Transitional Care Program - A New Initiative
- November 2001
A new initiative has patients, hospital staff, home care providers and retirement homes working together to provide Alternate Level of Care programs outside the hospital. The Transitional Care Program was launched in September and is a partnership between the Niagara Health System, ACCESS Niagara (formerly Community Care Access Niagara) and Central Park Lodges.
Under this program, certain patients who meet specific criteria are placed in retirement homes, rather than waiting in hospital for a long-term care bed to become available. While in the retirement homes, they are eligible to receive home care from ACCESS Niagara staff. This ensures that all their health care needs continue to be met, even though they’re living in a facility that doesn’t normally provide that level of care.
"We are very excited to be able to offer our Alternate Level of Care (ALC) patients an option while they wait for a long-term care bed in the community," said Patty Welychka, Regional Director of Utilization Management for the NHS.
"In hospital, patients are designated as ALC when they are medically stable but unable to return home to independent living. The challenge for the NHS is that these patients no longer require an acute care bed, yet they have to remain in hospital while they wait for a bed in a long-term care or nursing home facility," said Ms. Welychka. While ALC patients wait for a bed, they are required to pay to the Ministry of Health hospital co-payment fee, which is geared to the patient’s income, with a maximum charge of $44 per day.
Sometimes the wait for a long-term care bed can be months. Niagara has a shortage of long-term care beds, with as many as 1,480 people on the waiting list at any one time. Following are the categories of care for seniors outside the hospital acute-care setting:
- Retirement Home (Privately-funded) – patients/clients are generally ambulatory or mobile, but may need help with medications
- Long-Term Care or Nursing Home (Publicly-funded) – these patients require help with the activities of daily living
- Complex Continuing Care or Chronic Care (Hospital setting) – these are patients with two or more complex medical conditions and are generally not ambulatory
"To make sure that patients at all sites are treated consistently, the NHS has implemented a new guideline that evaluates patients for the appropriate setting, whether it is complex continuing care, long-term care, or home with home care support," Ms. Welychka explained. "The introduction of Niagara’s first regional ALC process this past April has streamlined the co-ordination and movement of patients throughout the health system in a consistent way."
"For ALC patients, the hospital setting is really not the best place," said Dr. Mohammed Ali, Physician Director for the Utilization Program at the Welland Hospital Site. "They are no longer acutely ill but have no where else to go except to stay in the hospital environment."
New Partnership
This new partnership with Central Park Lodges in Niagara means ALC patients now have an option of being placed in a privately owned retirement home until a regional long-term-care bed is available.
Participating homes are Lundy Manor in Niagara Falls, Residence on Garrison in Fort Erie and The Loyalist in St. Catharines. Patients from all corners of Niagara are eligible for the program. Unlike Niagara’s long-term-care facilities, there are vacant beds in retirement homes. The ALC co-payment fee continues to be charged during the patient’s stay at the retirement home.
It is a win – win – win situation: first and foremost, the patient gets to stay in a wellness environment while waiting for long term care; secondly, the hospital frees up an acute care bed for someone else who may need it; and thirdly, the retirement home fills its beds to capacity.
These patients may require home care support, such as physiotherapy or personal care, and that is where ACCESS Niagara comes into the equation. "By clustering ALC patients at these homes, ACCESS staff can provide the services needed in an efficient manner," Ms. Welychka said.
Already, this new partnership has made a difference to six NHS patients. "The patients are in a more social environment with well people around them, and there are far more recreational opportunities open to them in the retirement homes," Ms. Welychka said. "Even the concept of central dining is making a difference to their quality of life."
In fact, patients like their new setting so much that "We are finding some patients prefer to stay in the retirement home, even when a long-term-care bed is offered to them."
It’s no secret that health care resources are stretched to the limit. "By freeing up hospital beds and making better use of community care settings, we are really providing better health care to our whole population," Ms. Welychka said. "We are also exploring new opportunities, which could mean the NHS having access to other beds, if needed, for the elderly in our community. We will be investigating the benefits for our patients and the health system as a whole."
The Utilization Program implemented the Transitional Care Program in September as an important strategy to help address the ALC days currently being identified at our hospitals. "These days in our system will often cause an increase in overall length of stay numbers, and it may then be difficult to determine further efficiencies unless we address these system issues and designate our patients 'ALC' when appropriate," she said.
With a growing elderly population and changing service levels, the NHS needs to be innovative and work more closely with our partners. This Transitional Care Program is an excellent first step.