Enfermedades de Origen Laboral

Many initiatives are proceeding in the CE LHIN which will have a direct impact on the requirement for comprehensive rehabilitation services, either locally, at the district or LHIN wide level. These will require thoughtful consideration to address some of the ALC issues noted above and to assess the gaps in access for rehabilitation services across the LHIN. There is a need to review the broad scope of rehabilitation

• The Flo Collaborative – is an Ontario Health Performance Initiative to improve the timeliness

and effectiveness of the transition process. Peterborough Regional Health Centre is a pilot site. A significant number of these collaboratives have focused on the flow from general internal medicine units into post acute care programs, with a large number of these patients being geriatric and medically complex.

• Home at Last – is a program that helps people to transition back into the community without

relying on family/caregivers to provide transportation and other essentials as well as facilitate community linkages to decrease emergency visits.

• Geriatric Emergency Management (GEM) Nursing – this program has GEM nurses to assess

and manage frail, at-risk individuals providing early identification and intervention in order to meet their needs and address the care requirements in the most appropriate setting.

• Timely Discharge Information System Demonstration Project – the project supports timely

communication to a patient’s primary care practitioner to facilitate the exchange of information. • CE LHIN Aging at Home Strategy – The Aging at Home Strategy was announced in the fall of

2007 by the then Minister of Health and Long-Term Care, the Honourable George Smitherman. The Strategy is a $702 million investment – over three years - that is targeted to enable seniors to live healthy, independent lives in their community for as long as possible.

For the 2008/2009 period, the priority areas that received funding were related to Community Support Services, Caregiver Support and Well-Being and Supportive Housing. The funding supported programs such as meals on wheels, Central East Home at Last, health promotion education, adult day programs and in-home respite.

For the 2009/10 period the focus of proposals was: Community Support Services, Caregiver Supports and Well Being, Supportive Housing and Specialized Geriatric Services. Proposals aimed at Specialized Geriatric Services would include initiatives related to comprehensive geriatric assessment that is

multidisciplinary, coordinated and integrated. This assessment would lead to a care plan for treatment and follow up. The projects would demonstrate linkages with the established community and facility resources, e.g., Geriatric Emergency Management Nurses currently in place in most of the Emergency Departments in the CE LHIN. The announcement of 2009/10 funding has not yet been made but approximately half of the funding will be to support initiatives that will directly impact on the ALC issue.

• ALC Activation Project – is a 6 month project that follows the ALC Task group recommendation

to review existing models of activation type programs with the aim of assisting the LHIN hospitals to plan services that prevent or reverse deconditioning/functional decline in the elderly.

The project will describe the service inputs, outputs and outcomes using a program evaluation approach. There may be on ongoing linkage or realignment to the ALC/Wait List provincial group. • Ontario ER/ALC Wait Times Strategy – the goal is to reduce the length of stay in emergency

and improve patient satisfaction. The strategy includes “discharging patients who require an alternative level of care (ALC) faster” supported by increased capacity and community supports.

A key factor in this initiative is the early identification of admitted patients at risk for functional decline matched with planned therapeutic interventions to maintain optimal functionality and mental wellness while in hospital.

• Specialized Geriatrics Project – the project charter is still being completed but the task group

has had many meetings to start to structure a plan for the review, assessment and implementation of comprehensive geriatric services across the LHIN. Work is currently underway to assess plans for comprehensive geriatric assessment services and a proposal has been submitted to the LHIN. Note that the Specialized Geriatric Services pre-charter group had only met a few times as many meetings were required instead to deal with the Aging At Home Strategy, year 2, and Specialized Geriatric Services bucket. In these discussions and meetings, the community-based Comprehensive Geriatric Assessment Team model was created. However, the integration with the Rehabilitation Task Group will be essential as the Seamless Care for Seniors Network and the Specialized Geriatric Services pre-charter group plans the component of Senior Friendly Hospitals. A Senior Friendly Hospital will require rehabilitation services for the prevention strategy for all frail patients, not just those that have decompensated and then become designated as requiring an alternative level of care (ALC).

• Clinical Services Plan – the final report is now available and work will continue across the

LHIN to move forward in the implementation of the vision for “one acute care network.” It will be important for the rehabilitation component to be continually assessed during this implementation phase to ensure a more integrated system that meets the needs of the patient across the continuum of care.

2. Rehabilitation Common Language Definitions Document

Several definitions of rehabilitation were reviewed by the Task Group to inform them in the development of one common language document.

Rehabilitation is a goal-oriented process that enables individuals with impairment, activity limitations and participation restrictions to identify and reach their optimal physical, mental and/or social functional level through client-focused partnership with family, providers and the community. Rehabilitation focuses on abilities and aims to facilitate independence and social integration. It involves many different health care professionals including occupational therapists and physiotherapists (Hospital Report Research Collaborative, 2006).

According to the World Health Organization, “rehabilitation is a progressive, dynamic, goal-oriented and often time-limited process, which enables an individual with impairment to identify and reach his/her optimal mental, physical, cognitive and/or social functional level.” (WHO, 1993)49 _{The CE LHIN definition} was expanded to include, “It is multidimensional, consisting of prevention and treatment of medical complications, restoration of independence of psychological coping and adaptive functioning, promotion of community reintegration and enhanced quality of life”. See Appendix VI for the complete Common Language Document developed by the Rehabilitation Task Group.

Definitions for other specific populations such as acquired brain injury or amputee, were researched to provide a standardized understanding. Utilizing common service setting definitions such as stroke rehabilitation units and rehabilitation in acute care will ensure consistency across the LHINs to improve the application and referral process as well as improve the standardization of data collection.

3. CE LHIN Rehabilitation Survey

Purpose

The purpose of this survey was to collect an initial baseline of information about current rehabilitation services available in the CE LHIN, outline gaps in service and strengths and opportunities in order to begin a more thorough analysis of the issues and challenges facing the region. The intent was also to guide the CE LHIN planners and providers on where to focus on with a more detailed review of the gaps in order to inform the LHIN on potential next steps and opportunities for rehabilitation service provision.

Methods

The survey was emailed to 135 publically funded service providers throughout the CE LHIN including nine community hospitals across 14 sites, 55 community agencies and 66 LTCHs. An introductory letter and link to the survey tool was sent to facility/agency CEOs or Executive Directors. It was to be forwarded to the individual most knowledgeable about their rehabilitation services. Additional email and telephone follow-up was conducted to increase the return rate of the surveys. The survey was sent a second time when initial follow-up indicated many had not been received. Subsequently, it was forwarded directly to the individual responsible for rehabilitation services in the organization. Since the majority of community agencies do not directly provide rehabilitation services, a large proportion did not complete the survey. A random sample of community agencies was contacted to ask whether they delivered rehabilitation services. If ‘no’, they were not asked to complete the survey.

Surveys were completed on-line via Zoomerang and sent into the CE LHIN. Zoomerang is an on-line market research software program used for data collection and data analysis. Analysis was completed in the Zoomerang program. Frequency tabulations were performed in order to describe rehabilitation services available within this sample. A content analysis of the responses to the open-ended questions was also performed.