Nancy Sears, RegN, CHE, PhD
November 19, 2008
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Goals
• To increase access to services and supports for
unique circumstances faced by seniors
• Provide respite for caregivers
• Divert ED (CTAS IV & V) and ALC episodes of care
by acting before frail seniors predictably present to
acute care
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Why SMILE and Not More of the Same?
• Current community services are built to provide a critical mass
of services that meets common needs in common ways
• Needed a process that is sufficiently nimble to provide ‘one of’
service responses, customizing that response one senior at a
time
• … with a minimalist administrative structure
• And nimble enough to go away when the ‘one of’ no longer
needed
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Key Program Features
•
Senior presents at an access portal or to the
regional centre
•
Functional assessment using InterRAI-CHA
•
Service plan centres on those IADLs that seniors
cannot manage by themselves or with the social
supports that they have built around them
•
AND on respite for families so they can continue
providing daily care to high needs seniors
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Key Program Features …continued
•
Individualized budget (not cash) for each senior that will be
used to purchase IADL supports to meet these needs (up to
$150 per week)
•
Reimbursement or direct payment
•
Senior and family choose the service source that makes the
most sense for their situation (neighbours, other seniors, ethnic
groups, businesses, traditional community support services)
•
Expenditures over the full year rather than week by week
•
Budget moves with the senior if they move
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How Did We Get To This Point?
• By listening to seniors re: the “what”
• By bringing health care providers together
with seniors to design the “how”
• By stealing shamelessly from the
successes of others
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First Came Seniors
Asked a senior’s advocacy group that
was NOT associated with the delivery
of health care services to bring together
a Senior’s Forum
• We did not influence the invitation list
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We Asked 2 Questions
Question #1
• Which principle should we follow?
• Unique services and programs customized to each
community OR
• Single, shared approach that is available in all
communities
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So We ….
• Created one regional program that very
frail seniors have access to – no matter
what South Eastern Ontario urban,
rural or remote community they live in
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We Asked 2 Questions….continued
Question #2
• What “kind” of service makes the most
sense?
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• Supported living services
• The most elderly, the most frail and/or those
with the most significant conditions should
come first
• Basic needs should be taken care of first
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Next We Considered What Works
Best…continued
History of 3 publicly funded programs:
•
Veterans’ Affairs Canada – VIP program (federal)
•
Children’s Special Needs (Ontario – Community and
Social Services)
•
Self Managed Attendant Care (Ontario Comm & Soc
Services + Health)
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Health Service Providers Were
Then Invited In
• Health service providers joined the
seniors
• Seniors outnumbered providers
• Asked the HOW questions
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Opposing Views
• At first some HSPs initially regretted that
Aging at Home funds in the SE were not
used to directly expand their existing
budgets, programs and infrastructures
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What Seniors Said About The
Experience
At first they were skeptical………………….
•
We “expected a program to be rolled out and
were prepared to dutifully clap”
•
“Congratulations … for setting a new standard in
health care planning by asking the recipients first!”
•
And…seniors continue their involvement in the
oversight of program implementation
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What We Know About our SMILE
Seniors
Number of SMILE seniors (in first 90 days): 209
Average age: 83
Popular needs
Housekeeping
Meals
Seasonal outdoor chores
Shopping
Non-traditional providers chosen 56.1% of time
Self-managed – 16%
Average monthly service cost/client - $255
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