Thursday, January 25, 2018
Licensing and Policy Branch
Ministry of Health and Long Term Care
Dear Ms. Hylton,
Thank you for inviting the Ontario Long Term Care Clinicians to participate at the Roundtable Consultation Session on November 29. I have shared Aging with Confidence: Ontario’s Action Plan for Seniors Long Term Care Quality and Staffingwith the OLTCC Board of Directors and other physicians active in Ontario’s long term care homes.
The Action Plan recognizes the increasing need for capacity in the long term care sector. It promotes growth and quality improvement in our LTC system. We feel it could go further to address education and advance care planning. OLTCC promotes with following:
1. Greater emphasis on long term care training
2. Province-wide advance care planning
3. Support for Medical Director curriculum
4. Recognition and support for residents with special needs
5. Expanded use of telemedicine
6. Mobile diagnostic units
7. Greater public education about frailty and long term care
OLTCC is a not-for-profit organization representing medical directors and attending physicians in long term care. Our membership includes nurse practitioners and pharmacists. Our Vision is that “all Ontarians will receive excellent care”. We promote education and advocacy. Our annual conference is the largest for LTC physicians in Canada. Our Medical Director Curriculum promotes leadership and quality improvement in long term care.
Greater emphasis on long term care training The current exposure to long term care in medicine and nursing is inadequate. Our well-trained health care professionals are not meeting the needs of an expanding LTC sector. Long term care is perceived as risky and over-regulated. The front-line providers need to be valued for their skills and professionalism. Evidence shows that exposure of LTC to medical students and family medicine residents will increase the likelihood of providing care in long term care.
Province-wide advance care planning Several Local Health Integration Networks (LHIN) have developed advance care planning strategies for their communities and facilities. There should be a province-wide effort to scale-up their successes. Physicians are concerned about the incidence of avoidable transfers to the emergency departments. Better advance care planning is essential to improving this quality indicator.
Support for Medical Director Curriculum The Long Term Care Homes Act requires all facilities to have a medical director who is a physician. OLTCC developed a Medical Director Curriculum that provides training in in administration, the LTC Act and regulations, and quality improvement. The quality improvement methodology aligned with the IDEAS platform for health care workers in Ontario. The program has continuing education certification from the College of Family Physicians of Canada. The Ministry and licensee should support the Medical Director Curriculum.
Recognition and support for residents with special needs The recognitionof residents with special needs, including behaviours, cultures and medical complexity, cannot be met by specialized units alone. The resident that we care for have varying needs. Better staffing ratios and other focused use of resources are required for a variety of special needs. Such additional resources at the LTC level will improve quality and lessen the burden on other parts of the health care system.
Expanded use of telemedicine Avoidable transfers to emergency departments, and between facilities, can be reduced by greater use of telemedicine and virtual visits. Projects like LTC-Connect provides interconnectivity between the Regional Clinical Viewer (RCV) and the electronic health record (EHR) in long term care. Fasting tracking is needed to assure access to programs like the Digital Health Drug Repository (DHDR) and Ontario Laboratory Information System (OLIS). The entire LTC EHR—records, reports and prescribing—should be seamless and paperless. The Ontario Telemedicine Network (OTN) will provide more timely consultations and reduce costly transfers.
Mobile diagnostic units Mobile diagnostic units for laboratory and imaging brings services to our residents. With the interconnectivity with the RCV and OTN, mobile diagnostics will permit more expedient care, reduce transfers between facilities and reduce costs.
Greater public education OLTCC urges greater public education about long term care. This includes issues like frailty, palliative care, advance care planning, antibiotic stewardship, ED avoidance, quality improvement, quality of life. This not just for the benefit of the facilities but also for the frail elderly in the community moving through a continuum of care.
We support the government’s plans to improve the capacity of the long term care sector. In addition to assuring the best care for our residents, we want to give a positive, compassionate image of life in long term care.
Thank you again for requesting our input.
Fred Mather, MD
OLTCC Advocacy 2018 - click here to review the issues for long term care physicians to promote with current politicians and candidates in the upcoming provincial election.