Caroline Brereton, RN, MBA is a registered nurse and holds an MBA from Queens University. She is a graduate of the Rotman School of Management Advanced Health Leadership Program.
A senior healthcare executive with 15 years of leadership experience, Caroline became Chief Executive Officer of the Mississauga Halton CCAC in May 2010. Caroline has a vision for a system that is fully aligned to support the needs of patients.
The growing population of seniors across the province
will continue to increase pressure on the health sector to provide health care
at home, including community services to help seniors move from hospital to home following acute treatment
and programs to help residents remain safely at home for longer. We feel it
acutely in our Mississauga Halton communities of South Etobicoke, Mississauga,
Oakville, Milton and Halton Hills. We experienced one of Ontario’s
highest growth rates in population, a 12 per cent increase in population from
2006 to 2011. The Mississauga Halton region
is the second fastest
growing population of seniors in Canada (projected 32.3 per cent increase in
75 to 84 year-olds and 71.1 per cent increase in seniors 85 and older, by 2013).
In 2009, anticipating
population growth, the Mississauga Halton CCAC, was the first to launch the Home First Philosophy. In collaboration
with our region’s hospitals, Trillium Health Partners and Halton Healthcare
Services, funding was provided by the
Mississauga Halton LHIN.
The philosophy embodied our
objective: to slow the growth of alternate level of care (ALC)
rates in hospital, while at the same time supporting the province’s goal to
increase access aging at home. It
was ambitious; the number of ALC days nearly doubled from 9.3 per cent in 2007
to 17.5 per cent in 2008.
The Home First Philosophy was the
foundation for a new suite of Wait at Home services and that was
our approach to tackling the growing ALC rate. It is a team-based philosophy
that promotes safe and timely care, services and supports, which helps to meet
the health care needs of patients and families in the most appropriate setting.
The Home
First philosophy recognizes that the home environment is the best place
for recovery and supports people in returning to their homes from hospital
wherever possible. It also provides the necessary services to help older adults
maintain their continued independence in the community.
Challenges and Hurdles
This new philosophy necessitated
changes in workflow, culture and communication. When we introduced it to our patients, staff and partners,
it was a huge culture shift in health care thinking for families and physicians. Traditionally, patients
applied to long-term care homes from the hospital.
Physicians were concerned about safety and risk to
patients leaving hospital and returning home. We helped physicians understand
the quality of care provided in the community through the Mississauga Halton
CCAC. We explained our approach and introduced new services that would ensure
patients, even those with complex care needs, would be safe at home while they
applied for long-term care or recovered and realized they could stay at home
safely with services from our CCAC.
Better Outcomes
Together, with our partners, we drove better
results and we continue to bring proactive change to the health care system. With
innovative efforts and focused teamwork, the consistently low ALC rates in
Mississauga Halton is evidence of system integration as a key mechanism for
delivering the right care, in the right
place, at the right time. In fiscal
2012/13 our ALC rate was seven per cent and 6.3 per cent in the previous year. This
means that 93 per cent of hospital beds in our region were available to patients
needing hospital care.
Staying in hospital after
surgery or treatment is not in a patient’s best interest. There is an increased
risk of infection; and patients become less independent the longer they stay in
hospital.The Home First philosophy
is an enormous cost savings to our health system. Every ten per cent shift of ALC patients from acute care to home
care results in a $35-million saving. And
most importantly, it provides better outcomes for patients where they are
happier and more comfortable in a familiar setting and they tend to recover more
quickly.
Recently, a patient’s son, who is caring for his 83-year-old
father at home, told us: “The Mississauga Halton CCAC made it so
simple and smooth. You take care of everything – personal support workers,
nurses, occupational and physical therapists, medical equipment and
supplies. They brought the hospital to our
home. Now my father is safe and secure,
and getting the quality of life he deserves.
My father belongs here. Without
you, we could not do it. It would have
been impossible. It is a blessing to have my dad here.”
However, if a patient and family decide that
long-term care is the right place to be, we help them through the process from
beginning to end. We start by directing them to our long-term care website – http://mhccac-ltc.com/ –which provides information about wait
lists and costs, as well as a virtual tour of our region’s 27 long-term care
homes.
At the Mississauga Halton CCAC, we look at health
care differently. We recognize health care at home is not the future; it is the
reality of health care today.
*Watch the video on the Home First program, part of the Health Council's Wait Times video series.
