CCAC Health Care At Home Essential Guide

Transcription

Health Care At Home:Your Essential Guide toMississauga Halton CommunityCare Access Centre ServicesIn-home and community-based health careservices and long-term care placement inSouth Etobicoke, Mississauga, Oakville, Milton,Georgetown and Halton HillsThe Mississauga Halton CCAC services are funded through theMississauga Halton Local Health Integration Network (MH LHIN)1

We’re part of your health care teamMost of us visit our family doctor totake care of our day-to-day healthcare needs. And we use the servicesof our local hospital when we needemergency, medical or surgicalcare. But where do you turn whenyou need help with your health careneeds at home or at school?That’s where your local MississaugaHalton Community Care AccessCentre (CCAC) can help.Like your family doctor and localhospital, the Mississauga HaltonCCAC is an important part of yourhealth care team. Think of us asyour personal health advisor forconnecting you with in-home,community-based services and/orlong-term care options.We coordinate professional health care services for people of all ages,from birth through to end-of-life, with a particular focus on helpingolder adults, who are at high risk, get the help they need to live safelyat home for as long as possible. Our services are funded through theMississauga Halton Local Health Integration Network (MH LHIN), sothere is no direct cost to you.To help you get the care you need when and where you need it, ourhighly qualified case managers: conduct detailed health assessments of your care needs todetermine whether you are eligible for services coordinate professional health care services in your home,at school, or at community-based clinics. These services mightinclude nursing care, occupational therapy, physiotherapy, personalsupport, speech and language pathology, social work or nutritionalcounselling (these service costs are funded by the MH LHIN) provide information about community-based services that canhelp you with preparing meals, housecleaning and transportation toappointments, (some services are provided for a fee) provide referrals to community-based services, such as adultday programs and provide information about bathing services andother supports from outstanding local community-based agencies coordinate the application process for admission to long-termcare facilities provide end-of-life care and coordination2

Table of ContentsWhat we do4How to access services5Connecting you with the right services7Your personal health care advisor7Your health care assessment7Your personalized care plan8Finding a family doctor8In-home & community-based health care services9In-home health care services9Community nursing clinics9Specialized services10Children’s health services10School Health Supports Services10Specialized programs12Convalescent Care12Restore12Home First13Wait at Home13Wait at Home Enhanced13Stay at Home13Short-Stay13End-of-life services16Long-term care facilities and other options18Caregiver Services20Relief for family caregivers20Respite20Adult day programs20Honouring caregivers21Other valuable resources223

What we doWhen it comes to your health, life canoften throw you a curve ball whenyou least expect it. Whether you arehaving surgery in the hospital, have achild who is struggling at school dueto a significant health issue, are caringfor a loved one with dementia, feelyou can no longer manage living onyour own at home or you have beendiagnosed with a life-limiting illness,you may find yourself wondering howyou are going to get through this.We’re here to help.Our case managers are your personal health care coordinatorsfor setting up health care services in your home, at school and inthe community: nursing occupational therapy physiotherapy personal support speech language therapy social work dietetic servicesWe are your personal health care advisors for long-term care andother care options: exploring options for long-term care helping with the long-term care application process providing relief for family caregiversWe are your personal care connectors for community-based services(Note, there may be additional costs for some of these services) bereavement support (following the death of a loved one) support groups (for family caregivers) friendly visiting services in-home help (e.g. shopping, housecleaning, home maintenance, etc.) meal delivery/dining programs retirement homes supportive housing transportation to appointmentsWe work closely with all levels of government, hospitals, our contractedservice providers, local school boards, community support services, longterm care facilities, family doctors and emergency medical services tomake sure that those living with chronic and complex health conditionsand whose independence is at risk can enjoy a good quality of life athome and in the community.4

How to access servicesContact the Mississauga Halton CCAC. You can call about yourself or onbehalf of a family member, friend or neighbour who needs support.Phone 310-CCAC (2222). No area code needed.8:30 am – 9:00 pm, seven days a weekThe most important first step you can take if you think you need helpis to contact us. The friendly team in our Contact Centre will ask you afew questions to better understand how we can help you.There may be one of two ways we can meet your needs:1. C onfirming if you qualify for CCAC health careand support servicesIf it sounds like you might benefit from professional health careservices coordinated through the Mississauga Halton CCAC,our Contact Centre staff will connect you with one of our casemanagers. To better assess your needs, our case manager will askyou more questions over the phone. This assessment may take 20to 40 minutes depending on the reason for your call.a) U rgent needsAlthough rare, there are times when it is clear following thephone assessment that someone is in urgent need of CCACservices. If this is the case, we will arrange for professionalhealth care services to start immediately until we can perform amore in-depth assessment in the home.b) N on-urgent needsWhen you call our contact centre, our team assistants will askyou a few questions and, based on your response, they mayschedule the phone assessment with you for a later date. Afterthis initial phone assessment, a case manager may visit you atyour home within 14 days to conduct a more detailed healthcare assessment.2. P roviding you with information about othercommunity servicesWe often receive phone calls from people who don’t require healthcare services, but who need help to enable them to continue livingsafely and independently in their own homes. This might includehelp doing laundry, housecleaning, home maintenance or preparingmeals. Or it may include help with transportation to health careappointments or connecting with a support group. Our ContactCentre team references a list of valuable community-based servicesand will be happy to provide you with the names and phonenumbers of agencies that might be able to help you. Please notethat some of these organizations may charge a fee.5

Arranging for CCAC services when you arein the hospitalIf you are in the hospital, your health care team may ask oneof our Mississauga Halton CCAC hospital case managers tomeet with you to talk about what supports you might needin place once you return home. Or you can ask your hospitalnurse or doctor to contact our hospital-based case managerto arrange for a meeting with you before you are discharged.Or call us directly at 310-CCAC (2222). You will want to talkto our case manager if you need: short-term support following surgery (e.g. wound care foran incision, rehabilitation following hip or knee surgery) long-term support to help you to continue living safely andindependently at home (e.g. nursing care, occupationaltherapy, physiotherapy and personal support) end-of-life care at home (e.g. pain and symptommanagement, advanced care planning) transitional care (e.g. convalescent care) to regain yourstrength before returning home help applying for admission to long-term careOur services focus on individuals who have high needs andwho are at risk of losing their independence. We have hospitalcase managers available onsite at The Credit Valley Hospitaland Trillium Health Centre, Georgetown Hospital, MiltonDistrict Hospital and Oakville Trafalgar Memorial Hospital.6

Connecting you with the right servicesSo what are the next stepsafter you place that call to theMississauga Halton CCAC? If thequestions posed by our ContactCentre team assistant indicateyou or your loved one mayqualify for CCAC services, we willsend one of our highly qualifiedcase managers to your home,usually within 14 days to meetwith you.Your personal health care advisorThink of our case manager as your personal health care advisor. Heor she will be your main point of contact with the CCAC and will workwith you and/or your loved one to identify which services will bestmeet your individual short or long-term health needs. When our casemanager visits you in your home, he or she will: ask you questions about your health care needs and how you arecurrently managing (health care assessment) while being sensitiveto diversity and culture talk to you about who is currently helping to support you walk around your home to assess your home for safety speak with your family caregiver to find out how they are doingand to see if they have any needs as wellYour case manager will use this assessment and experienced judgmentto confirm if you require Mississauga Halton CCAC services and tocoordinate the right mix and level of services based on your needs.While you receive CCAC services, your case manager will check inwith you regularly to see if your needs have changed. Your casemanager will also refer you to other community-based services thatmay further support your needs like meal delivery, housecleaning orfriendly visiting.If you don’t require Mississauga Halton CCAC services at this time andother organizations are more appropriate to meet your needs yourcase manager will recommend other valuable community supports thatmay be able to help you.Your health care assessmentAll CCACs in the province use a common set of provincial assessmenttools to determine health care needs. Based on your assessment,your case manager will either develop your care plan or refer you tocommunity service organizations for services. Generally, most of theservices we provide are best suited for people who are considered athigh risk of losing their independence and ability to continue livingat home.7

Your personalized care planIf you qualify for Mississauga Halton CCAC health care services, yourcase manager will develop a personalized care plan, which will includea schedule outlining which health care professionals will be coming intoyour home, their contact information, how often they will be visitingand on what days and times. Your case manager will take the worryout of scheduling these visits by coordinating them on your behalf. Allhealth care services coordinated by the Mississauga Halton CCAC areprovided by contracted service providers that share the same valuesand commitment to high quality client-focused care that we do.Finding a family doctor with Health Care Connect:In 2011/12, we collaborated with local family doctors and helped1,702 people find a family doctor. With just 770 citizens requestinga family doctor, our region has one of the lowest rates of residentswithout a primary care physician in Ontario.If you need a family doctor, call 1-800-445-1822 and ask forHealth Care Connect.8

In-home & community-basedhealth care servicesIn-home health care servicesIn-home health care services may be available to you on a short-termor long-term basis, depending on your needs. If you qualify for inhome services, one or more of the following health care professionalsmay be involved in your care at home or in your child’s school: nurse, if you are not ableto visit a clinic personal support worker occupational therapist physiotherapist speech language therapist(in-home only) social worker dietitianCommunity nursing clinicsThe Mississauga Halton CCAC arranges services through fivecommunity clinics that are conveniently located for easy access.These clinics are for individuals who require nursing care and havethe ability to attend appointments.Clinic locations and hours of operation:LocationAddress, ContactHours of OperationMississauga5 Watline Avenue,Suite 501Mississauga, ON, L4Z 2Z1Monday - Friday7:30 a.m. – 7:30 p.m.1300 Central ParkwayWest, Suite 105Mississauga, ON, L5C 4R3Monday - Friday8:00 a.m. – 9:00 p.m.Weekends/Statutory holidaysTel: 905-896-02008:00 a.m. – 4:00 p.m.Toll free: 1-800-234-8661MississaugaTel: 905-272-2271Mississauga2785 Skymark Avenue,Unit 7Mississauga, ON,L4W 4Y3Tel: ealthcareWeekends/Statutory holidays8:00 a.m. – 5:00 p.m.Monday - Friday8:00 a.m. – 8:00 p.m.CaleaWeekends8:00 a.m. – 4:00 p.m.Weekday/Statutory holidays8:00 a.m. – 8:00 p.m.Weekends/Statutory holidays8:00 a.m. – 4:00 p.m.Oakville2370 Speers Road,Oakville, ONTel: 905-827-8800Toll free: 1-800-387-7127Milton611 Holly Avenue, Unit203, Milton, ON, L9T 0K4Monday - Sunday includingStatutory holidays8:00 a.m. – 8:00 p.m.AcclaimHealthMonday - Friday8:00 a.m. – 8:00 p.m.AcclaimHealthTel: 905-827-8800Weekends/Statutory holidaysToll free: 1-800-387-7127 8:00 a.m. - 4:30 p.m.9

Specialized ServicesChildren’s health servicesIn-home healthcare servicesWe support families in the care oftheir infant, child or youth withcomplex medical and health careneeds until their child is 18 yearsof age or 21 years of age if theirchild is attending school andaccessing School Health SupportServices.Our highly qualified case managers contact the family within 72 hoursof admission and works with families to support the development oftheir child. The family maintains the role as the primary caregiver.Within 14 days, our case manager will complete an assessmentand develop a personalized care plan for the child. In some cases,your child’s health care needs may be met by attending one of ourcommunity nursing clinics.Speech and language pathology services for pre-school children whoqualify are available through ErinoakKids (for children up to the ageof five) and through our School Health Support Services program,starting in Grade One.School Health Support ServicesYou want your child to have every opportunity to attend, learn andtake part in activities at school. But this can sometimes be challengingfor children who have physical or other health care needs.We work closely with the Public, Catholic and French school boardsin your community, and with private schools, to identify and supportschool-aged children who are struggling in the classroom due to asignificant physical or health issue. For example: a medical diagnosis can hamper a child’s ability to attend schoolunless the child has support with things like gastric tube feedings,catheterization, insulin injections or suctioning and monitoring fine motor delays can make it hard for a child to grasp a pencil orpen affecting their ability to print or write oral motor problems can affect a child’s ability to communicate withthe teacher and classmates an awkward gait or frequent falls can make it difficult for a child tojoin classmates in the school’s physical education program10

We work with school staff, parents andregulated health care professionals totransfer learning to parents and schoolteams to ensure support is integrated intothe school environment. Please note thatthese services are only available duringthe school year and are not available in thesummer months.Contact your child’s school principal or special education resourceteacher about making a referral to the Mississauga Halton CCAC foryour son or daughter.What services are provided?No two children have the same health needs. Based on an individualassessment of your child’s needs, our case managers will work withyou and your child’s teacher to coordinate health support services inthe classroom which may include one or more of the following: nursingpersonal supportphysiotherapyspeech and language pathologydietetic servicesHow do I know if my child is eligible for services?To be eligible for School Health Support Services, your child must: be enrolled in a publicly-funded, private or home-school, up to theage of 21 years be identified by the school as needing School Health SupportServices programs to attend, learn and/or take part in activitiesat school have a valid Ontario health cardIf you aren’t familiar with School Health Support Services and thinkit might benefit your child, contact the school principal or your school’sspecial education resource teacher about making a referral to theMississauga Halton CCAC for your son or daughter. More than 3,000children currently receive support through this programDid You Know?The Mississauga Halton CCAC conducts assessments onbehalf of the Ontario Ministry of Children and Youth Servicesto determine if a child’s family is eligible for enhancedrespite funding. This grant is paid to families who are caringfor a child who is medically fragile and/or depends on atechnological device and who needs care 24 hours a day,365 days a year. Families may be eligible for up to 3,500 perchild per year. The children of eligible families are re-assessedevery year.11

Specialized ProgramsPrograms helping youmove from hospital tohome safelyWhether you have been in thehospital receiving medical carefollowing an illness or injury,or you are recovering fromsurgery, sometimes you mayneed care to safely manage onyour own at home.Based on a referral from yourhospital health care team,one of our CCAC hospital casemanagers will meet with youto assess your needs. If yourequire significant support toreturn home and you are over 16 years of age, you may benefit fromour Wait at Home or Wait at Home Enhanced programs. Thoseprograms provide more support than our traditional programs andenable you to either return home or return home and wait for longterm care.Convalescent Care programThe Convalescent Care program provides 24-hour care to peoplewho require specific medical and therapeutic services in a supportiveenvironment. The program will help you recover your strength,endurance and functioning before returning home following a stay inhospital. This program supports clients able to benefit from two hoursof rehabilitation daily. This program operates out of Post Inn Village.The average length of stay is four to six months. There is no fee forthis program.Restore ProgramThis short-term care program was designed to help you return toindependent living with the support of a specialized team of healthcare professionals who will help you to regain your physical strength.If you qualify for the program, you will move from the hospital toa semi-private room in the Restore program at the Cooksville CareCentre in Mississauga. The average length of stay in this program isfour to six weeks.12

Home FirstAlternatives tolong-term careWorking together with ourhospital and long-term carefacility partners, we believeit is important to exhaustevery available option to helpsomeone who has high needsto remain living safely at homeinstead of moving into longterm care. This Home Firstphilosophy of care is supportedby a number of programsdesigned, highlighted below.Wait at Home programWe help you move from hospital to home safely, where you cantake the time you need to apply for long-term care and wait in thecomfort and safety of your own home. One of our highly qualified casemanagers will assess your needs and assist in completing your longterm care application.Wait at Home Enhanced programWe provide an enhanced level of in-home health care services toenable clients to move safely from hospital to home while theyconsider whether a long-term care facility is the best choice for th

Halton Community Care Access Centre (CCAC) can help. Like your family doctor and local hospital, the Mississauga Halton CCAC is an important part of your health care team. Think of us as your personal health advisor for connecting you with in-home, community-based services and/or long-term care options.