Friday, March 04, 2011
Partnership with Champlain CCAC and Arnprior & District Memorial Hospital Helps Seniors Navigate the Health Care System
OTTAWA – A pilot project in Arnprior is improving care for frail seniors, coordinating care and ultimately improving patient outcomes.
The Champlain Community Care Access Centre (CCAC) and Arnprior District & Memorial Hospital (ADMH) have combined the roles of the CCAC Case Manager and the ADMH Geriatric Emergency Management (GEM) Nurse. The Case Manager/GEM Nurse works with the care team in the Emergency Department (ED) to identify high risk frail seniors and screen for potential challenges. From there, she works with the patient, family and inter-professional team to formulate an optimal plan and ensure appropriate referrals and follow-up. The Case Manager/GEM Nurse also serves as an educational resource to health care practitioners regarding what services are available.
“This unique service recognizes that care planning for frail seniors needs to start on presentation at the ED,” notes Leah Levesque, Director of Patient/Resident Services. “The combined role facilitates early intervention and integration of the ED with community support and healthcare services. The information provided helps patients make informed choices.”
Karen Lapierre, Manager of Clients Services, Champlain CCAC agrees. “From the CCAC’s perspective, the project allows us to fulfill several of our strategic directions including building partnerships for better integration and evolving health care teams improve the continuum of care – all of which ensure the very best care for our clients. The Case Manager/GEM Nurse acts as a care facilitator, ensuring a smooth transition between the healthcare sectors and minimizing the number of people involved with the client’s care plan.”
Following four weeks of orientation, the project began in November 2010 and to date, the number of CCAC referrals from the Emergency Department has doubled to 58 clients. Anne Silbernagel is the Case Manager/Gem Nurse in Arnprior and has worked in geriatric nursing for more than 20 years. She sees up to 10 clients each day and says the pilot results are very encouraging: “It’s all about support. If we see a patient who could benefit from some type of support to stay in their own homes and keep their independence, we can help them. We provide options for them and they are very grateful.”
“The healthcare system can be difficult and confusing for clients to navigate. The Case Manager/GEM Nurse is in an ideal position to be a positive change agent,” sums up Karen Lapierre. “She is able to synthesize disparate information and competing demands and identify options for the client, family and caregiver to review. In turn, the health care system benefits through more integrated care and reduced admissions to hospital. Everyone wins.”
For more information, please contact:
Suzanne Charest
Senior Communications Manager
Champlain CCAC
Phone: 613-745-8124 ext. 5997
Cell: 613-864-3925
E-mail: suzanne.charest@champlain.ccac-ont.ca
Wendy Knechtel
Manager, Communications and Fund Development
Arnprior & District Memorial Hospital
Phone: 613-623-3166 ext. 293
E-mail: wknechtel@arnpriorhospital.ca
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