As Health Sciences North and the North East Community Care Access Centre (CCAC) work together to re-launch the Home First program, what's really needed is a change in the mindset of front-line health-care workers, Richard Joly said.
“We're talking about thousands of employees that interact through the journey of that patient and family to change every single one and to say 'Did you ever think of Home First and and not necessarily long-term care?,' it takes time,” the CEO of the North East CCAC said.
In his Oct. 9 Peer Review report examining Health Sciences North, Hamilton Health Sciences CEO Murray Martin focuses on the need to re-launch the North East CCAC's Home First program.
The program has been touted as one of the solutions to the alternate level of care (ALC) patient challenge at the hospital.
ALC patients are those who no longer need acute care, but cannot find placement in a community facility such as a long-term care home.
Martin said the program is underutilized because it's underfunded and there's a challenge in personnel who want to work in home care.
Under the program, those who would normally have waited in hospital for a bed to open in a long-term care home are instead sent home with enhanced home care supports.
Joly said he agrees the program could use more funding and it's difficult to find workers to staff it. Despite these challenges, he said the Home First program, which was launched a few years ago, recently helped its 1,000th patient.
As the hospital and North East CCAC work together to re-launch the program, what's really needed is a change in mindset by front-line health-care workers.
“It takes time,” Joly said.
Families also need to realize their loved ones aren't necessarily going to be placed into a long-term care home right out of the hospital, Joly said.
As part of the re-launch of Home First, if hospital staff want to put an ALC patient on a long-term care waiting list, it now has to be approved by senior administrators at both the hospital and the North East CCAC.
Health Sciences North chief nursing officer and vice-president of clinical programs David McNeil told Northern Life during a recent interview that since this practice was started, very few ALC patients have been put on long-term care wait lists.
When asked if patients will still be able to get onto a long-term care home wait list once they've been released from hospital, if necessary, Joly said they will.
“The door is never, never closed,” he said. “The family can ask for a reassessment.”
Martin also asked the partners to determine requirements to provide 24/7 home care for those enrolled in Home First.
We are a viable alternative when it comes to offering services like the Home First philosophy instead of staying in hospital.
CEO of the North East CCAC
This presents a problem, Joly said. “24/7 in the community can be very, very costly.”
Joly said the North East CCAC is working with the North East LHIN to figure out what to do with regards to 24/7 care.
Whatever is decided, he said he hopes the initiative comes with new funding. Other areas of the province have received additional funding to bring in this program, he said.
“At this point, we all know the economic situation in the province of Ontario, but we would require additional resources to support 24/7, even for a small number of patients.”
At this point, the North East CCAC is looking at potentially providing this sort of care for end-of-life patients, or those who temporarily require high levels of care, but will recover relatively quickly.
Martin also recommends a re-think of the hospital's discharge planning process, which involves both Health Sciences North and CCAC staff.
The hospital, the North East CCAC and some of its service providers, including Bayshore and the Red Cross, are meeting this week to talk about how discharge planning can be improved.
Joly said the partners will look at ways that duplication can be eliminated and the whole process made more “patient-centred.”
“I can tell you now we've been at it for 24 months,” he said. “You do not change a culture and change every single process that affect thousands of employees and thousands of patients overnight. It's a cultural shift.”
When asked if he finds it galling the recently released peer review report is ostensibly about the hospital, but many of the recommendations seem to focus on the North East CCAC, Joly says he doesn't.
“I think it's refreshing to see,” he said.
“The community has something to offer and add to the solutions in regards to the ALC population. We are a viable alternative when it comes to offering services like the Home First philosophy instead of staying in hospital. Our programs have emerged in the last three years.”
Since the report's release, Joly and his staff been meeting with executives at Health Sciences North and St. Joseph's Complex Continuing Care to discuss the organizations' collective next steps.
Last week, they submitted a preliminary plan to the North East Local Health Integration Network (LHIN), outlining actions which can be taken to implement the recommendations.
Joly said the partners will continue to meet and discuss the issue.
“I think everything needs to be aligned as a system, and we should not have silo thinking,” he said.
“What we do in the community affects the hospital, and the hospital's decision-making on program changes in turn affects the community. It makes a lot of sense for us to all be on the same page.”