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We have approximately 89 admitted patients designated as alternative level of care and of those 58 are awaiting for LTCH placement. We have a shortage of nursing home beds in our community. We partnered with Community Housing to develop an 80 unit seniors supportive housing complex that will provide 24/7 Personal Support Worker care for 50 of the residents. 20 of the units will be designated for discharge planning. The goal of this initiative is to build capacity in the system and to support the frail elderly to remain in the community. Clustered care is an alternative to traditional care for patients requiring assistance with activities of daily living. Community Housing is funding the capital for the building and the Local Health Integrated Network is funding the on-going operating funds for the care services. The complex will serve as a hub for other healthcare services. The residents old age security will cover the monthly charge.
Hello
The local health integrated network has developed a system that supports palliative patients to die at home by choice and spend 15,000 fewer days in hospital by increasing the number of patients discharged home with support by 17% by 2019. We recently signed a MOU with 5 other health care agencies to support care in the community. The hospital usually has a shortage of palliative care beds as the demand is greater than our capacity. The Hospital Palliative Care Coordinator visits patients in their homes to assess their need for admission to hospital. The Palliative Care Physicians also support the community on-call roster.
Hello
Have you considered partnering with a Family Practice Residency Program – the residents could complete a rotation at the rural hospital sites and support the Nurse Practitioners. Patients from the rural sites could be repatriated back once their acute phase of their hospitalization is completed. Perhaps the smaller hospitals sites market share should be targeted at patients requiring sub-acute, rehabilitation and convalescence care.
Hello
We have implemented a high risk for discharge team, that includes a ALC Resource Nurse, Social Worker, Home Care Coordinator, and other care providers as required. The role of the team is to engage the patient and significant others in the discharge planning process. Due to the shortage of nursing home beds, we have partnered with Community Housing to establish a Seniors Supportive Housing Complex – 20 of the 80 units will be dedicated for discharge planning purposes. The cost per unit will be approximately $1200/month which will be covered by old age pension.
Hello Ruth
What is the new nurse-patient ratio for the night shift. How did you evaluate the effectiveness of this initiative?
Hello Amal
These are amazing results. Did you trial alarming devices that sound when the patient exits their bed or chair?
Hello
How did you get the buyin from the nurses to sustain the purposeful rounding? Brenda