcare professionals at Adanac Park Lodge.

Because of all these people, mom and dad were reunited again.” Now in the final sunset of their lives, they are together once again - to

give comfort to one another. It is a love that has survived and flourished and an example of which

to be proud. Both daughters are very grateful that they have this chance to be

together again for their parents. This is a great example of the health care system working well with

very positive results.

The Gerharts Today

Users of Long Term Care

Consumers – It does take a village Independent to care needs. Receives a service provides another Neighbours: frail elder, living next

door is a mom and a preschooler – neighbours support each other.

Community services are an extension of such neighbouring.

Retain power of decision making.

Users of Long Term Care

Clients Less independent to care needs. Use services based on a

multidimensional assessment. Formal system controls delivery of

services and care. Informal system retain control over

daily living activities.

Users of Long Term Care

Residents Lack of informal supports to be

cared for safely in the community. 24/7 supervision, care, safe, secure,

protective living environment. Ethnocultural & geographic specific. Limited control over surroundings.

User of Long Term Care

Patients Physical, mental illness, long-stay. Med. complex, heavy, tech dependent

and conditions may change over time – discharged to home of LTC Facility.

Limited choice food and clothing. Regionalization: movement of funds from

acute care to long term care and community care.

Demographics of Long Term Care Users

Demographics of Long Term Care Users

Demographics of Long Term Care Users

Demographics of Long Term Care Users

Users of Long Term Care

Needs and Expectations Based on assessed needs. Older, frailer, sicker, chronic care. Longer life = functional disability. Need to support informal caregivers Baby boomers will want larger

collective solutions to long term care services needs

Users of Long Term Care

Major Concerns Caregivers consume health care. Women caregivers, low wages, no

family support networks, friends. Substantial personal investment in

time and money. Multitude of issues impact on users

Users of Long Term Care

93-year-old former fitness instructor and physical education teacher diedin November 2006.

He helped popularize basketball in Britain. Basil "Joe“, died of pneumonia at a

hospital in England, about a week after he was injured during a fall at his home.

His Australian-born wife of 59 years, Eva, died of heart failure in 2000.

He is survived by two sons Mick and Chris

Users of Long Term Care

Challenges for LTC Management

Aging of the population. Shortage of LTC beds & wait lists. Mergers, conversions and closures. No new construction of facilities. Acute care hospital stays reduced. Frail, medically complex illnesses. Home and community alternatives

to institutional care.

Challenges for LTC Management

1 Projecting populations and their health status

2 Providing support for supporters3 Discovering innovation in LTC4 Working for an aging society5 Financing LTC in the future

Challenges for LTC Management

Projecting Populations and Their Health Status

1 % people at various stages of health unpredictable.

2 Cognitive impairments first than physical health problems, for some the impairments are intertwined.

Challenges for LTC Management

Projecting Populations and Their Health Status

3 Not all impairments are degenerative in progression.

4 92% 65+ females are active 85% 75+ females are active 60% 85+ females are active 50% 95+ females are active

Challenges of LTC Management

Projecting Populations and Their Health Status

5 Activity level does not drop after 956 Men are more active to the end, at

advanced age in particular. 60% 95+ men are active 50% 95+ women are active

Challenges for LTC Management

Providing Support for Supporters Family caregivers provide the most

important role. Caregivers do not have social or

recreational outlets. Challenge – create effective care

plans for both client and supporters.

Challenge for LTC Management

Discovering Innovations in LTC Single point of entry – one stop

shopping for a full range of services Case management Increase in choices & care settings. Innovation funds dedicated for pilot

and demonstration projects.

Challenges for LTC Management

Home Care Programs Core of community-based services. Demonstrate cost effectiveness. Expand services SW, OT, PT. Focus on problem-solving with

volunteers, self-help groups and professionals to show case home care – effective, satisfied customers

Challenges for LTC Management

Respite Care Evidenced caregiver recuperation Link respite to the continuum. Caregiver assessment is needed. Need to educate public about the

benefit and availability of respite care services.

Challenges of LTC Management

Alternate Care Delivery Options Home Adaptations – grab bars Flex Housing – widened hallways Garden Units – intergenerational Group Homes – Facility in a home Assisted Living – LTC alternative Supportive Housing – High end Adult Day Care – Seniors Centre +

Challenge of LTC Management

LTC Centres Challenges Accreditation – public confidence Priority admissions suitable facility Qualitative social balanced with

quantitative functional impairment Removing production line aspects Strive to improve quality of life

Challenge of LTC Management

LTC Centre Challenges Effective recruitment, caring people Help workers feel that there work is

important Develop a fair funding model Encourage recruitment of young

people into LTC

Challenges for LTC Management

Evidenced Based Classification System

MDS – Minimum Data Set RAI – Resident Assessment

Instrument RUGs- Resource Utilization Groups CIHI – Canadian Institute of Health

Information

Challenges for LTC Management

Professional Issues in LTC More autonomy, variety, career

satisfaction in community-based Emphasis curriculum on cognitive

process Management training HR & Finance Professional incentives Merge community and facility

cultures

Challenge for LTC Management

Frontline Providers of LTC Help lower paid staff feel important Respect and value non-prof. staff Create career ladders non-prof staff Create an atmosphere where staff

are motivated to treat residents as individuals like their own family and friends in an efficient manner

Challenge of LTC Management

Unions and Management Unions want assurance from

management that the overall number of positions will not be reduced and that workloads will not increase.

Nursing union has cast a suspicious eye on delegation of regulated nursing functions.

Challenge of LTC Management

Financing LTC for the Future The costs of long term care should

not come as an unpleasant surprise that causes financial distress for individuals and their families.

Long term care is a normal risk of living and growing old.

Challenges of LTC Management

Protection Against Catastrophic Costs As long as public health insurance

remains in place, there is room for both public and private long term care facilities and programs, especially with the use of assessment tools that review the needs in an impartial manner.

Challenge of LTC Management

Creating a Balance Between Informal, Home Care and Institutional LTC

1. Seniors wish to age in their home.2. Home care preserves

independence, delaying admission to LTC facility and assists in early discharge from hospital.

3. Positive attitudes toward home care

Challenge of LTC Management

Can the Continuum be Sustained? Expand cost effective home care

and adult day care programs and reduce residential beds.

Expand short stay, supportive housing, respite care & innovative LTC programs at the expense of residential beds.

Challenge of LTC Management

Can the Continuum be Sustained? Reverse the trend toward reducing

eligible contributions to RRSPs to discourage the dipping into savings before retirement.

Encourage people to save for retirement.

Challenge of LTC Management

Can the Continuum be Sustained Bring about a national debate

defining what belongs in the universal and comprehensive basket of long term care services and which, if any, services may be offered at varying levels of quality and price.