Sunday, September 30, 2012

Home First - but not enough Ontario funding for all to die at home

This is a fabulous service, Home First, but there are limited funds. With hospitals closing beds, many are being sent to other forms of group care. I am never surprised that someone will jump on a bandwagon for the one person who needs more care. There are hundreds of people like this. Home First is not designed to give 24/7 palliative care in the home. I blame CCAC Case Managers who do not communicate this well to clients.

For those with family members who may be able to take time off of work, they can manage to assist loved ones in dying at home. This is not for all. Those who are ill have specific requirements for home care. As in the case of the woman in the story below, she has Spinal Stenosis. This is a terribly painful disorder. My friend has it. I wrote about her in my book.
My friend, Michele

She requires two-person lifts to get her in and out of bed. She requires to people to bathe her once a week. She has been having many meals in bed due to pain issues during transfers. She requires an ambulance to get her to the dentist. She is in a special bed, with a mattress that is electronically inflated to keep her comfortable. She has been in this condition for many years after working for 41 years as a nurse.

We often read about these tear-jerker news items, about specific cases where one person wants to die at home. Unfortunately, for the patient and family and friends, this might not be the best placement. Those in palliative care require much care: they must have their medications monitored, they have mobility issues, they may need adult incontinence products, dressings may need to be changed, they must be shifted every two hours to prevent bed sores, and their food intake must be regulated, as many cannot digest food in the last weeks of life.

Dying woman outlives her 90 days of home care so CCAC cuts her services

complex medications
Home First is meant to divert elderly patients from long term care facilities after they are discharged from the hospital following an “acute episode.” The idea is that at-home support can eventually be lessened after the patient improves, or, it will give families 90 days to decide to transition into another form of care, like a long-term care home, which Landry does not want to do. Central CCAC has offered the program since 2009, and 1,713 clients have gone through it. The average 60-day stay (many transition out before 90 days) costs the ministry $10,500.

What is Home First?

Home First is an enhanced care service that is offered in partnership with Central Local Health Integration Network (LHIN) hospitals and Central Community Care Access Centre (CCAC). 

Central CCAC’s Home First program helps older adults return home with the necessary post-hospital supports to safely continue healing when their acute care hospital treatment is complete. The program promotes better long-term health outcomes, with more than half of the Home First clients becoming well enough to remain in their home, with a reduced level of CCAC support.

In addition, Home First provides adults who may be facing a decision to move to a Long-Term Care Home with the time they need to make an informed and thoughtful choice from the dignity and comfort of their home, in a healthier frame of mind. 

The program offers compassionate, dignified, quality care and helps to prevent return visits to the hospital.

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