CIHR - Team in community care and health human resources
home what's new about us researchers projects partners reports and publications links contact us

Theme 1: Community Care

Theme 2: Health Human Resources

Theme 3: Cross-Jurisdictional, Integrative Policy Analysis

Theme: Community Care
Project 1-1: Seniors at “The Margins” of Care (updated March 2008)

Project Lead:
Paul Williams

The specific objectives of Project 1-1 are to: a) Identify groups of seniors who qualify for institutional placement but could potentially receive appropriate care in community settings; b) document actual patterns of care decisions and care costs for seniors “at the margins” in different areas of Ontario characterized by different population needs and care configurations, c) compare these actual patterns to potential care decisions made by an “expert panel,” and d) conduct sensitivity analyses to estimate how these decisions, the balance of care (BoC) and care costs would be affected by specific system shifts, including greater access to supportive housing.

Project Details:

What proportion of frail seniors deemed eligible for long-term care (LTC) facility placement could be maintained at home (diverted from the LTC facility waiting list) if given access to appropriate community-based care packages?
This question is answered by examining the Resident Assessment Instrument for Home Care (RAI-HC) data for individuals waiting for long-term care placement in Waterloo and Toronto, Ontario.  Individuals on LTC wait lists were categorized into relatively homogeneous groups based on: activity of daily living impairment (ADLs) (e.g., eating, bathing, toileting, locomotion and personal hygiene); instrumental activity of daily living impairment (IADLs) (e.g., meal preparation, housekeeping, transportation and medications management); cognition; and presence of a caregiver in the home.  Expert panels of care managers from across the care continuum including hospitals, LTC facilities, home care, and community support services then collectively reviewed the characteristics of typical individuals in each group and prepared appropriate care packages. Costs were then calculated using provincial funding data, and possible “diversion” rates were estimated using the costs of a LTC facility bed as a comparative base. Diversion rates also considered the safety of the client and his/her family caregiver.

Key findings include: The majority of seniors currently waiting for a long-term care bed in both Waterloo and Toronto have great difficulty with IADLs (e.g. meal preparation, housekeeping, transportation, phone use and medications management) and lesser difficulty with ADLs (e.g. eating, bathing, toileting, locomotion and personal hygiene); half are cognitively intact. Diversion rates range between 30% and 50% based on currently available services delivered in the client’s home, ranging as high as 80% if alternatives such as supportive housing were available.   

Research Team:
Janet Lum
Kerry Kuluski (PhD Student)
Jillian Watkins (PhD Student)

Partners and Collaborators:

Steering Committee for Balance of Care Project in Waterloo, Ontario

  1. Eileen Bain, VP Patient Services, Guelph General Hospital
  2. Audrey Devitt Wilson, Manager, St. Joseph Health Centre, Guelph
  3. Deb Gemmell, Executive Director, RAISE Home Support
  4. Linda Gordon, Project Coordinator, Balance of Care
  5. Laura Holtom, Assistant Administrator, Wellington Terrace Long Term Care
  6. Barbara McKay, Manager, Waterloo/Wellington CCAC
  7. Beatrice Mudge, VP Patient Services/Chief Nursing Officer, CMH
  8. Janice Paul, Client Services Manager, Community Support Connections
  9. Maria van Dyk, Senior Integration Consultant, WWLHIN
  10. Marianne Walker, CEO, St. Joseph Health Centre, Guelph

Expert Panel for Balance of Care Project in Waterloo, Ontario

  1. Goldie Barth, Special Services Manager, County of Wellington Social Services Department
  2. Audrey Devitt Wilson, Manager, Community Outreach, St. Joseph Health Centre
  3. Laura Holtom, Assistant Administrator, Wellington Terrace Long Term Care Home
  4. Veronica MacDonald, Executive Director, Community Care Concepts
  5. JoAnne Maxwell, Case Manager, CCAC Waterloo
  6. Diane McCabe, Support Services Manager, Spruce Lodge Home for the Aged & Supportive Housing (Stratford)
  7. Jane McKinnon-Wilson, Seniors Mental Health Team at the Community Mental Health Clinic, Guelph
  8. Barbara Nytko, MOHLTC
  9. Irene O’Toole, Director, Home Support Services, The City of Waterloo
  10. Janice Paul, Client Services Manager, Community Support Connections
  11. Bil Smith, Attendant Services Director, Independent Living Centre of Waterloo Region
  12. Diane Thistel, Case Manager, CCAC Waterloo

Steering Committee for Balance of Care Project in Toronto, Ontario

  1. Claire Bryden, Executive Director Bellwoods Centres for Community Living
  2. Andrea Cohen, Executive Director Lawrence Heights Community Health Centre
  3. Stacey Daub, Senior Director of Client Services, Toronto Central Community Care Access Centre
  4. Wolf Klassen, VP, Program Support, Toronto East General Hospital
  5. William (Bill) Krever, CEO, Don Mills Foundation for Seniors
  6. Helen Leung, Executive Director, Carefirst Seniors & Community Services Association
  7. Dr. Barbara Lui, Program Director, Regional Geriatric Program, Toronto Sunnybrook & Women's College Health Sciences Centre
  8. Terry McCullum, Chief Executive Officer, LOFT Community Services
  9. Odete Nascimento, Director of the Older Adult Centre, St. Christopher House
  10. Jane Piccolotto, Director of Community Support Services, Woodgreen Community Services
  11. Sandra Pitters, General Manager, City of Toronto Homes for the Aged
  12. Penny Reid, Project Coordinator, Balance of Care
  13. Josie Walsh, VP, Programs and Chief Nurse Executive, Providence Healthcare

Expert Panel for Balance of Care Project in Toronto, Ontario

  1. Lisa Abbatangelo, Care Coordinator, Toronto Central Community Care Access Centre
  2. Laurie Barker, Care Coordinator, Toronto Central Community Care Access Centre
  3. Bernita Borgh, Vice President Resident Services, Don Mills Foundation for Seniors
  4. Mary Campbell, Community Health Nurse, Lawrence Heights Community Health Centre
  5. Gillian Coyston, Geriatric Nurse Specialist, Toronto East General Hospital
  6. Suzanne Crawford, Program Director, LOFT Community Services, St. Anne’s Place
  7. Janice Hayden, Director, Bellwoods Centres for Community Living
  8. Gregory Kolesar, Manager, Community Programs, City of Toronto Homes for the Aged
  9. Mary Lang, Manager, Supportive Housing and Homemaking, WoodGreen Community Services
  10. Therese Liston, Professional Practice Leader, Social Work, Providence Healthcare
  11. Rola Moghabghab , GEM Clinical Nurse Specialist, St. Michael's Hospital
  12. Alex Moulopoulos, Social Worker, Geriatric Day Program, Toronto Sunnybrook & Women's College Health Sciences Centre
  13. Kathryn Well, Social Worker, Toronto East General Hospital
  14. Angela Xavier, Client & Family Services Coordinator, St. Christopher House
  15. Vivian Yuen, Director, Home Support Services, Carefirst Seniors & Community Services Association

Current project status:
The Waterloo, Ontario and Toronto Central Balance of Care Case studies have been completed. Balance of Care studies in Northwestern Ontario and other parts of Ontario are currently in the planning stages.

 


 
Home | What's New | About Us | Researchers | Projects | Partners | Reports and Publications | Links | Contact Us
home