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Wednesday, December 11, 2013

The Home First philsophy - creating safe transitions for patients from acute care to home

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

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 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.

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