. . . . . . . . . . . . . . . . . . .

AGING IN PLACE -EXPLORE THE OPTIONS

Presented by:

Kathy Taylor, Winnipeg Regional Health Authority

Dr. Lori Mitchell, Winnipeg Regional Health Authority

Jackie Prentice, Manitoba Health/Healthy LivingCross-Department Coordination Initiatives

PRESENTATION OVERVIEW• Gap in the system

• Addressing the gap

• Centre on Aging report

• Where are we at now?

Manitoba Health RegionPopulation: 1,148,401

11 Regional Health Authorities (RHAs)

Winnipeg Health Region Population: 694,668

Churchill

GAP IN THE SYSTEM• Baby boomers are coming!

– Projected population increase in Manitoba residents 75+ from 2003-2036 is 92.1% (82,056 to 157,590) – Manitoba Bureau of Statistics, 2008

• High demand on Home Care Program• Caregiver stress• High rates of institutionalization• Shortage of affordable housing with supports• Seniors want to remain in their communities

ADDRESSING THE GAP

• Aging in Place Principle• Long Term Care Strategy

MANITOBA’S “AGING IN PLACE”

• Aging in Place is the central principle of Manitoba’s Long Term Care (LTC) strategy

• Aging in Place supports the ability of individuals to remain in their community

Long Term Care Strategy: What?• Plan to balance services and resources

within Long Term Care (LTC) sector• Creation of affordable community housing

with support options• Partnerships (Manitoba Health,

Department of Family Services and Housing, Regional Health Authorities and other stakeholders)

• Placing too many people in personal care homes (prematurely and inappropriately)

• People staying in hospital longer

• Lack of affordable community living options with appropriate supports

Long Term Care Strategy: Why?

Long Term Care StrategyFour Models:

• Supports to Seniors in Group Living (SSGL)

• Supportive Housing• Specialized Supports• Personal Care Homes

IndependentLiving

Specialized Supports

Supports to Seniors in

Group Living

Supportive Housing

Personal Care Home

Home Care

Support Services to Seniors

Community Support Expansion

Independent LivingExamples:

HouseApartmentCondominiumCo-op HousingLife LeasePublic Housing (Manitoba Housing Authority)

Eligible individuals can access WRHA Services(e.g. Home Care, Support Services to Seniors, Mental Health Services)

Independent Living with a Service Package

Assisted Living, Retirement Residences, etc.Service package may include:

Regular mealsHousekeepingLaundryRecreationTransportation

No referral through WRHA is required

Supports to Seniors in Group Living (SSGL)

Who:• Older adults in some designated

existing seniors buildingsWhat:

• Enhanced support services• Maintain independence• Regional Health Authority funded

Access:• Available to all tenants at no cost • No referrals required

SUPPORTS TO SENIORS IN GROUP LIVING (SSGL)

Supportive HousingWho:

• Primarily cognitively impaired, frail elderly

• Require 24-hour support and supervision

What: • Individual apartments within a

community group setting• Secure environment • Personal support/supervision (24

hours/ 7 days a week)• Person pays rent and service package

(meals, laundry, housekeeping)• WRHA funds care component

Access:• Referral through WRHA

SUPPORTIVE HOUSING

Specialized SupportsWho

• People with complex health needs and/or challenging behaviors (e.g. persons with acquired brain injuries, young adults with disabilities and ventilator dependent individuals).

What• Services for people who require

specialized supports to live in community.

Access• Referral through RHA

Personal Care HomesWho:

• People who require 24-hour professional care (i.e. nursing)

What:• Facility-based• 24-hour professional care • Residents pay daily

residential rate based on income

Access:• RHA panel process

• Key findings of LTC Strategy research project

• Use of findings for program support and reform in the long term care continuum

Long Term Care Strategy: An Examination of Clients

Across the Care Continuum(Mitchell, Blandford, Menec, & Nowicki, April 2008; Centre on Aging & WRHA)

Project ObjectivesCompare home care clients in:

1) private dwelling,2) assisted living, and 3) supportive housing, to residents in personal care homes (PCH);

Examine transitions of individuals from one setting to another:

– Private Dwelling to Supportive Housing– Community settings to PCH

Long Term Care Continuum: Study Components

IndependentLiving

AssistedLiving

Supportive Housing Personal

Care Home

Home Care

Data Sources & Study Population

• RAI-HC for Home Care:• Assessments from 2001 – 2007;• 23,575 clients age 65+ in total

– private dwelling (PD), n=20,606; – assisted living (AL), n=2,367; – supportive housing (SH), n=602;

• RAI 2.0 for Long Term Care Facilities:• Assessments from 2004 – 2007;• 25 non-proprietary sites;• 5,322 PCH residents age 65+.

Socio-Demographic Profile: Age 65+

Private Dwelling

Assisted Living

Supportive Housing PCH

% % % %

Women 66.8 72.1 85.2 72.9

Age 65-84 60.5 39.0 37.4 37.2

Age 85+ 39.5 61.0 62.6 62.8

Married 33.1 22.6 5.1 21.5

High School or greater

34.5 44.0 45.7 18.7*

* Education unknown: 53% of PCH residents

Transition to PCH:% of Clients that Moved to PCH

• Private Dwelling: 3,900/20,606 = 19%

• Assisted Living: 557/2,367 = 24%

• Supportive Housing: 257/602 = 43%

Conclusions• Care continuum is evident:

– Similar characteristics among clients living independently in community and clients in assisted living

– Supportive Housing manages clients with greater care needs, cognitive impairment

• SES is a factor for access to Supportive Housing

– PCH residents exhibit greatest care needs and impaired function

• Wide range of needs in PCH still evident

Results for Program Planning• Profiles of the older adults indicate the range of

characteristics supported in each care setting– Helps to identify the type of individual who could be

maintained in the community with proper supports• Factors associated with entry into SH indicate

areas to focus on for entry criteria• Factors associated with entry into PCH indicate

risk factors to focus on to prevent institutionalization

• Results identify support and resources required to age in place

Program Change• Affordable Supportive Housing spaces

– added 96 rent geared to income spaces (total = 116)– added 25 rental subsidies (total = 35)

• Supplemental funding for enhanced support services in Supportive Housing– assessed for eligibility for increased ADL support,

management of incontinence

• Examine Supportive Housing profiles for entry/exit criteria revision

Program Change Cont’d

• Caregiver Strategy– Enhance IADL service to benefit caregiver

• Laundry, meal preparation, housekeeping

– Improve detection of caregiver burden

• Revised panel for PCH placement guidelines– Use more objective measures from RAI-HC

• MAPLe score, Institutional Risk Clinical Assessment Protocol

– Document ‘exception’ placements to identify areas for program change

WHERE ARE WE NOW?Since the Introduction of Aging in Place in January 2006:

Supports to Seniors in Group

Living (SSGL)Supportive

Housing (SH)Specialized

Supports (SS)

Totals

Total

WinnipegRural & Northern Winnipeg

Rural & Northern Winnipeg

Rural & Northern

1150 1669 256 126 113 602819 382* 173

*101 affordable, rent geared to income spaces

WHAT WE FOUND…IMPACT• Domino Effect• Individual community health care

system

WHAT SENIORS AND FAMILIES ARE SAYING…

“Didn’t realize how (parent) was actually isolated in their own home until they moved to a Supportive Housing site.”

“SSGL has given us a new lease on life and has helped to stay independent…able to stay in the community.”

“Happy for an option in (Supportive Housing) as (parent) did notrequire all the services of the PCH, just the 24 hour supervision and support. (Parent) has been encouraged to participate in household activities e.g. baking and feels (she) is contributingand participating in life.”

WHERE ARE WE GOING?

• Continued implementation of Long Term Care strategy (provincial)

• On-going monitoring for results• Objective data to guide decision-making

Contact InformationKathy Taylor, Winnipeg Regional Health Authority

Phone: (204) 831-2969email: ktaylor@wrha.mb.ca

Dr. Lori Mitchell, Winnipeg Regional Health AuthorityPhone: (204) 940-2003email: lmitchell3@wrha.mb.ca

Jackie Prentice, Manitoba Health/Healthy Living, Cross-Department Coordination Initiatives

Phone: (204) 945-8242email: jackie.prentice2@gov.mb.ca