Yee Hong Centre for Geriatric Care

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Yee Hong Centre for Geriatric Care

• Scarborough
• McNicoll Centre
• 2311 McNicoll Ave
• Scarborough, ON
• M1V 5L3
• Tel [phone]

Scarborough Finch Centre 60 Scottfield
Drive Scarborough, ON M1S 5T7 Tel [phone]
Markham Ho Lai Oi Wan Centre 2780 Bur Oak
Ave Markham, ON L6B 1C9 Tel [phone]
Mississauga Centre 5510 Mavis Ave Mississauga,
ON L5V 2X5 Tel [phone]
CE - LHIN
C - LHIN
MH - LHIN
Website www.yeehong.com
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Yee Hong Centre for Geriatric Care

• Continuum of Care

• Presenters
• Amy Go, Executive Director YHC Markham
• Eric Hong, Director of Corporate Development
  YHC
• K.Y. Liu, Director of Social Services YHC

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Yee Hong Centre for Geriatric Care

• Continuum of Care

• Thoughts Driving Actions
• The Yee Hong Continuum
• Alignment with C-LHIN IHSP
• Looking Ahead
• Making A Continuum Work

Eric
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Thoughts Driving Actions (I) Aging in Place

• Seniors
• able to remain, by choice, at their accustomed
  residences, and
• No unnecessary relocation just to secure required
  support services in response to changing needs.
• To age in place, support needed to
• maintain a desirable lifestyle
• continue residing in a familiar environment where
  one feels safe,
• remain independent as ones health allows,
• have access to educational, cultural,
  recreational opportunities, and
• continue to participate in ones community.

Eric
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Pre-conditions for Aging in Place
More Structured Residential Care
Autonomous Community Residence
Need for Support
Capacity for Independence
Eric
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Thoughts Driving Actions (II) Prevention

• Primary Prevention
• Help to avoid health problems e.g. wellness
  education and health promotion.

• Secondary Prevention
• Detect and address, as early as possible, common
  asymptomatic diseases that have significant risk
  for negative outcome if not treated.

• Tertiary Prevention
• Treat established disease,
• Attempt to restore to highest function,
• Minimize negative effects of disease, and
• Prevent disease related complications.

Eric
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Thoughts driving Actions (III) The Yee Hong
Mission

• Deliver high quality and culturally appropriate
  services within the capacity of the organization.
• Enable seniors to live their lives to the fullest
  in the healthiest, most independent and dignified
  way.

• YHC currently provides
• Culturally linguistically appropriate
• community support and long-term care home
  services to Chinese seniors
• long-term care home services to seniors of a
  number of ethno-cultural backgrounds, including
  South Asian, Filipino, and Japanese Canadians

Eric
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Translating Principles into Services at Yee Hong
Aging in Place

• Primary Prevention

In-Home Services

• Wellness Education Health Promotion

Community Support
Secondary Prevention

• Support for Community Residence

Tertiary
Prevention
Long-Term Care Home Services

• Remedial Treatment Supportive Care

Culturally Appropriate Care
Eric
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In-Home Services

• Service Supported Housing
• 156 Supportive Housing Living Units
• 2 MOHLTC funded supportive housing
• projects
• 1 Fee-for-Service supportive housing project
• 308 Life Lease Housing Units
• In-Home Services
• to Isolated Seniors
• Friendly Visiting
• Security Checks
• Meals on Wheels

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Community Support Services

• Active Seniors Program
• Congregate Dinning Program
• Adult Day Programs
• Dementia
• Post Stroke
• Integrated
• Client Intervention and Assistance
• Caregiver Support Program
• Chronic Disease Self Management Program
• Transportation Service

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Chronic Disease Prevention Management (CDPM)
Yee Hong Chronic Disease Self Management Program

• The Stanford Model
• (based on years of research and development -
  widely adopted worldwide.)
• Emphasis on Three Self-management Tasks
• Take care of ones health problem
• Carry out normal activities
• Manage ones emotional changes
• By managing these tasks, youll be in better
  control of your condition!!

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Yee Hong Chronic Disease Self-Management Program

• Underlying Assumptions
• Patients with diverse chronic conditions have
  similar concerns and problems
• Patients can learn to take responsibility to deal
  with their diseases and with their impact on
  their lives and emotions
• Confident patients who practices self-management
  will experience improved health status and
  utilize fewer health care resources
• Lay people with chronic disease experience and
  training can teach the program as effectively as
  professionals their being role models can
  enhance patients self-efficacy to manage their
  disease
• Process of the program is more important than
  what is actually taught (content).

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Yee Hong Chronic Disease Self-Management Program

• Progress to Date
• Staff sent to Stanford to train as master
  trainers.
• Further trained other staff and volunteers as
  trainers.
• About 70 clients have gone through this program
  with encouraging results since December 2006.
• Health Fair in October to promote patient
  self-management.
• Conducting more volunteer training in December
  2007.
• Continue to roll out this program in the Chinese
  Community within GTA.
• This program was a finalist for the Celebrating
  Innovation Expo 2007 Grand Prize within the
  theme of Innovation in Health Promotion.

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Community Support Services Utilization
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Medical Services
Scarborough
Markham
Mississauga
Medical Centre/Clinic
Medical Centre/Clinic
Medical Centre/Clinic
Rehabilitation Services
Movement Disorder Clinic
Cancer Palliative Care Ambulatory Dialysis
Program
Communication Disorder Program
Eric
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Medical Centre Services

• Family Medicine (Scarborough
  Mississauga)
• Geriatric Internal Medicine (Scarborough)
• Cardiology (Scarborough)
• Neurology (Scarborough)
• Internal Medicine Rheumatology (Scarborough)
• Dermatology (Scarborough)
• Physiatry (Scarborough)
• Podiatry (Scarborough)
• Prosthetics/Orthotics (Scarborough)
• Memory Program (Scarborough)
• (Eventually also Markham)
• Cancer Palliative Care (Scarborough)

Eric
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Affiliated Programs

• Central East LHIN
• Ki-Kit Li Rehabilitation Centres
• Scarborough McNicoll Centre
• Scarborough Finch Centre
• The Scarborough Hospital Ambulatory Dialysis
  Program
• Scarborough Finch Centre

• Central LHIN
• Guttman-Adams - Movement Disorders Clinic
• Markham Centre
• York Region Aphasia Ctr. Communication Disorder
  Program
• Markham Centre

• Mississauga Halton LHIN
• Opportunities available

Eric
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Long-Term Care Homes Scarborough
Amy
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Long-Term Care Home Markham
Amy
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Long-Term Care Home Mississauga
Amy
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Long-Term Care Components
Amy
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Priorities for change in the C-LHIN Integrated
Health Services Plan

• Access
• Opportunities for a consumer to fully benefit
  from a specified necessary service, as well as
  necessary concurrent and follow up services in a
  timely way.
• Coordination
• Provision of harmonized services and service
  policies at the organization /system level and at
  the client/caregiver level.
• Efficiency
• A measure of the value derived from a set of
  resources to produce a specific result. From an
  economics perspective, efficiency is a relative
  measure of the ratio of inputs (resources) to
  outputs (results).

Amy
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Priorities for change in the C-LHIN Integrated
Health Services Plan

• Quality
• Related to values and client expectations.
• Consistent performance of a uniform product and
  denotes achievement or excellence in the eyes of
  the beholder.
• Operationally, an ongoing process of building and
  sustaining relationships by assessing,
  anticipating, and fulfilling stated and implied
  needs.
• Implementation of a quality culture requires up
  front identification and definition of
  stakeholders needs.

Amy
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Yee Hong Continuum of Care Contributing to
achieving the C-LHIN change priorities

• Access to Coordination
• The Yee Hong continuum model resides primarily
  with the Yee Hong organizational context,
• Yet, it enhances access to, and facilitates
  coordination with, other services outside of Yee
  Hong
• Changing CCAC mandate to one of coordinator of
  home care services Often challenged when needing
  to help non-English speaking communities navigate
  service system
• Yee Hong Client Intervention (Social Worker)
  helps Chinese community seniors and their
  families navigate through and access both
  services offered by Yee Hong and by other
  providers

Amy
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Yee Hong Continuum of Care Contributing to
achieving the C-LHIN change priorities

• Early exposure to community and social support
  programs e.g. Active Seniors Program, and their
  health promotion components
• Precipitates improved overall health
• Allows for participants to delay need for
  intensive services
• Better prepares them to make appropriate use of
  such services along the continuum as their needs
  intensifies,
• Helps alleviate anxiety
• Promotes acceptance and ultimately,
• Improves care outcomes.

Amy
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Yee Hong Continuum of Care Contributing to
achieving the C-LHIN change priorities

• Coordination across the health sector and
  different providers hinges on preparedness and
  readiness of providers, as well as their
  resources and commitment to collaborate and
  innovate.
• YHC, with solid foundation in community and
  long-term care service bases, believes in
  collaborative projects, and is a strong partner
  with the skills and commitment ready, and
  prepared, to engage in innovative collaborative
  initiatives.
• Current and prospective partners include Mt
  Sinai Hospital The Scarborough Hospital Hong
  Fook Mental Health Association Central East
  CCAC Gutman-Adams Movement Disorder Clinic York
  Region Aphasia Centreetc.
• Can contribute more substantively to
  collaborative projects and effect bigger impact
  on the community, and ameliorate resources
  otherwise required of partner organizations.

Amy
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Yee Hong Continuum of Care Contributing to
achieving the C-LHIN change priorities

• Efficiency and Quality
• Economy of Scale e.g. a central transportation
  program with 7 vehicles supporting programs
  across the organization in Scarborough and York
  Region.
• Corporate Infrastructure HR, IT, Finance, and
  volunteer development services
• Corporate Focus on Quality Improvement, Client
  Safety, and ethics demonstrated by devotion of
  corporate resources to these critical functions
• YHC success also attributable to extensive
  community support in the form of donations and
  volunteer resources
• In 2006, volunteer hours spent in YHC is the
  equivalent of 47.44 FTE staff hours across the
  organization, and ( ) FTE in York Region alone.

Amy
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Yee Hong Continuum of Care Contributing to
achieving the C-LHIN change priorities

• The Yee Hong Model - steeped in community
  development principles
• Yee Hong has come about through grassroots
  community organization initiatives in the 1990s
• Its integral connection with the community is
  what makes it so successful
• An IHSP is a community development plan
• Premised upon engaging the community to develop
  services in response to its needs and as such,
• That can only be successfully realized with
  community engagement and involvement.
• Yee Hong strongly supports this premise and
  emulates through its continuum of care model
  which illustrates how working closely with the
  community can/will achieve.

Amy
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Stretching Service Reach
Markham 30 of population of Chinese descent
Richmond Hill 25 of population of Chinese descent

• ADP (Scarborough) Clientele
• 20.9 from North York
• 16.4 from Markham/Richmond Hill
• Congregate Dining (Scarborough) Clientele
• 28.7 from North York
• 4.6 from Markham/Richmond Hill
• (one program is operating out of a church
  basement in North York)
• Resources extended from Scarborough to meet needs
  in North York and Markham
• Caregiver support
• Transportation

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Projects/Programs in Waiting Central LHIN

• Community Support
• Adult Day Program (C-LHIN/Markham) launched on
  Trillium Grant
• Adult Day Program (C-LHIN/North York)
• System Navigation
• Client Intervention and Assistance (C-LHIN/York
  Region)
• Supportive housing
• Seneca Tower (C-LHIN/North York)
• Cliffwood Manor (C-LHIN/North York)

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Continuum of Services Goal

• To provide a basket of services to seniors in
  order that they can age in place.
• Services are provided to seniors when they are
  active until a time when they can no longer
  care for themselves in the community and has to
  enter a more structured care environment e.g.
  LTCH.
• Seniors can move along this continuum of service
  according to their level of independence and care
  needs.

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The Complexity behind A Continuum

• A seamless Core Continuum
• Supportive Housing
• Active Senior Program
• Congregate Dinning
• Adult Day Programs
• Long-Term Care (Homes) Program

A network of Contributing Resources

• Client intervention (Crisis Response System
  Navigation)
• Caregiver support
• Friendly visiting
• Caregiver support

• Advocacy Community Education
• Housing
• Chronic disease self-management
• Ancillary Services PT, OT, Podiatry, Primary
  Care and Specialized Medicine, Dietitian etc.

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Yee Hong Continuum of Care
Need for Support
Capacity for Independence
Rehabilitation Mental Health Outreach Movement
Disorder Communication Dialysis
Family Medicine Medical Specialties
End-of-Life Care
Long-Term Care Homes
Congregate Dinning Program
Supportive Housing Services
Active Seniors Program
Adult Day Programs
Adult Day Programs
Client Intervention Assistance Service
Chronic Disease Prevention Management Program
Health Promotion Caregiver Support Programs
Transportation
Eric
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Yee Hong Centre for Geriatric Care

• Scarborough
• McNicoll Centre
• 2311 McNicoll Ave
• Scarborough, ON
• M1V 5L3
• Tel [phone]

Scarborough Finch Centre 60 Scottfield
Drive Scarborough, ON M1S 5T7 Tel [phone]
Markham Ho Lai Oi Wan Centre 2780 Bur Oak
Ave Markham, ON L6B 1C9 Tel [phone]
Mississauga Centre 5510 Mavis Ave Mississauga,
ON L5V 2X5 Tel [phone]
CE - LHIN
C - LHIN
MH - LHIN
Website www.yeehong.com