Long Term Care Administration

1. Long Term Care Administration Long Term Care Facilities February 19, 2009

2. Long Term Care Facilities The Current Environment • Health reform has focused on improving access, quality and cost-effectiveness, and on moderating future growth curves. • Reforms have occurred in every sector of health care.

3. Long Term Care Facilities The Current Environment • Cost pressures will continue at a rapid rate. • Every province and territory will need to focus on the growing demand for health care services, fueled by demographics, new technologies and other growing costs of providing services.

4. Long Term Care Facilities Support Service Living Units • Provide totally integrated units with services provided on an as required basis. • Availability of 24 hour service and a quick response capability provided by on site staff. • Amenity spaces, dining room, communal laundry, 24 hr monitoring, two meals/day.

5. Long Term Care Facilities LifeCare Communities • Continuing Care Retirement Communities (CCRC) allow seniors to "age in place," with flexible accommodations that are designed to meet their health and housing needs as these needs change over time. • Residents entering Continuing Care Retirement Communities sign a long-term contract that provides for housing, services and nursing care, usually all in one location, enabling seniors to remain in a familiar setting as they grow older.

6. Long Term Care Facilities LifeCare Communities • Many seniors enter into a CCRC contract while they are healthy and active, knowing they will be able to stay in the same community and receive nursing care should this become necessary. • Seniors who invest in a Continuing Care Retirement Community have adequately planned for housing and care for the remainder of their life, and have the financial means to support it.

7. Long Term Care Facilities LifeCare Communities • Continuing Care Retirement Communities offer service and housing packages that allow access to independent living, assisted living, and skilled nursing facilities. • Seniors who are independent may live in a single-family home, apartment or condominium within the Continuing Care retirement complex. • If they begin to need help with activities of daily living (e.g., bathing, dressing, eating, etc.), they may be transferred to an assisted living or skilled nursing facility on the same site. • Seniors who choose to live in a Continuing Care Retirement Community find it reassuring that their long-term care needs will be met without the need to relocate.

8. Grace Communities Corp. • Grace Communities Corporation (GCC) is committed to providing quality, affordable housing to adults 55+. Our customer service approach to housing management follows carefully crafted rules, regulations, policies and procedures we've established to make living here the best it can be. Gracious Living, Simply Amazing! • Local CCRC Life Lease in Abbotsford, B.C.

9. Long Term Care Facilities Abbeyfield Vancouver is a non-profit organization that offers 18 supportive housing units for elderly people in the Marpole area. 

10. Long Term Care Facilities The Abbeyfield Pattern • To involve local Abbeyfield volunteers in setting up and managing each house, where the residents will pay their share of the running costs. • Every household will have its own housekeeper to look after the house, to provide meals and to care generally for the residents. • The residents will have their own rooms, furnished as they wish, where both their privacy and their right to invite visitors are assured.

11. Long Term Care Facilities Home Sharing • Provides additional income and companionship. • Option for seniors who experience difficulty in maintaining their own homes due to accelerating costs, reduced income, declining physical health and loneliness.

12. Long Term Care Facilities Congregate Housing • Elm Ridge is a congregate housing project operated by the Baycrest Centre for Geriatric Care in Toronto, Ontario. • The home for fourteen senior adults provides a balance of companionship and privacy, of support and independence for those who would otherwise find themselves alone and at risk.

13. Long Term Care Facilities • The customized project was built in 1985 by Cityhome, the former non-profit housing arm of the City of Toronto. • Elm Ridge was styled as a single family dwelling, to blend with the neighbourhood, while graciously distinguishing itself with a colourful landscaped garden. • Its central location offers easy access to synagogues, public transit and shopping.

14. Long Term Care Facilities • Staff at Elm Ridge offer 24-hour supervision, weekly housekeeping, counselling services and bi-weekly bathing assistance, if needed. • These are complemented with an extensive program of activities, which include arts and crafts, music, discussion groups, exercise classes, outings, and observance of all religious occasions and the celebration of festivals.

15. Long Term Care Facilities Home Equity Conversion Plans • Allow seniors to have supplemental income. • Equity from the ownership of a given property is used, monies are obtained to complete any required home modifications or to accommodate a changed health status.

16. Long Term Care Facilities Garden Suites/Granny Flats • Small portable dwellings, provide seniors with the opportunity to stay on their own property, while freeing up the main house for the use of close relatives or friends.

17. Long Term Care Facilities Retirement Homes – Assisted Living • 24/7, on site staff, security in communal living • Room, board, recreation, social & activities • Nursing and personal care not provided • $800 - $7,000 per month

18. Long Term Care Facilities Access to Long Term Care Facilities • Severely compromised functional ability and self-care • Severe chronic illness/disability • Abuse and/or neglect • Insufficient community services to support care at home • Absence/unwillingness of informal caregivers to continue care

19. Long Term Care Facilities Problems that result in admission • Cognitive Impairments • Major chronic and/or multihealth problems • Major physical frailty • Loss of mobility and independent ambulatory movement

20. Long Term Care Facilities Problems that Result in Admission • Sensory Disorders • Incontinence • Loss of a spouse or significant other Note: 85%+ have more than one health problem

21. Long Term Care Facilities Desires Prompting Admission • Provision of extensive, regular 24 hr nursing and personal care • Provision of extensive, regular 24 hr supervision, monitoring and assistance with ADLs • Assurance of safety and security • Preservation of self-respect, self-esteem, dignity, companionship

22. Long Term Care Facilities The Eden Alternative • Tool for improving quality of life in LTC facilities. • Coalitions of people and organizations are created committed to creating better social and physical environments for people. • Dedicated to helping others create enlivening environments and the elimination of the plagues of Loneliness, Helplessness, and Boredom. • Dedicated to helping people grow.

23. Long Term Care Facilities Eden Alternative • Teaches that the environments seniors live in are habitats for human beings rather than facilities for the frail and elderly. • What Mother Nature has to teach is about the creation of vibrant, vigorous habitats.

24. Long Term Care Facilities Eden Alternative • Companion animals gives the opportunity for meaningful care to other living creatures, and the variety and spontaneity that mark an enlivened environment can succeed where pills and therapies fail. • The goal is to help people weave together the philosophy of The Eden Alternative™ with the real world of daily practice.

25. Long Term Care Facilities GentleCare • The system is prosthetic in nature. • It seeks to arrange an environmental fit between the person with dementing illness and the physical space, the programs, and the significant people with whom the person must interact. • The system accommodates and supports existing levels of function and development, rather than challenging the person with dementia to adapt and perform in ways no longer possible.

27. Long Term Care Facilities GentleCare Includes • A correlation between disease pathology and client behaviour • Environmental design concepts • A system of programming that helps locate the client's appropriate zone of activity • Daily living care planning and implementation • Numerous innovative, creative strategies

28. Long Term Care Facilities GentleCare • Nutritional assessment and strategies that create powerful treatment opportunities • Stress identification, prevention and reduction that eliminates catastrophic incidents • Functional assessment that provides individualized care plans • Evaluation • A unique system of therapeutic partnership with families, communities and volunteers

29. Long Term Care Facilities Organizations that use the GENTLECARE system report: • Increased client function • Reduced catastrophic incidents • Decreased staff and family stress • Reduced use of psychotropic medications • Cost containment • Increased community commitment and involvement

30. Long Term Care Facilities Little Mountain Place • This beautiful facility consists of 117 resident beds, including a 26 bed Special Care Unit called The Garden Terrace. • Each of the resident rooms is furnished with a bed, night table, dresser and wardrobe closet, has a memory display box and a washroom. • Memory boxes are located just outside a resident's private room and are a great way for residents to recognize their room easily. • All rooms are private, with an ensuite bathroom and nurse-call system. • One of the beds at Little Mountain Place is maintained solely for respite service, which is a valuable resource for individuals and family caregivers who require support on a short term basis.

31. Long Term Care Facilities Little Mountain Place • Provision of 24 hour care and supervision • Full nutritional and food service • Leisure and volunteer program • Medical services supervised by a Medical Coordinator • Podiatrist, psychiatrist and dentist

32. Long Term Care Facilities Little Mountain Place • Each resident's care is individualized to meet his/her needs. • Primary Nurses, LPNs and Care Aides work with residents and their family to develop, review and evaluate each resident's plan of care. • Through these care plans we acknowledge the rights and responsibilities of each resident, their family and the staff at Little Mountain Place. • The staff are committed to ensuring the best quality of life for all residents.

33. Long Term Care Facilities Services • Environmental - residents' rooms are cleaned regularly, clean linens and towels are provided as necessary • Laundry - in house laundry service is limited to washable items only, however a dry clean service can be arranged if required • Hairdressing - an on-site hairdresser is available by appointment • Mail - a volunteer will deliver mail directly to a resident's private room. • Chaplain - conveys the presence of God through compassionate listening, recognizing God at work in residents' lives and helping to interpret the meaning of their life experiences in relation to God • "The Nook" - a shop operated by volunteers, where residents may purchase items such as toiletries, gifts, stamps, batteries, or candy

34. Long Term Care Facilities Little Mountain Place, Leisure Services • Recognizing that medical and nursing care are only a part of providing quality care for residents, we provide a wide variety of programs such as: • Tzu Chi Chinese Luncheons • Newsweek discussions • carpet bowling • Bingo • video nights • bus trips/outings • Pub nights • Residents are encouraged to participate in "Music Therapy" which encourages them to socialize and express themselves through music in group sessions. Programs and services are ongoing. • The staff encourages residents and families to make suggestions for any new programs.

35. Long Term Care Facilities Little Mountain Place • The Garden Terrace provides a home-like environment which supports, nurtures and enhances the potential of residents who suffer from dementia. • Although dementias such as Alzheimer's Disease can be debilitating, we believe that we can offer residents an outstretched hand, a caring heart and programs that maintain and enhance their abilities.

36. Long Term Care Facilities Little Mountain Place • Specifically designed for individuals with Alzheimer's Disease or other types of dementia, the Garden Terrace has a home-like common living area with limited access and a secured patio and garden area. • Families will feel comfortable visiting and participating in resident's lives. • Having a feeling of their own personal space and their belongings close by, we believe residents will ultimately have higher functioning, increased self-esteem, control and independence.

37. Long Term Care Facilities Little Mountain Place • Within the Garden Terrace there are three categories of leisure programs which occur; Therapeutic, Home Life, and Activities. • These programs occur in a small group or individual settings and can be formal or spontaneous. • Therapeutic Recreation Programs are offered based upon residents' needs; they have a specific goal and purpose, they assist in bringing meaning and satisfaction to one's life and they help to maintain physical and emotional well being. • Examples of such programs include: baking, reminiscing groups, gardening, socials and "discovery boxes".

38. Long Term Care Facilities Little Mountain Place • Home Life Programs give the residents the opportunity to contribute to their new home by assisting with the various chores which need to be done to take care of the Garden Terrace. • Chores are assigned according to what is most familiar to each resident. • Through assisting with the various tasks, individuals maintain a sense of purpose to their life. • Examples of chores include: sweeping, meal preparation, washing dishes, preparing vegetables and folding towels.

39. Long Term Care Facilities Little Mountain Place • Activities are offered to residents and their friends and families. • In the Garden Terrace there are supplies and a reference book full of activity suggestions and we encourage everyone to participate. • This is a great way for everyone to socialize. • Activities may include: polishing silver, watering the garden, reading the newspaper or enjoying a cup of tea.

40. Long Term Care Facilities Little Mountain Place • The Family Council is a independent, self-determining group of family members and friends of residents living in a care facility. • At Little Mountain Place, our group is called "Families of LMP" and participants meet once a month. There are several benefits which stem directly from this council: • Orientation and information for families of new residents • ongoing support • volunteering and fundraising • education and information • forum to discuss concerns or problems • Family and friends are welcome to attend as many or as few meetings as they are comfortable with. We believe it is important to have a voice, especially if you can make a difference in residents' lives.

41. Long Term Care Facilities Food Services • Three meals and three between meal nourishments are provided daily, utilizing a multi-cultural six week menu planned by our full time Nutrition Manager and Dietitian/Nutritionist. • Due to a significant population of Asian residents, menus are written in Chinese as well as English. • A Food Service Committee is in place to provide residents and family input into the menu planning and meal service process. • A special alternate dining area meets the needs of residents who require assistance or supervision during meal times.

42. Long Term Care Facilities Food Services • The Garden Terrace has it's own small home-like relaxed dining area. Residents are provided foods of appropriate texture and consistency with modified utensils to promote independent eating and ensure adequate nutritional intake. • A 24 hour feeding program is set up so that extra foods and drinks are provided to The Garden Terrace residents. • The purpose is to allow residents to have food at any time they desire and not be restricted to fixed meal hours.

43. Long Term Care Facilities Food Services • Friends and family are welcome to bring gifts of food to their loved ones. • The Nutrition Manager and Dietitian/Nutritionist would be pleased to help you select appropriate foods for the resident's diet as well as for storage. • Family and friends are encouraged to join residents for meals - both in the facility and off-site.

44. Long Term Care Facilities Little Mountain Place • A social worker is available to meet with you at your convenience. • The social worker is available for assessment, information and consultation with residents, families and other professionals and can assist with social, emotional or financial concerns.

45. Long Term Care Facilities • Application for admission is made by contacting the local Health Unit in your community. A Long Term Care Manager will assess the eligibility of your application and determine the level of care you or your family member requires. The level of care is determined by an assessment of each applicant's physical and mental capabilities. When it is determined an applicant is eligible for Long Term Care, a Long Term Care number is assigned.

46. Long Term Care Facilities Referral/Placement, cont… • Once accepted, the date of application becomes the priority date on the Long Term Care waiting list. • This list is sent to the Little Mountain Place Social Worker. • Priority Access for the facility is controlled by the Vancouver Coastal Health Authority. • If there are problems regarding this procedure, the Social Worker or the Director of Resident Care Services at Little Mountain Place are available to both the applicant and the applicant's family for consultation and advice.

47. Long Term Care Facilities Little Mountain Court • A wonderful facility designed for independent living. • Tenants make themselves at home in no time. There is a minimum age requirement of 55, except for handicapped residents and no more than 2 people may occupy a double suite. • Social work and nutritional services are available from Little Mountain Place for a nominal fee.

48. Long Term Care Facilities • Little Mountain Court has 96 self-contained suites consisting of: • 81 single suites • 1 single handicap suite • 10 double suites • 4 double handicap suites

49. Long Term Care Facilities Each suite includes: • 1 bedroom • 1 bathroom • 1 kitchen • 1 living/dining room • storage areas • The rent at Little Mountain Court is subsidized by BC Housing. A wait-list system gives priority to those who are in greatest need.

50. Long Term Care Facilities Little Mountain Residential Care & Housing Society • Established in 1983, Little Mountain Housing Society (the "Society") is a not-for-profit care giving organization. The Society has adopted a philosophy of care called "Gentle Care" which means residents' needs and wants are our priority. • "Residents First" is a heart and soul attitude towards residents and their families. • Residents are the focal point of all our activities and everything we do recognizes the requirements to serve their needs and exceed their expectations.