Nurse practitioners will help to keep long-term care residents out of hospital

TORONTO - On Monday, March 3, Ontario’s Ministry of Health and Long-Term Care announced plans to fund an additional 75 nurse practitioners in long-term care homes, rolled out over the next three years.

“This is excellent news,” says Candace Chartier, CEO of the Ontario Long Term Care Association (OLTCA), which represents 439 long-term care facilities in the province. “With the ongoing shift in Ontario to care for people at home as long as possible, seniors who are now coming into long-term care are more frail and clinically complex, requiring more advanced care than even a few years ago.”

The vast majority (93%) of long-term care residents have two or more chronic diseases such as diabetes and arthritis. Many have Alzheimer’s, other dementias, and mental health challenges, with nearly half (46%) displaying some form of aggressive behaviour.

“Health care in long-term care is much more medically complex and challenging than it used to be,” Chartier says. As some facilities have difficulty getting access to medical directors for their homes or to family doctors in the community, adding more nurse practitioners to help provide on-site monitoring and care for residents’ physical and mental health is expected to reduce the large number who are taken to hospital.

“Many of our residents are currently in and out of hospital emergency departments and hospitalizations due to various reasons,” Chartier says.  “It’s costly for the system and very stressful for our residents, particularly those with cognitive and mental health challenges.”

Chartier, who worked for many years as a registered nurse in long-term care, says the 75 additional nurse practitioners will provide “a new level of expertise to support the teams that are already in each home providing safe, good-quality care.”

Expanding advanced nursing capacity in long-term care homes and reducing the number of transfers to hospital were two of the recommendations in OLTCA’s seminal 2012 report, Why Not Now? A Bold, Five-Year Strategy for Innovating Ontario’s System of Care for Older Adults.

How long-term care is changing:

• The latest data from the Canadian Institute for Health Information  shows that Ontario’s long-term care residents have prevalence rates of endocrine, metabolic, pulmonary, and heart/circulatory diseases similar to patients in complex continuing care hospitals—and much higher than long-term care residents in other provinces. End-stage disease is increasing at more than 10% per year.
• Currently, 61% of residents live with Alzheimer’s or other dementias. More than one-third (38%) have a psychiatric or mood disorder. Dual diagnosis, such as both dementia and a psychiatric diagnosis, is increasing at 11% per year.  And nearly half of all residents (46%) have some level of aggressive behaviour such as hitting or disproportionate anger, often triggered by perceived insults or transgressions.
• Residents have highly complex needs that require specialized and intensive care, and significantly more support with activities of daily living. As one example, research shows that in the four-year period between 2008/2009 and 2012/2103, the proportion of residents who needed higher levels of support with toileting increased by 22%. Other increases included bathing (16%), personal hygiene (23%), and dressing (23%).

“The Ministry’s announcement shows that the government understands long-term care is changing rapidly, and needs more investment,” says Chartier.

OLTCA is Canada’s largest long-term care association and represents 439 homes in a full spectrum of charitable, not-for-profit, private, and municipal long term care operators. OLTCA members provide health care and a home to almost 70,000 seniors annually.