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Alberta’s Continuing Care System Organization and Priorities
Presentation to BC Care Provider’s Conference
Tyler James, Executive DirectorContinuing Care
Alberta Health
May 6, 2013
Continuing Care SystemGovernance
• Alberta Health Services (AHS) created as single health authority on April 1, 2009.
• Alberta Health, accountable to the Minister of Health sets directional policy, legislation, regulations and standards, and provides funding to AHS for the delivery of continuing care health services.
• AHS is accountable to the Minister of Health, and is responsible for developing and implementing operational policies, delivering continuing care health services, and assessing and placing continuing care clients.
Continuing Care SystemSystem and Standards
• Continuing Care Health Service Standards– Apply to all publicly-funded continuing care health services.– Currently under review; revisions expected to focus on areas of risk and
quality of life.• Supportive Living and Long-Term Care Accommodation Standards
– Apply to all supportive living and long-term care accommodations.– Last updated April 2010.
Home Living Designated Supportive Living (DSL)
Long-Term Care (LTC)
95,975 Unique Clients 7,985 DSL Spaces* 14,565 LTC Spaces*
Cumulative total to December 31, 2012
Point-in-time information as of March 31, 2013
Point-in-time information as of March 31, 2013
Continuing Care SystemCapacity Planning
• Capacity Planning – Provincial Capacity Planning Model– Commitment to add 1,000 continuing care spaces per year between 2010
and 2015. • Affordable Supportive Living Initiative (ASLI)
– Capital funding provided to operators to support the development of affordable supportive living spaces in the province.
– Since 1999, almost $600 million in funding has been provided to develop, renovate or renew approximately 10,000 supportive living spaces.
– Work in collaboration with AHS to increased the continuing care capacity in priority areas of the province.
Continuing Care SystemPolicy Priorities
• Shift to the Community
90% of Albertans want to live in their own homes during their senior years; 59% of individuals over 95 years of age still live at home.
– Growth in Home Care• Home Care Redesign and Directional Policy Development
– Supportive Living Capacity Growth• Quality and Innovation
– Policy Review– Standards– Innovation Grants– Information Resources
Continuing Care SystemPolicy Priorities
• Accommodation Charges– Long-Term Care Maximum Accommodation Charge increased in January
2013.• Private Room Rate: $58.70/day (~$1785.00/month)• Semi-Private Room Rate: $50.80/day (~$1545.00/month)• Standard Room Rate: $48.15/day (~$1465.00/month)
• Business Model review– Alberta recognises increasing pressures related to cost on the
accommodation and the health side– Upcoming work will look at the funding/revenue and expense issues
review options to develop a model that is more sustainable.
AHS Seniors Health
The Right Care in the Right Place
Presentation to Members
of
BC Care Providers Association
By
David O’Brien
SVP, Primary and Community Care, AHS
May 6th, 2013
8
Familiar Challenges with the Numbers
• Number of older adults in Alberta will grow from 375,000 to 880,000 by 2030
• As cognitive impairment is associated with age, the number of individuals living with dementia will also grow
• Of concern – Alberta has the highest proportion of early onset dementia – 17% (e.g. 1,693 individuals under 65 with a primary diagnosis of dementia were seen by physicians in 2008)
9
Familiar Challenges with Public Expectations
• Higher levels of education and income• Greater interest in being partners in their
own health – autonomy and choice• Expect a higher level and quality of services• Younger, disabled adults want to stay in
community• Older adults want to stay in community or as
close to home as possible
10
Principle Driven Service Delivery
Client based care• Coordinated and trained case manager staff –
increasing integration within community• Acting from a position of wellness and independence;
enhancing individual and community capacity– Caregiver respite; education– Common Home Care services– Adult day programs – Self managed care funding – Testing technology
11
Principle Driven Service Delivery
Aging Closest to Home – Aging in Place
• 90% of Albertans want to live in their own homes during their senior years - 59% of individuals over 95 years of age still live at home
• Increase the services provided through home care– Increase number of clients by 3,000/year for 3 years– Increase the variety of home care services– Provide for assessed extra-ordinary funding
12
Principle Driven Service Delivery
Right Care – Right Place – Shift to Community• Provide home care, and continue to support individuals
who are unable to remain in their own home in living options close to home
• Increasing the range of congregate living options• Increasing supports within current environments, such
as lodges, to accommodate unscheduled health needs• Increase the number of living options
– Add 5,000 new spaces over 5 years – Align living option with right mix of staffing– Provide added care option for episodic care
13
Community Health and Pre-Hospital Supports (CHAPS)
Right patient to the right place at the right time to be cared for by the right practitioner
• CHAPS is an EMS referral program• Connects patients to community and home based services• Helps patients stay at home longer and stay healthier with
additional home services Connect more patients to community services Reduce calls to EMS Reduce Emergency Department presentations Reduce acute care admissions
14
ED To Home (E2H)• Connects Seniors visiting the ED with services in the
community, ensuring access to the right care in the right place
• Currently there are 13 EDs across Alberta with E2H program in-place
• The E2H program is a model of integration between Community and Acute Care
• 5,003 additional Home Care referrals generated, enhancing client knowledge of Home Care and increased communication among service providers
15
Destination Home• Represents philosophical shift in how Health System
currently responds to seniors with complex needs, and those at risk for admission to supportive living, long-term care and/or ED/acute care
• Mirrors similar approaches in other provinces (Home is Best in BC and Home First in Ontario)
• Transfers to congregate living settings will not be considered until all community-based options have been exhausted. Moving to a residential care facility is a life-changing decision that optimally should be made from home.
16
Path to Home• Is an AHS discharge model to effectively and consistently
discharge patients in a standardized method from in-patient beds• Coordinates teams within Acute and Transition care, enabling
completion of activities required prior to discharge in a timely manner, to allow return to home with appropriate community supports
• Model developed on 5 best practices:– Anticipated date of discharge upon admission– Estimated day and time of departure– Readiness for discharge– Complex discharge targeting – flagged and proactive on admission to
acute care– Right time to diagnostics and timeliness of reports
17
Home Care Redesign
• 3-year plan to address provincial inconsistencies around– Home Care Service Guidelines (hours of care
available): developed and implemented across AB– Integration of Home Care with Community & Primary
Care supports– Types of services provided– Rates of pay for Home Care services– Service effectiveness and quality outcomes
18
Responding to the Needs
Patient Care Based Funding – Case Mix Indexing• Started with Long Term Care Facilities; then Supportive
Living; then home care services • Systematic equitable way of dividing available resources
based on client needs• Based in RAI assessments
19
Capacity Changes since 2010
• Added >3,000 new beds• All of them in Supportive Living• Services designed for client need• 24X7 Home Care in retirement homes/lodges• Cost per client reduction• Placement options increasing
20
Outcomes - Making Progress
21
Wait Time for Living Options
22
Seniors ED Utilization
23
Seniors ED Utilization
24
Questions?
Alberta’s Continuing Care System from a Provider’s Perspective
Presentation to BC Care Providers Association
Bruce West, Executive DirectorAlberta Continuing Care Association
May 6, 2013
About the ACCARepresent the owners and operators of publicly funded long term care and supportive living facilities and the providers of publicly funded home care and home support services.
• 26 facility-based members operating over 11,000 beds/spaces in 110 facilities• 26 home care and home support members providing over 5 million hours of care
annually to over 40,000 clients
Vision: The recognized voice for advancing excellence in continuing care
Mission: We advance the continuing care system by:• Advocating for effective public policy;• Assisting members in networking, education and pursuit of best practices;• Promoting a sustainable and innovative continuing care system; and• Championing quality care and quality of life for individuals receiving
continuing care.
Values: As ACCA members our actions are guided by a commitment toexcellence, professionalism, integrity and accountability.
Challenges for Providers in 2010 Health System Restructuring
Loss of corporate memory Revisions to contracts and regional programs and policies Changing roles and responsibilities
Communication and Consultation Lack of consultation on policy and program development Inconsistent and contradictory messages (Gov’t and AHS)
Operating Funding – Health and Accommodation Continuing care underfunded Regional funding and accountability differences No acuity adjustments since 2005 Introduction of Activity Based Funding No accommodation fee adjustment mechanism Taxation inconsistencies
Capital Funding Capital funding available for supportive living but not LTC No capital component (debt servicing or upgrading) in
accommodation fees
Aging LTC Inventory No action on 2008 strategy to replace 7,000 aging long term
care beds by 2015
Standards and Monitoring Regional accountability differences Impact of standards on operating costs Introduction of new health and accommodation standards Multiple, uncoordinated inspections
Workforce Labour shortages Aging workforce Higher expectations and standards Injury and lost time rates
Challenges for Providers in 2010
Challenge Industry Rating Trend
Health System Restructuring B
Communication and Consultation BOperating Funding – Health and Accommodation C
Capital Funding B
Aging LTC Inventory D
Standards and Monitoring B
Workforce B
Challenges – 2013 Status Report