Area hospitals see early success with home care

KITCHENER, Ont. – Grand River Hospital has launched a Hospital to Home program that is designed to help patients with complex care needs move from hospital-based services to their homes. Patients are recovering more quickly, with less complications, and leaving more beds available in hospital for those who need them, early indicators show.

“I would have been lost without this program,” Rob Schramm recently told the hospital. His 94-year-old mother, Trudy, was admitted to Grand River after a fall.

As she recovered and got to a stage where she could continue the healing process at home, Schramm said he began looking at what options were available.

“I had no clue how to get her home and transition her care before talking to mom’s care team,” he said. “I knew she’d need more care than before her fall, and through this program I have support workers who can watch mom while I do laundry or shop without worrying about her.”

Care plans can range in scope and duration, with some lasting up to 12 weeks before a full transition to lower intensity home and community care.

The transitional care team also helps to ensure remaining care needs can be provided by lower intensity community care services.

The program is funded by Ontario Health and uses a wraparound support model in partnership with Bloom Care Solutions, Home and Community Care Support Services and Community Care Concepts. No cost of service passed on to patients unless they choose to augment care with private service providers.

“Once the patient is medically stable and ready for discharge, being able to safely transition the patient home to recover or convalesce from an acute illness or injury instead of in the hospital, reduces the risks of functional decline, delirium, pressure injuries, and hospital associated infections that can be associated with prolonged hospital stays,” said Elliott McMillan, director of operations, transformation and integration at Grand River.

Meanwhile, in March, St. Mary’s General Hospital – also in the Kitchener, Ont. area – launched its own Hospital to Home program.

The program provides home care for up to 21 days and acts as a bridge for people who might need longer-term community-based services beyond those three weeks. “It allows them to do their waiting at home with supports, rather than sitting in hospital blocking a bed,” said Brandon Douglas (pictured), vice-president of clinical services at St. Mary’s.

The program expects to serve about 20 to 30 patients a month, freeing up beds in hospital, and reducing waits for patients who are waiting in the emergency department for a hospital bed to open up, he said.

Before the initiative, patients discharged from St. Mary’s who needed home care had to plan through Home and Community Care (formerly the Community Care Access Centre), a process that typically takes seven to nine days. Now, patients will be able to be discharged as soon as they no longer need acute care and get home care immediately through the Hospital to Home program.

“Often, we are unable to discharge a patient because they do not yet have the services and support that they need to be at home safely. By remaining in our care, this means that an acute bed is not available for someone who needs it,” said Douglas.

SOURCE: The Kitchener Record