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Transcript of jan 27- 24
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Planning for future
Coordination of outpatient, inpatient and geriatric care in
the community of New Tecumseth
Dr. Izabella Kogan, MD Ph.D CCFPAlliston Family Health Team
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Sky is the limit
SMH
Town of New Tecumseth
AFHT- Ambulatory care/Medical ArtBuilding
Nautical Land Group
KInsgmere village/Geriatric Center
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Central LHIN is the most populated out of 14Ontario LHINs : 1,7 million
Central LHIN will experience greater-than-averagepopulation aging over the next 10 years, with the65+ age category projected to grow from 204,139
to 285,555.Thats an additional 81,416 seniors,
Central LHIN Statistics:
LHINs are the only organizations in Ontario that bring
together health care partners from the following sectors
hospitals, community care, community support services,community mental health, long-term care to developcollaborative solutions leading to more timely access to high-quality services for the residents of Ontario
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Central LHIN resources:
7,292 LTC beds - 1400 beds are deficient
102 Rehab beds - ? Are deficient1380 GPs
1000 Specialists
8 Geriatricians about 1 per 35 000seniors
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Aging at home
Each LHIN is required to allocate a minimum of 20 percent of the funding throughout the three years to deliverinnovative approaches, and new preventive and wellnessservice approaches within Aging at home
Measures:Reduction of ALS in the hospitalReduce avoidable emergency department visitsSupport reduction in provincial ER wait time targets
Delayed or diverted application for long-term care homeadmission
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Central LHIN , AGE at Home
Transitional Beds (Convalescent, Rehab ,Respite)For Nautical Land consideration
Assisted leaving beds (Kingsmere RH) Supportive Housing (Kingsmere Village) Adult day Programs (Geriatric Centre) Weekend admissions (Kingsmere RH) At home Palliative care (CCAC, Geriatric Centre)
Geriatric assessment clinic (Geriatric Centre) Geriatric outreach teams (Geriatric Centre) Enhanced homecare programs
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ADP objectives:
Will enable seniors to maintain their health andlevel of functioning and avoid unnecessary ERvisits and hospital
Services provided should support caregivers ofcommunity-living seniors by providing caregiverrespite and support.
Proposals should reflect an integratedmultidisciplinary support to clients (e.g. formallinkages to primary care and other serviceproviders).
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Kingsmere medical Center
Location: Industrial rd, Size: 30 000 SFFirst floor:
Urgent care clinic, will provide same day appointments for patientswho are not FHT clients or unable to get to AFHT
X ray
Specialty clinics:Geriatric assessment clinic + memory clinic,Urology/urogynecologyDermatology - ? Dr. Katz
Psychiatry - ? Dr.DanielsPain/RheumatologyNurse Practitioner clinic (wound, skin integrity, pessary)
Mobility clinic/ physiotherapy Pharmacy Home care store
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Kingsmere medical Center
Second floor: Audiology, Chiropody Optometry Dentist/ dental hygienist/ denturist
Medical cosmetic/anti-aging CCAC treatment room Board room/ patient education/ office for CDM brunch
Chronic disease management brunch ( COPD, DM, OA) in collaborationwith SLRH , Sandra Mierdel , manager
Geriatric outreach program brunch in collaboration with SLRH , Dr.Bida( RN, PT, OT, SLP do home visits after GP referrals re
dementia, malnutrition, depression, incontinence, mobility, falls, pain,polypharmacy)
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Adult Day Program
(respite for caregivers + restoration of function for seniors) Health Promotion (medications check, BP/BS check, dental checks, foot care) Nutritious Snacks and Meals Personal Care Physical Activity Cognitively stimulating games/activities Musical Entertainment
Community Outings
Currently there is one ADP in New TecumsethLocation: Simcoe MannorCapacity: 10-18 patients a day
ADP staff Registered Nurse (RN)
Physiotherapist (PT) Occupational Therapist (OT) Social Worker (SW) Recreation Therapist Rehabilitation Assistant Secretary
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Alliston Family Health Team
Young and growing, established 2006
Reliable (MDs cover for each other in case ofvacation/ absence
All MDs work in the hospital can helpcoordinate the care
Wide spectrum of services (regular assessment +cardiac work up+ lung function monitoring)
Internet based patient chart AFHT is the most attractive for new graduates
Group in the area
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Current home of AFHT- best example of restoration work in Southern Ontario
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Boyne River Edge Treatment &
Parking Re-organization Plan
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Alliston Medical Art Building
Location: 106 Victoria st west , UCC zoning
Existing building: 8000 SF
- Home care store
- Medical fitness
- AFHT admin offices + board room
- space for 4 physicians upstairs
Proximity to the Hospital (attract hospital services,
Convenience for physicians and patients)
Municipal parking lot
Will help to revive downtown
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Alliston Medical Art Building
Able to build 6200 SF x 4 (22 m height restriction)
Ground floor: Lab, DI, Physiomed, Vital air
First floor: pharmacy ,Echo, spirometry,
stress test, FHT services (SW, RD, RT,breastfeeding, pharmacist)
Second floor: FHT MDs+ NPs offices
Third floor: specialists/ ambulatory careGen Surgery, pediatrics, ENT, GI,cardiologist , dentistry , mental health
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AFHT/Kingsmere village/GeriatricCenter/ Hospital collaboration
Primary care access for senior residentsChronic disease management: COPD, DM, Cognitive
impairment
Interdisciplinary approach: GPs, NPs, RN, RD, SW,Pharmacist, RT24/7 Telephone Health AdvisoryContinuity of care: same group of doctors working ER/Hospital/ AFHT/Geriatric Center- same EMR sharedReduced number of unnecessary hospital visits due toDisease prevention, medications vigilance, early access tocare provider
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ER wait time reduction/ ALC projectanother LHIN priority
Because moving people through theemergency department depends, in part,on the ability to either admit patients to
acute care beds, or to discharge patientsto appropriate destinations, reducing waittimes cannot be solved by focusing on the
emergency department alone.
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A patient who cannot be
discharged home but no longerrequires hospital care is
designated ALC
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ALC floor
Alliston Medical Art will accommodate/ provideturn key operation for the specialists currentlyoccupying 2 nd floor of SMH:
SMH will be able to create an ALC floor
(RPN, PSW, PT assistant)Acute beds will have higher turnover therefore
helping to reach Ministry targets:- Reduce ER wait
- Reduce ALS- Improve financial health (pay for results strategy,
acute care finding> ALC bed )
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Geriatric Center and Kinsgmerevillage / Hospital collaboration
Urgent care
Outreach programs
Specialists care
Respite/ADP
Transitional beds
Objectives and measurements:
= reducing demand in unnecessary Hospital use
(Failure to thrive, caregiver burnout, respite)
= Reduce ALS by Accepting ALC patients for supportivehousing/transitional beds
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Coordination of outpatient, inpatient and geriatriccare in the community of New Tecumseth
AFHT Geriatric Center
Hospital
Senior
Reducing Demand (CDM) Increasing Supply (Age at home)
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New Tecumseth CommunityGeriatric Care Network
ER GEM
CCAC
Inpatient D/C planner
AFHT Geriatric Center
Geriatric Outreach
LTC
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Happy2012
Thankyou !