Review of Alberta Health Services' Continuing Care
Total Page：16
File Type：pdf, Size：1020Kb
REVIEW OF ALBERTA HEALTH SERVICES’ CONTINUING CARE WAIT LIST: FIRST AVAILABLE APPROPRIATE LIVING OPTION POLICY March 26, 2014 TABLE OF CONTENTS FOREWORD ....................................................................................................................................... 4 EXECUTIVE SUMMARY ..................................................................................................................... 5 OVERVIEW ....................................................................................................................................... 12 INTRODUCTION TO CONTINUING CARE WAIT LIST MANAGEMENT ......................................... 15 FINDINGS ......................................................................................................................................... 19 SUMMARY OF QUALITY ISSUES ................................................................................................... 56 ISSUES, ANALYSIS, RECOMMENDATIONS, AND REQUIRED ACTIONS .................................... 58 APPENDICES ................................................................................................................................... 64 Appendix I: Terms of reference ..................................................................................................... 65 Appendix II: Terms of reference – extension letter ........................................................................ 67 Appendix III: Environmental scan of first available living option policies ........................................ 68 Appendix IV: Literature review ....................................................................................................... 76 Appendix V: Resident and family interview report ....................................................................... 128 Appendix VI: Key documents....................................................................................................... 162 Appendix VII: Glossary ................................................................................................................ 168 REFERENCES ................................................................................................................................ 170 FOREWORD Every day in our province there are individuals grappling with the myriad of challenges that come with making the difficult transition from independent living to facility living in continuing care. This can be a distressing and emotional time. In this review we examined the quality and patient safety implications of Alberta Health Services’ policy “Continuing Care Wait List: First Available Appropriate Living Option”. Our findings and analysis discuss critical operational topics such as capacity planning, measurement data, and policy development. However at its core, the report is focused on people. We provide practical recommendations about how the healthcare system can and should consistently respond to patients’ and families’ needs for an acceptable and appropriate process for decision‐making about their future home. We have outlined steps to equip both family members and care providers with tools and information so they are prepared to make these decisions and can support individuals through this challenging transition. There are many individuals who contributed time and expertise to this review. I would like to thank all of the members of the review team for their diligence in conducting the review, their passion for a quality and comprehensive report, and their commitment to the Albertans we serve. On behalf of the team, I would very much like to thank residents, their families, and all individuals, who participated in interviews, provided documentation, and were readily available to answer questions and provide background information. The Health Quality Council of Alberta is proud to have supported Alberta Health Services by conducting this review. We commend the thousands of healthcare professionals and support staff who work each day to provide better care for Albertans. We are confident that our recommendations will lead to quality improvements for patients, families and care providers. Patricia Pelton, Acting Chief Executive Officer, HQCA Calgary, Alberta February 28, 2014 FOREWARD 4 EXECUTIVE SUMMARY On June 18, 2013, Alberta Health Services (AHS) requested that the Health Quality Council of Alberta (HQCA) conduct an independent review of the quality and patient safety implications of the April 2013 AHS policy Continuing Care Waitlist: First Available Appropriate Living Option (FAALO). The Health Quality Council uses the Alberta Quality Matrix for Health to define and assess health system quality. Quality is defined through the following six dimensions: accessibility, acceptability, appropriateness, effectiveness, efficiency, and safety. The matrix provided a platform to understand the quality and patient safety issues related to the FAALO policy and its application in the healthcare system. This review concluded that: . A policy and procedure to support fairness in transitioning patients to a continuing care living option is required. The policy development process and the policy elements need to be congruent with AHS values. An underlying assumption is that patients facing this transition should have some degree of choice in determining a living option. The transition experience should provide sufficient time and information for patients and families to make an informed decision about their future living option. There is generally a wait to transition to a continuing care living option. This results in patients being cared for in a less than optimal environment to meet their needs. Further, if the patient is waiting in acute care, there is a downstream impact on those needing hospital services. In order to manage this capacity challenge and better align resources now and in the future, appropriate use of data and demand/capacity modeling is required. Methodology To meet the Terms of Reference for this review, as shown in Appendix I, the HQCA’s Quality Assurance Committee (QAC) conducted a review under section 9 of the Alberta Evidence Act. The review included: . Current but not operational AHS FAALO policy . FAALO policies in the legacy health regions in Alberta . Similar FAALO policies in Canada and elsewhere . Client experiences with FAALO policies in Alberta . Effect of FAALO policies on the performance of the continuing care system and the broader Alberta health system A mixed methods approach was used to gather information to meet the review objective. Information was gathered from a number of sources: . Environmental scan of other Canadian provinces and territories and their approach to continuing care placement. Documentation review included those provided by interviewees as well as other documents acquired through Internet searches. A review of the literature on the topic of continuing care wait list management and the impact of continuing care placement on individuals. EXECUTIVE SUMMARY 5 . Semi‐structured interviews with key informants and experts across the health system to discuss the evolution of and challenges with the FAALO policy. Semi‐structured interviews with a purposive sample of residents (or family members) currently residing in continuing care and placed initially in one of their preferred options or were required to take the first available appropriate living option. Review of current AHS data and performance indicators for continuing care wait list management (capacity and demand). An expert in operations management research was consulted. Background Continuing care in Alberta is defined as a range of healthcare services including home care, supportive living (with four levels of care, at home or in a facility), and long‐term care in nursing homes or auxiliary hospitals. People access continuing care from home, hospital, or another continuing care facility. Various policies have been in place since 1993 that set out how patients access continuing care in Alberta. Most of the legacy health regions established their own wait list management policy or protocol as early as 1997, including placement in a first available living option. When AHS became an entity in 2008, work began on a province‐wide policy, which resulted in the FAALO policy that is the focus of this review. The FAALO policy was developed as part of an over‐arching policy to address capacity issues that affect the flow of patients in the healthcare system. According to the FAALO policy, if a patient’s preferred location is full, the patient “shall be temporarily admitted to the first available appropriate site or location as near as possible to the patient’s primary preferred site(s) or location” until a space opens. The policy states that the temporary site is to be no farther than 100 kilometres from the patient’s home or preferred site. A companion document, the Continuing Care Waitlist: Prioritization policy, ensures that patients who have agreed to a first available space will have priority for moving into a preferred location when space becomes available. In June 2013, AHS withdrew the policy, initiated an internal policy review, and requested the HQCA conduct its independent review of the quality and safety implications of the policy. Findings Shortcomings in policy and information to support the transition into continuing care Despite years of attempts, and multiple policy drafts, a province‐wide FAALO policy is not in place. As a result, the way in which patients are transitioned into