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Facilitating System Change:
Specialized Units in LTC
OLTCA Annual Convention
April 1, 2015
Melissa Donskov, Director, Bruyère Centre for
Learning, Research and Innovation
in Long-Term Care
The Ontario Centres for Learning, Research and
Innovation (CLRI) in Long-Term Care
Supported with funding from the Government of Ontario
The views expressed in this publication are the views of the
author(s)/presenter(s) and do not necessarily reflect those of the Province.
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Points to Discuss
• Specialized Units in LTC Homes – An
Introduction
• Bruyère CLRI Research Project on Specialized
Care in Ontario LTC Homes
• Emerging Themes
Specialized
Units
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Facilitating System Change in LTC
From Sinha’s Report (2013): 135
“…development of new or
expanded service delivery models
that address system gaps and the
location of more specialized longterm care services, like
behavioural support units, to
promote quality and efficiency in
local service delivery”.
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Specialized Units – An Introduction
• LTC Homes Act and Regulation (Sections 198-206)
• Further supports LTC residents whose care needs
cannot be met within the general LTC population
• Additional flexibility to plan for and address local
area needs
• Needs determine the type of accommodation, care,
services, programs and goods that are appropriate
to the targeted residents
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Designation Process
• Designation is for existing long-stay LTC beds
• CCACs keep separate wait list (exchange
category)
• Approval from MOHLTC PICC Branch for
designation (LHIN support needed as a first
step)
• Possible extra funding (e.g., for staffing levels
and mix, equipment, environmental modification)
from LHIN
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Current Context
• 8 units in the province (6 Behavioural Support, 2
dialysis)
• Pilots (not permanent)
• Complex application process
• Potential for capacity planning through units to
address specialized care needs and improve the
quality of care provided to residents
– Potential care areas: palliative, young adults,
mental health, ABI, neurological disorders
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Project Objectives
• Understand how LTC Homes
provide specialized care
(with or without a designated
unit)
• Explore capacity planning
aspects
• Create Toolkit
Understand
specialized
care in
LTCH
Explore
capacity
planning
Toolkit
LTC system change
Project Activities
• Global literature scan
• Consultation with designated
Specialized Units and LTC Homes
with specialized care, stakeholders
(CCACs, LHINs, LTC associations,
MOHLTC)
• Develop toolkit
• Disseminate findings
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From Definition to Interview Inclusion Criteria
Inclusion
• Homes with designated
Specialized Unit
• Homes with specialized
care/programs in long stay
beds without designation
Exclusion
• Care for a group of residents
with specific religious, ethnic
and/or linguistic origins –
covered in Ontario Regulation
79/10 sec.165(2)
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Consultation Participants
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Emerging Themes
Each Specialized Unit is Unique
• Residents must be eligible for LTC Home
admission and meet the Unit’s admission criteria
Behavioural Specialized Units provide transitional,
high-level support, specialized care for adults with
responsive behaviours that are not manageable in
their current settings, but each Unit has different
admission criteria
• Operations differ (e.g., number of beds, staffing,
programming, partnerships)
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Emerging Themes (cont.)
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Benefits of Having Designated Specialized Unit
• Setting own inclusion criteria facilitates tailored care
• Enables strong multidisciplinary teamwork
• Extra start-up and ongoing training increases staff
expertise within Unit and often across the Home
• Ability to continue to offer care for residents within
their communities
• Acting as an informal reference centre for other
Homes and stakeholders about the specialized
care provided
Emerging Themes (cont.)
Challenges for Non-designated Programs
• Only regular LTC admission criteria is used,
limiting ability to track & manage demand, or to
group residents for tailored care & programming
• No access to top up (start up and/or per-diem
funding)
• Specialized training for staff harder to organize
and maintain
• Difficult to connect with Homes with similar
programs
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For Homes Considering Designation
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Facilitators
Challenges
• Partnerships & innovation
• Provincial push for care
integration
• Expanding role of
specialized care in LTC –
designation supports both
social and medical models
of care
• Redevelopment
• “Why seek designation when
our wait list is already very
long?”
• Understanding Ministry
criteria for approval
• In-depth needs assessment
– what is our catchment?
• How do we know we are
successful?
• Temporary vs permanent
designation
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Contact Us
We value your ideas and comments.
Bruyère Centre for Learning and Innovation in Long-term Care
613-562-6262
Peter Walker
Melissa Donskov
Tracy Luciani
Zsofia Orosz
Scientific Director
Director of Operations
Knowledge Broker
Project Coordinator
Ext. 2515
Ext. 2571
Ext. 2672