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Hospital News, September 2007 April 2009

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Volume 22, Issue IV CPC# 40065412

Gerontology/Palliative Care/ Home Care: Geriatric medicine and aging-related health issues. Innovative programs in homecare delivery. Innovative approaches to home care and palliative care delivery.

nominate a special nurse

4th Annual Nursing Hero Contest in honour of National Nursing Week See pages 15 & 32 for details

Canada’s Health-Care Newspaper

Mount Sinai helps guide children through grief

Inside • Ethics�����������������������11 • Natural Path������������18 • Financial Health Matters��������������������19 • Patient Safety����������26 • Nursing Pulse����������28 • CEO Column�����������29 • Careers��������������������32

More Features •Technology enhances home care •Improving access to care for frail seniors • Dying is a fact of life • And more

This young camper was one of 30 campers who attended The Max and Beatrice Wolfe Centre for Children’s Grief and Palliative Care overnight camp in January 2009.

By Christina Salvino


hen Janna Cheng’s husband Steve was diagnosed with a terminal illness in March 2007, it was devastating for the entire family but particularly their

daughter Jenny, who was only 12 at the time. “Jenny was always close to her father, but after the diagnosis things changed,” says Cheng, whose husband was diagnosed with Amyotrophic Lateral Sclerosis – also known

as ALS or Lou Gehrig’s Disease. “Steve’s disease progressed aggressively, and Jenny struggled with this. Sometimes it seemed like she was avoiding him.” ALS is a progressive, usually fatal neurodegenerative dis-

Join the SickKids team.

Develop, provide & support the best in paediatric care.

ease that causes degeneration of the nerve cells in the brain and spinal cord. As the disease progresses, the brain loses the ability to control muscles and patients may become totally paralyzed. To help Jenny cope with

her father’s illness, Janna was referred to Mount Sinai Hospital’s Max and Beatrice Wolfe Centre for Children’s Grief and Palliative Care. The referral was made by the ALS Clinic at Sunnybrook Health Sciences Centre, where Steve was being treated. “Our society is full of kids grieving in lonely silence when a loved one is dying or has died,” says Lysa Toye, Counsellor and Expressive Arts Therapist at the Max and Beatrice Wolfe Centre. “The lifelong impact is profound.” The Centre provides support for children and youth, as well as their families, before and after the death of a loved one. The counsellors help educate and support children through stories, play, music, movement and visual expressive arts. Continues on page 5

Work in an environment where excellence and innovation in practice, education, informatics and research are valued. Promote and restore optimal health and assist children and families to effectively adjust to health challenges. Provide care that recognizes and respects the diversity of the community you serve and the uniqueness of each child and family.

We are currently accepting resumes for nursing positions in all Paediatric specialty units. For a complete listing, visit

If you share our commitment to kids and to your career, please forward your resume, in confidence to

Hospital News, April 2009



Health-care professionals recognized for efforts to increase organ and tissue donation By Carrie Hoto


his May, Wendy Fortier, the Ottawa Hospital’s Clinical Director of Critical Care, Emergency and Trauma, is being recognized for her tremendous work in the promotion of organ and tissue donation. “It is an honour to be recognized by Trillium Gift of Life Network,” says Fortier, who will be retiring in June. “Until everyone knows and truly cares about organ and tissue donation, we have not done enough for the families we care for or the hundreds in desperate need awaiting their gift of life.” The need is great. Today in Ontario there are more than 1,684 people waiting for an organ transplant. One organ and tissue donor can save up to eight lives and enhance as many as 75 others. Yet every three days, someone in Ontario dies waiting for a transplant, because not enough people have taken the simple step to register their consent. Fortier is one of 12 healthcare professionals across

the province who have been acknowledged for their contributions in raising awareness of the cause by Trillium Gift of Life Network (TGLN). The provincial agency is responsible for planning, promoting, coordinating and supporting activities relating to the donation of organs and tissue for transplant; coordinating and supporting the work of designated facilities in connection with organ and tissue donation and transplant; and providing education to the public and to the health-care community about organ and tissue donation, as well as facilitating the provision of such education by others. April 19 to 26 marks National Organ and Tissue Donation Awareness Week. As part of its efforts to make more people aware of the need for organ and tissue donation, TGLN has featured health-care professionals like Fortier in the 2009 calendar that it has distributed across the province this year. The faces of those being recognized will also be

seen on posters in their healthcare facilities. “The relationships we have with our hospitals and healthcare professionals are vital to our success. I commend the work that our health-care professionals do year round to increase awareness of the need for organ and tissue donation within their hospitals,” says Frank Markel, President and CEO of TGLN. “Because of them, we are able to save and enhance the lives of thousands of men, women and children in Ontario each year.” The posters and calendar photos show each individual with a green hand, to mark them as supporters of the “Green Hand Campaign” that was launched in April 2008 to generate a growing network of Ontarians who support organ and tissue donation. You can support Fortier, her colleagues and TGLN in their lifesaving mission by registering your organ and tissue donation decision and by talking to your family about your wishes. Registering your consent with

Wendy Fortier is one of 12 health-care professionals in Ontario being recognized for their efforts in the promotion of organ and tissue donation by Trillium Gift of Life Network. the Ministry of Health and Long-Term Care database makes that information available on a 24/7 basis when it is needed. All you need to do is visit your local Service Ontario Health Card Services – OHIP office or Outreach Site where you renew your health card. Or you can go to the Trillium Gift of Life Network website www. and download

a Gift of Life Consent Form, fill it out and mail it in to the address on the form. For more details on Trillium Gift of Life Network, please visit or call 416-363-4001 or toll free 1-800-263-2833. Carrie Hoto works in Public Affairs and Communications at Trillium Gift of Life Network.

Bariatric treatment now available in Hamilton hospital By Debbie Silva


n February 2009, St. Joseph’s Healthcare Hamilton received welcome news that as part of the provincial government’s comprehensive strategy to prevent, manage and treat diabetes, $75 million will be invested to increase bariatric surgery capacity in Ontario by 500 per cent over the next three years. As part of the initiative, St. Joseph’s Healthcare Hamilton will become one of four locations in the province to become a bariatric centre of excellence providing services such as pre- and post- surgical care, counseling and weight-loss treatment. “This initiative is about patient care,” says Dr. Mehran Anvari, Medical Director, Bariatric Surgical Program at St. Joseph’s Healthcare Hamilton. “It’s about providing much-needed services to an increasing group of patients who are suffering from comorbidities and complications due to excess weight. Not only will we improve the productivity and quality of care for this important group of patients but we will also help reduce the cost of health care for dealing with chronic problems that oth-

Dr. Mehran Anvari demonstrates minimally invasive surgical methods used in bariatric surgery. erwise will be facing us in the next few years.” “This ‘one-stop-shop’ approach is a model of care to be delivered by a multidisciplinary team of physicians, nurses, dietitians and allied health professionals working collaboratively,” says

the Honorable David Caplan, Minister of Health and LongTerm Care. “The centre will also provide training for surgeons and other health-care providers.” Minister Caplan added that the program will help to decrease pressure on Ontario’s

Out of Country Program, saving approximately $10,000 for every bariatric case done here and not sent to the United States. “We’re delighted by the government’s investment that will make us the centre of excellence for bariatric surgery

in Hamilton,” says Dr. Kevin Smith, President and CEO of St. Joseph’s Healthcare Hamilton. “We look forward to having our outstanding bariatric program help more Ontarians receive this highly specialized surgery closer to home.” In 2007/2008, there were 244 bariatric procedures performed in Ontario. By 2012, it is estimated that 1470 surgeries will be delivered across the province. With this expansion, SJHH will provide 600 assessments and 140 surgeries in its first year alone. In three short years, that number is expected to rise to 450 surgeries. In addition to becoming the provincial hub of bariatric care, St. Joseph’s Healthcare will also receive an additional $1.5 million to purchase a CT scanner specifically designed to accommodate patients who suffer from severe obesity. Also known as gastric bypass surgery, bariatric surgery involves the modification of a patient’s digestive system to reduce nutrient intake and/ or absorption and ultimately achieve weight loss.   Debbie Silva is the Media Relations Coordinator at St. Joseph’s Healthcare in Hamilton.

Hospital News, April 2009

College issues recordbreaking number of new licenses

A report released by the College of Physicians and Surgeons of Ontario (CPSO) shows new licenses were issued to more doctors in 2008 than ever before. The record number of 3,467 certificates of registration issued continues a decadelong upward trend. The report, Registering Success, highlights a number of historic statistics, particularly for international medical graduates (IMGs). For example, in 2008, IMGs were issued 393 independent practice certificates, breaking a record set in 1985. This also surpasses 2007’s number of unsupervised licenses for IMGs by 43 per cent, a record one-year increase. In fact, the development of CPSO registration policies and programs have allowed for the issuance of 1,355 practice certificates since 2002, the majority going to IMGs. Other key highlights from the report include: • 1,511 practice certificates were issued in 2008 - the highest annual total since 1985 (includes all license classes except the educational class); • Issuance of independent (unsupervised) practice certificates to IMGs has nearly quadrupled since 2000; • Overall supply of physicians in practice is up 16% since 1997 (from 20,133 to 23,266). The full report is available on-line at under What’s New.

Study finds anesthesia consultation before major surgery reduces hospital stay

A simple consultation with an anesthesiologist before a major surgical procedure could cut hospital stays by 11,000 days a year in Ontario, according to a study released by the Institute for Clinical Evaluative Sciences (ICES). The study of 271,082 people who had major elective, non-cardiac surgery in Ontario from 1994 to 2004 found: • Patients who had seen an anesthesiologist in consultation before surgery stayed in hospital for a shorter period of time than patients who had not. • The average difference per patient was about 1/3 of a day.

In Brief

• S  ince at least 32,000 people undergo major surgery in Ontario every year, this difference corresponds to more than 11,000 days of hospitalization that may be prevented, if patients regularly see anesthesiologists to help prepare for surgery. • Patients who had an anesthesia consultation underwent more routine testing prior to surgery (e.g. pulmonary function tests, echocardiograms). • Anesthesia consultation may lead to more efficient use of a scarce resource - hospital bed days – however, it was not associated with a reduction in mortality. More detailed study findings on the ICES website:  www.

Nurses across Canada are reducing wait times

A new treatment regime initiated by a clinical nurse specialist in New Westminster, B.C., means cardiac surgery patients have fewer complications and spend less time in hospital. A nurse-managed outpatient chemotherapy clinic in Toronto decreases wait times for treatment. Intervention from a nurse practitioner reduces the need for hospitalization for long-term care residents across Ontario. Nurses working collaboratively with physicians has almost doubled the capacity of some family practices in Halifax. Concern about wait times in Canada has increased over the last decade to become the most important health-care issue among the Canadian public and health-care providers (Health Care in Canada Survey, 2007). “Registered nurses play a key role on the front lines of patient care,” says CNA president Kaaren Neufeld. “They see first-hand the challenges of wait times and are ideally positioned to develop creative solutions - solutions from within the publicly funded health system. We urge governments, health leaders and nurses themselves to continue to roll out initiatives like these that improve access to care and reduce wait times, thereby improving the efficiency of Canada’s health system.”

Canadian Medical Association launches new “What makes a healthy doc?” international podcast series The Canadian Medical

Association (CMA) and the CMA’s Centre for Physician Health and Well-being has launched new Healthy Practices podcast episodes that take an up-close look at “What makes a physician healthy”. Recorded in London, England at the November 2008 International Conference on Doctors’ Health, host Dr. Mamta Gautam talks to physician health leaders from Norway, Spain, England, New Zealand, Canada and the United States and examines physician wellness through an international lens. The podcasts, six in total, will roll out over the next 12 weeks and will be available at physicianhealth.

Genetic research narrows in on cause of childhood brain cancer

Scientists at The Hospital for Sick Children (SickKids) have discovered a family of eight genes that are mutated in patients with medulloblastoma - the most common childhood brain cancer. The research is published in the March 8 online edition of Nature Genetics. Brain tumours, including medulloblastoma, are the leading cause of childhood cancerrelated deaths. Although recent medical advances mean that up to 60 per cent of patients now survive, survivors are often left with serious physical and neurological disabilities from both the cancer and the treatments. In the largest study of its kind, the scientists analyzed over 200 medulloblastomas that had been surgically removed from children. They discovered that eight of the mutated genes belong to a specific family of genes that encode for proteins involved in turning genes on and off. Specifically, the genes they identified are responsible for turning off growth promoting genes as the brain grows and develops. The way the genes normally work is that they make a protein that causes DNA to wind up very tightly. This tight winding would normally turn off the growth promoting genes once brain growth is completed. When these genes are mutated, however, growth in the developing brain does not cease and brain cancer results. This discovery is hopeful because similar genes involved in the “winding of DNA” have already been successfully targeted by drugs. The researchers hope

to develop new therapies for childhood brain cancer that will result in more survivors, and an improved quality of life for survivors.

Canada’s first Occupational Cancer Research Centre launched

In March, health and workplace safety organizations, businesses, and labour groups joined forces with a common goal of reducing workplace cancer, and officially launched Canada’s first centre dedicated solely to research in occupational cancers. The Occupational Cancer Research Centre will be charged with improving knowledge and evidence to help identify, prevent and ultimately eliminate exposures to cancer-causing substances in the workplace. While there is convincing evidence that a number of products, and processes used in the workplace cause cancer, the relationship between cancer and many carcinogens at low levels of exposure is much less clear. And some workplace substances that are suspected of being carcinogenic have never been adequately evaluated. To get a better understanding of the risks of occupational exposures, Ontario needs to develop a comprehensive surveillance strategy and undertake greater research in this area. “The 2008-2011 Ontario Cancer Plan’s goal is to transform the province’s already good cancer system into a great system that can significantly reduce the incidence of cancer, and improve outcomes through early detection,” said Terrence Sullivan, president and CEO, Cancer Care Ontario. “A key initiative of this plan includes working with our partners to develop this Centre to bolster our knowledge base about cancer and the workplace, and translate these research findings for the benefit of workers, their families, and Ontarians.”

Canadians seeking endof-life information turn to unique health website

Every day, thousands of Canadians are given the devastating news that someone they care about is dying - yet many simply don’t know where they can go for help. Now patients, families and healthcare providers can turn to an


expanded Canadian Virtual Hospice website ( to meet their needs. “Supporting someone with a terminal illness offers some of life’s most challenging experiences as well as some of life’s most meaningful moments,” says Shelly Cory, Executive Director of the Canadian Virtual Hospice. “Canadians are coming to virtualhospice. ca because it’s a place they can turn to for expert information and support.” A four-year, $2.4 million investment by the Canadian Partnership Against Cancer, Health Canada and the Winnipeg Regional Health Authority enables the Canadian Virtual Hospice to offer new features and, at the same time, raise public awareness about the valuable information, support and resources available to Canadians at this online site. Canadian Virtual Hospice is a fully bilingual online resource staffed by experts in palliative care that provides information and personalized support to patients and families facing life-threatening illness and to the health providers who care for them. Virtual Hospice can be found at and Virtual Hospice operates with the support of the Canadian Partnership Against Cancer, the Winnipeg Regional Health Authority and CancerCare Manitoba.


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Hospital News, April 2009



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Nominate a special nurse – Fourth Annual Nursing Hero Awards

Call for Nominations:

4th Annual Nursing Hero Contest in honour of National Nursing Week


76 year old woman is brought into a busy emergency department by ambulance after suffering an episode of dizziness and shortness of breath. Her concerned daughter called an ambulance after speaking with her mother on the phone – worried that her mother may be having a stroke. Upon arrival at the hospital the elderly woman is confused, alone and afraid – which only exacerbates her physical symptoms. Her daughter won’t be able to get to the hospital for another day because she is away on a business trip and unable to catch a flight any sooner. While waiting in the emergency room the patient starts

to cry, afraid because she has no idea what’s going on and is completely alone. The crying is worsening her condition. A keen nurse notices the patient’s tears of fear and looks for a relative to comfort the patient. Not finding one, the nurse goes to the patient’s bedside, puts a re-assuring hand on her shoulder and says: “It’s okay Mrs. Smith, my name is Jennifer, I am a nurse and I know you are afraid but you’re not alone. I am here and will take care of you.” The patient looks up at the nurse and sure enough, her breathing slows and becomes deeper. “Jennifer, please call me Dottie, I am really afraid and seem to keep forgetting

where I am, but from here you like an angel.” Nurse Jennifer hadn’t yet performed any life-saving procedure, and hadn’t yet had an opportunity to address the physical ailments the patient was presenting with. She simply touched her shoulder and addressed the emotional needs of a terrified elderly woman. But to that patient, it made a world of difference. While it’s not part of a nurses ‘job description’ to help their patients cope emotionally with their hospital visit, often times without even realizing it, nurses do exactly that. Nurses are highly trained health-care professionals whose clinical skills save lives everyday. But they are so much more than that. Just ask patients like Dottie Smith. Have you had a nurse who has made a world of difference in your hospital experience? Do you have a colleague who inspires you to be a better nurse? I want to hear from you. Our fourth annual Nursing Hero Contest is in full swing and we are accepting nominations. The stories we have received thus far are amazing. If you’re a patient and want to nominate a nurse but don’t have access to a -computer or are unable to write a letter please call me at 416-781-5516 ext.3. I look forward to hearing from you. Nominations can also be emailed to or mailed to: Hospital News Trader Corporation 405 The West Mall Etobicoke ON M9C 5J1 Kristie Jones Editor

Hospital News, April 2009



Mount Sinai helps guide children through grief

Continued from page 1

Dr. Larry Librach, Director of Mount Sinai’s Temmy Latner Centre for Palliative Care, founded the Centre in 2006 after meeting with representatives from The Max and Beatrice Wolfe Family Foundation, who wanted to help provide professional support for children dealing with death or dying and an opportunity for families to grieve together. The Centre’s interdisciplinary team of four part-time counsellors have backgrounds in nursing, child-life training, social work, expressive arts therapy, paediatric medicine and spiritual care. “There is a strong sense of social justice that motivates the four of us,” says Toye, who has been at the Centre for two years. “We want to make our services accessible for everyone, and we struggle every day with the fact that we have a waitlist.” In 2008, the Centre cared for 318 children from 160 families, all struggling to cope with a family member’s death caused by terminal illness, an accident, homicide or suicide. The children came from different ethnic backgrounds and neighbourhoods across the Greater Toronto Area. Clients are referred to the Centre by word-of-mouth, other palliative care units, social workers, mental health-care facilities for children, and Toronto Police Victim Services. The Centre also sees a small number of children who themselves have been diagnosed with a terminal illness and are receiving palliative care in collaboration with doctors at the Temmy Latner Centre. This support enables families to care confidently and safely for dying children at home. There is no charge for the Centre’s programs, which are unique in Canada. Along with individual education and support, the Centre provides opportunities to bring children and families together into group settings. Parent information nights give parents the chance to talk to the counsellors and each other, share strategies and provide support. During these sessions, the staff members run group activities for the children. In January 2009, the Centre held an overnight camp for 30 children and recently received a prestigious 10-year grant from the Moyer Foundation in the United States to host an annual summer grief camp – Camp Erin - for 50 children. “These camps complement the one-on-one care children

receive at the Centre, providing an opportunity for the children to meet new friends and learn that they are not the only ones dealing with pain and grief,” Toye says. “To grieve well is healthy,” she adds. “All of the

Centre’s events provide meaningful opportunities to recognize death.” Janna’s daughter Jenny felt isolated in her grief and did not talk about her feelings with her parents. But counsellors work

In 2008, the Centre cared for 318 children from 160 families, all struggling to cope with a family member’s death caused by terminal illness, an accident, homicide or suicide.

hard to be flexible and provide counselling at the Centre, in the home or by phone. Toye spent more than nine months with Jenny before Steve’s death and helped pull the Cheng family together. “Lysa was always straightforward about my husband’s disease and prepared Jenny to face her father’s death,” says Cheng. “She visited Jenny’s class to discuss death and grieving, but at Jenny’s request, did not mention which student was experiencing this situation. Because of Lysa, Jenny was brave enough to tell her classmates about her father’s illness.” In December 2008, Steve died of ALS. More than 50 of Jenny’s classmates and teachers came to the church service to support their friend. Even

today, Toye meets occasionally with Jenny to provide continuing support. “I feel better now than I did when my Dad was dying,” says Jenny, who turns 15 in August. “It was helpful to talk to Lysa because there weren’t a lot of people that I wanted to talk to.  I’ve had time to get used to being without him.”     Janna agrees the Centre’s support has made a difference in her family’s progress since Steve’s death. “The support from the Centre for my family was amazing,” says Cheng. “I am very thankful and lucky to have had Lysa’s help and guidance.” Christina Salvino is a member of Mount Sinai Hospital’s Communications and Marketing Department.

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On The Pulse of HEALTH CARE

Hospital News, April 2009



Birthing Unit has a ‘special delivery’ of its own By Donna Danyluk


he Birthing Unit at The Royal Victoria Hospital in Barrie - always a busy place—has experienced a little labour and delivery of its own. The end result of this six-week labour is a ‘bouncing’ six-bed Birthing Triage Unit. This new area of the Birthing Unit will operate in a similar fashion as the Emergency Department triage system. Expectant mothers who have a concern about their pregnancy can come directly to the Birthing Triage Unit and be assessed in one of the six new triage beds, freeing up the labour and delivery beds for women in active labour. Women can come to the new triage unit for a variety of reasons including noticing

Royal Victoria Hospital’s Karen Fleming, Dr. Vincent Wu, Barb Pollard, and Kathy Leonard, show off some the “tools of trade” recently used to construct the new Birthing Triage Unit.

a decrease in fetal movement; being unsure if their water has broken; bleeding; if they feel unwell or for a non-stress test. “These women will be able to be assessed quickly without using a labour bed which means we are using the right resources in the right place,” says Kathy Leonard, Obstetrics Manager. “This new unit offers expectant moms peace of mind. They know if they have any concerns they have a place to go so that they and their fetus can be assessed.” All women attending the Birthing Unit for care will be assessed in the Birthing Triage Unit. The six-bed unit is open 24 hours a day, seven-days-a week, and will be staffed by expert obstetrical nurses who will have ready access to a physician or midwife. In addi-

tion to conducting some outpatient procedures—for example, non-stress testing—nursing staff will assess labour. The triage is located just outside the existing Birthing Unit and will not have an impact on the provision of birthing care. Waiting times will vary with patient acuity. For instance, a woman who is in active labour and pushing will go straight through to the Birthing Unit. Someone who is questioning whether they are in labour or not may have to wait a little longer to be seen, depending on how busy triage is and if there is a higher priority patient ahead of her. Donna Danyluk works in communications at The Royal Victoria Hospital in Barrie.

Meeting the demands of Canada’s aging population By Lori Cranson


ore than 300 high school students, teachers and guidance counsellors from the Greater Toronto Area were invited to George Brown College on February 27th for Health in Action, an interactive education forum designed to help students learn about careers in health care. After hearing from current health-care professionals in the day’s opening panel discussion, students got a chance to participate in interactive sessions led by current George Brown

College students. The stations provided a variety of hands on experiences that highlighted the interprofessional model of health-care delivery being taught to today’s students. These ranged from learning about and wearing prosthetics to monitoring blood pressure and a rare chance to work with simulated mannequins, complete with voice response. The activities got students engaged and introduced them to career possibilities in health sciences through real-life scenarios. One of the simulation exercises addressed the myths of aging.

George Brown students from the Health Sciences faculty demonstrate how to assist patients from a laying to a seated position.

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Led by students in George Brown’s Personal Support Worker program, secondary students learned about palliative care and how to assist clients from a bed to a wheelchair and back again. As the Canadian population continues to age, there is a rapidly growing demand for workers with the knowledge and skills specific to the needs of later life individuals. For example, the aging population is a key factor in The Canadian Nurses Association’s prediction of a national shortfall of 78,000 RNs by 2011, growing to 113,000 by 2016. Providing Ontarians with quality health care continues to be at the very top of the current government’s public agenda, and the health-care system is responding with advances in knowledge, treatment and prevention of disease. As a leading educator in the health-care sector, George Brown’s Centre of Health Sciences is part of that response, offering a wide range of practical health-care programs such as nursing and fitness and lifestyle management to meet the growing demand. George Brown’s Health Sciences curriculum has been designed with the needs of the community and the health-care sector in mind. The focus is on educating future health-care providers and social and community service professionals so that they understand the importance of integrating health promotion and disease management for optimal patient wellbeing. Lori Cranson is the Associate Dean, Community Services and Health at George Brown College.

Hospital News, April 2009

Hospital News, April 2009



Handbook helps health-care practitioners deal sensitively with survivors of childhood sexual abuse By lori Chalmers morrison


Canadian research team has developed the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse to help healthcare practitioners – from physicians to physical therapists – provide sensitive care for male and female adult survivors of childhood sexual abuse. The handbook is the result of a research project involving consultation with over 400 individuals, including healthcare practitioners, counselors and female and male adult survivors of childhood sexual abuse. Prevalence rates suggest that students and practitioners work, often unknowingly, with survivors on a regular basis. Conservative estimates reveal that at least 20 per cent of adult women and between five to 10 per cent of adult men have a history of childhood sexual abuse. Childhood adversity –

including sexual, physical and emotional abuse – is associated with an increased risk of a range of health problems. Many live with chronic conditions that bring them into contact with a variety of health-care practitioners who have little training about childhood sexual abuse, and who may unknow-

crucial for a survivor due to the violations experienced in the past.� The handbook outlines the nine principles of practice that facilitate survivors’ sense of safety during health-care encounters. “The principles are analogous to the infection control guidelines and need

Conservative estimates reveal that at least 20 per cent of adult women and between five to 10 per cent of adult men have a history of childhood sexual abuse. ingly re-traumatize individuals during routine examinations. “The interactions between health-care practitioners and survivors are often fraught with difficulty and discomfort for the survivor,� explains professor and lead researcher Candice Schachter from the University of Saskatchewan. “Feeling safe in health-care encounters is

to become part of everyday health-care practice,â€? says professor Eli Teram from Wilfrid Laurier University. â€œâ€ŚSome [need a] really safe technique,â€? explains a male survivor of childhood sexual abuse interviewed for the study. “Because otherwise you’re going to have a certain segment of patients that are

going to walk away feeling as though they’ve been abused all over again, quietly abused, just walking away and seeking another health-care practitioner, just going through the cycle, again and again and again, and maybe not understanding why‌â€? Beyond the nine principles, the handbook provides background information about childhood sexual abuse and offers guidelines that address the entire context of a healthcare encounter from the receptionist’s greeting to the issue of disclosure and how to deal with difficult interactions. “The handbook is an essential read for all those in the human service field,â€? says Rick Goodwin, executive director of The Men’s Project in Ottawa, Ontario. “It speaks knowledgeably to the complex issues trauma survivors – both male and female – face and gives the reader confidence to do the right thing.â€? Survivors, practicing clinicians, students, academics, representatives of professional

associations and licensing bodies participated in the consultation process to ensure the clinical relevance of the handbook for health-care practitioners in all disciplines. The study was conducted by Candice Schachter from the University of Saskatchewan’s School of Physical Therapy; Eli Teram and Carol Stalker from Wilfrid Laurier University’s Faculty of Social Work; Gerri Lasiuk from the University of Alberta’s Faculty of Nursing, and Alanna Danilkewich from the University of Saskatchewan’s College of Medicine. The handbook is offered free of charge at: www.phac-aspc. by the Public Health Agency of Canada’s National Clearinghouse on Family Violence or in print at: cfm?catid=29&cid=17048674. Lori Chalmers Morrison works in Public Affairs at Wilfrid Laurier University in Waterloo.

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Hospital News, April 2009

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Esko Vainio moved to hourly pricing for a healthier bottom line. On May 1, 2009, Ontario’s hospitals will move from paying a fixed price to an hourly price for electricity. The Timmins and District Hospital made the switch way back in 2006. Since then, the hospital has saved over $230,000 in electricity costs, savings that have been reinvested in patient care and energy management programs. That’s just what the doctor ordered. To learn more, visit

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Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Care closer to home By Helen Reilly


he population of the Mississauga Halton Local Health Integration Network (MH LHIN) is one of the fastest growing populations in Canada placing it on the front line in the  race to meet the extraordinary and growing demand on health-care resources -  specifically for the care of seniors. Older adults use 80 per cent of the bed days in acute care, so hospitals and associated health agencies must act quickly to coordinate and expand their geriatric abilities if they are to cope with the increased demand for care. Dr. Barbara Clive, a geriatrician at The Credit Valley Hospital recently assumed a regional role as the Geriatric Lead for the MH LHIN to assess services, identify gaps and propose coordinated opportunities for enhancement of services for our growing senior population. The focus of her work is to create a regional geriatric program for the MH LHIN. Currently, the three hospitals share seven geriatricians which is an excellent ratio considering there are only 200 geriatricians in Canada. In order to meet the needs of the growing senior population, the MH LHIN was awarded $282,000 in 2008/2009 to develop a strategy to deliver enhanced, specialized geriatric services to the ‘frail’ elderly. All physicians have elderly patients but the strategy is focused on the frail among them, those who can benefit

The Credit Valley Hospital’s multi-disciplinary team members meet regularly regarding their patients. From left: Lynn McFerran, recreationist; Dr. Barbara Clive, geriatric lead for MH LHIN, Karyl Taylor, RN; Betty Vukusic, physiotherapist. from care by a geriatric medicine specialist, geriatric psychiatrist, specialized nursing and affiliated health-care providers for the elderly. Currently, service to our seniors is spotty. Dr. Clive’s hope is to ensure a quality, efficient and accessible program to provide a continuum of services for frail seniors with complex needs in the MH LHIN. The LHIN’s health human resources plan will play a big part in that success. “There aren’t enough of us to care for all our seniors but if we coordinate a plan to

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grow our resources to meet the need, we stand a chance of enhancing the quality of life to keep more seniors well for a longer period of time – keeping them out of the health-care system for as long as possible,” says Dr. Clive. The phased development of the regional geriatric program will build capacity and knowledge among our primary care professionals who care for the elderly. The patient-centred care will optimize the independence of seniors and support ‘aging in place’ (ideally at home), reducing the pressure on hospitals. The coordinated approach by hospitals, Community Care Access Centres and long term care facilities will fulfill the needs of seniors and identify those in need of services to maximize their independence. The goal of the Regional Geriatric Program is to make the services available in a single program for all three hospitals so that seniors can access all the right services

for ‘care closer to home’. The program is seen as a first step in a province-wide comprehensive, integrated system for frail elderly. Through the program, a range of health services to diagnose, treat and rehabilitate frail elderly with complex and multiple medical, functional and psychosocial problems would be developed to serve the senior population of the LHINs three hospitals, reducing the pressure on the hospital’s emergency department and the system as a whole. Seniors are indeed high users of hospital emergency and inpatient resources. Nearly 10 per cent of the population in the MH LHIN is over 65. In fact, 75 per cent of all emergency room admissions are for adults over 65 years of age. They account for 50 per cent of all patient days and their average length of stay is twice that of the general population. In most cases, a patient in the emergency department presents a single complaint of an

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acute nature such as chest pain. Ideally, the emergency department patient is diagnosed, treated and discharged in a timely manner. Conversely, a geriatric patient in the emergency department presents with multiple medical, functional and social issues as well as an acute or sub-acute medical complaint such as a fall; often requiring admission to hospital followed by a continuum of care in the community beyond the scope of emergency medicine. One of the enhancements Dr. Clive is excited about is the Geriatric System Navigator.  The system flags patients over the age of 75 for follow-up after discharge from the emergency department. They are contacted soon after discharge to assess their need for specialized services. The goal is to keep them well, independent, and at home for a longer period of time leveraging existing resources to develop a comprehensive, LHIN-wide program.  The project is a huge task but it is one Dr. Clive embraces. The work is demanding and the medicine is complex and challenging. It’s time-consuming and non-remunerative in a fee-for-service structure which places the emphasis on technical procedures and single patient complaints rather than the hands-on care required for the complex medical needs a senior presents. Still, Dr, Clive discovered her love of geriatric medicine early in her career and she’s never looked back. “I do this work because it’s challenging and interesting. It’s rewarding to care for this particular population – today’s seniors have been through two wars and a depression – there is much we can learn from them. They value most things more than most of us do today. They have been through so much that they are grateful for small victories and they are so appreciative for the ability to maintain their independence.” The work is not always glamorous and the equipment doesn’t cost hundreds of thousands of dollars but Dr. Clive and the multi-disciplinary team members work tirelessly, dedicated to the preservation of the most precious jewels in the crown of our society - our seniors. The work in the MH LHIN will become a model for other similar communities can benefit from it on communities across Canada. Helen Reilly is the publicist at the Credit Valley Hospital.

Hospital News, April 2009


Ask the Ethicist: The role of clinical ethics education and the health-care professional By Ken Kirkwood


: How do I become an ethicist? (from a working Register Nurse in Ontario). : There are a number of academic programs catering to health professionals. Most major universities (with the notable exception of my own) offer Masters Degrees in ‘health ethics’ to health-care providers on a parttime basis. These degree programs usually have some component of bioethical theory, followed by courses in specialized topics (e.g. reproductive ethics, end-of-life, informed consent in treatment and research) for those with more narrow interests in bioethics. Sometimes these degrees require the writing of a thesis of 100-200 pages, or are simply satisfied by passing a larger number of courses with no thesis required. The idea here is one with noble intentions. People who have worked in the frontlines can develop a deeper understanding of clinical ethics and can relate that theoretical knowledge to their own practice and assist other professionals from a peer-to-peer standpoint in answering questions of ‘what to do.’ Certainly, clinical ethics is growing into its own discipline, which I think it should not. The point of higher education in ‘bioethics’ is to create positive change on three fronts: 1. It should expand the knowledge of health-care workers and administrators 2. It should be used by scholars to educate those same workers and administrators 3. It should be taught to patients, to make them better, more independent patients Ethics often talks about issues that arise out of the relationships between health-care workers and patients, and it behooves us to make sure both parties are highly educated on the ethical questions that may emerge. So far, it is my experience that many physicians view ethics with suspicion or outright derision. One physician has told me that since I had not “tilled his soil” (been a physician) I could not comment on the doctor-patient relationship. This was especially disturbing because he surely could have guessed that I had been a patient, and as such, was half of the relationship of which he spoke. What I needed to understand was that to his mind, the relationship between doctors and patients was analogous to

the relationship between husbands and housewives of the 1950s – and I apparently did not know my place. This response to ethics as a part of medicine is stubbornly dying away, but ethical considerations – both professional and patient-centered – are critical to the future of our health-care system. Ideally, clinical ethics is a position that should make itself obsolete. Every day, clinical

ethicists should be focusing their energies on equipping the practitioners to make competent ethical choices and judgments for themselves and not be needed to advise every time. The danger of making clinical ethics a full and equal department with medical care organizations is that it becomes the professional property of a small group of people, instead of its proper perception as an essential skill

set that every practitioner should possess. The end result to avoid is the perception that morality can be ‘outsourced’ – if you want to know if what you’re doing is ethical, ask the ethicists. If they say ‘yes,’ then you are ‘good to go.’ This is fundamentally not what ethics is about, and is a horrifying scenario that is coming to pass. So I consider clinical ethics as a valuable short-term solution to


insufficiencies in professional health-care education. At the same time, based on the state of ethics education and ethical practice in Canadian health care, it is my sense that the ‘short-term’ need for clinical ethicists will not disappear in my lifetime. Kenneth W. Kirkwood, Ph.D is Assistant Professor of Ethics in the Faculty of Health Sciences The University of Western Ontario. If you’d like to submit a question to “Ask the Ethicist” please email


Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care

NPSTAT - Nurse Practitioners tackle ED transfers By ashley Callaghan


t’s a heart-wrenching scene. An elderly patient, disoriented and in pain, lying in wait on an uncomfortable stretcher in an emergency department. It’s a picture any emergency department caregiver hopes to avoid. A new initiative at the Credit Valley Hospital in Mississauga is painting a picture of a different sort, through a collaborative effort with its local nursing homes. It’s called NPSTAT – a nurse-led long term care outreach initiative. In the Mississauga Halton region, there are approximately 152,000 adults over the age of 60. Over the next ten years, this number is projected to increase by over 50 per cent to 231,000 adults, making up 18 per cent of the total local population. These statistics indicate that the Mississauga Halton Local Health Integration Network (MH LHIN) has the secondhighest projected growth rate in the fourteen LHINs across the province of Ontario. Persons over the age of 65 presently account for approximately 40 per cent of all hospital admissions in the MH LHIN and, due to the complex needs and multiple diagnoses of seniors, they stay longer and require more resources than younger patients. While most seniors are in good health and able to live independently, today 3.6 per cent of seniors in the MH LHIN reside in Long-Term Care (LTC) facilities. Survey results from a November 2007 – April 2008 study indicate that residents from LTC homes had a very

Linda Dacres, NPSTAT program coordinator, and Litizia Mary Mouti, a 91-year old resident at Specialty Care Mississauga Road, enjoy a moment together. high rate (63 per cent) of inpatient admissions to hospitals. Studies also indicate that hospitalization can often cause functional decline in many LTC facility residents. In addition to the potential for health decline in elderly patients awaiting treatment in a hospital, there are several other factors contributing to frustrations and problems in Mississauga Halton hospitals: the majority of LTC residents are transported to and from the hospital by ambulance, reducing access to emergency services for other patients requiring emergency transfer,

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and congestion caused by the wait for in-patient beds can also contribute to further delays in the emergency department. The risk for the elderly patient, especially when these factors are compounded, is that their normal levels of functioning may be seriously reduced, thus increasing the risk of further health decline and longer stays in hospital. In anticipation of the dramatic increase in the elderly population of Mississauga Halton and with support from the Province of Ontario’s Emergency Department (ED) Wait-Time Strategy and the Aging at Home Strategy, the MH LHIN has developed NPSTAT (Nurse Practitioners Supporting Teams Averting Transfers). NPSTAT provides nurse practitioner services to LTC facilities in the MH LHIN in an effort to decrease the rate of transfer to local hospital emergency departments by addressing acute and episodic illness in LTC residents through nurse practitioner assessment, diagnosis and therapy. While it is a MH LHIN initiative, NPSTAT has been managed primarily through The Credit Valley Hospital. NPSTAT program director Heather McGillis has quarterbacked the project since its inception and is delighted to see the program prosper. “Overseeing this program has been an interesting and exciting challenge and I have learned much about how integration can benefit all parties; in this case the frail elderly residents of LTCs and the reduction of some

of the pressure in our busy emergency departments. It is a real pleasure to see a successful pilot project reach sustainability.” The initial pilot project ran from April 2007 to April 2008 and by January 2008, the project included four LTC homes in the Central West LHIN as well as eight LTC homes in MH LHIN. The results were impressive: 42 per cent of LTC patients seen were directly diverted from the ED, 34 per cent were less-urgent cases, but care was instituted that potentially prevented a resulting transfer to the ED at a later time and 24 per cent were nonurgent but provided an opportunity for education and teaching. By September 2008, sustainable funding through the Aging at Home initiative divided the pilot along LHIN lines. The recent addition of Nurse-Led Outreach Team dollars will expand the MH LHIN program. NPSTAT is currently operational in nearly 50 per cent of the MH LHIN long term care facilities but will be expanding to cover all 27 LTC homes in the MH LHIN, hopefully by the end of summer 2009. “I feel very strongly that the NPSTAT team is filling a crucial role in providing an essential service to long term care facilities,” says Dr. Jess Goodman, medical advisor to the NPSTAT steering committee. “Physicians aren’t always able to provide the urgent assessments that the NPSTAT team is able to carry out.” Susan Ash is director of care at Sheridan Villa Long Term

Care Centre, a residence in the process of implementing the NPSTAT program. “The nurse practitioner program is a key component in the collaborative partnership between acute care and community, which ultimately leads to best possible outcomes for our seniors,” comments Ash. “Residents who thrive in familiar surroundings will often become fearful and confused by transfers out to an emergency department. Outcomes are much more positive when residents and their families are able to remain in the comfort of their familiar environment to receive services that may have otherwise been given in hospital.” The collaboration between the MH LHIN, physicians, the LTC facilities, the CCAC (Community Care Access Centre) and the nurse practitioners is integral to the success of the NPSTAT vision. While decreasing ED wait times and the number of transfers from LTC homes to hospitals are NPSTAT’s primary objectives, additional benefits seen in the program include enhanced development and sharing of best practices, process improvement and standards among all parties. Dr. Goodman, himself a physician at multiple LTCs in the MH LHIN, is thrilled with NPSTAT’s contribution to his facilities. “NPSTAT professionals are able to… resolve many medical issues that may have otherwise resulted in transfer to a hospital emergency department. The [NPSTAT] teams have assisted in improving the health of patients in long-term care facilities and in decreasing transfers in a very significant way.” Adapted from earlier pilots in Hamilton and Niagara region, the benefits of NPSTAT in the MH LHIN are now wellrecognized and similar teams are being developed across the various LHINs. The unique medical management of elderly patients is an opportunity for NPSTAT to support, enhance and collaborate with the healthcare teams at LTC homes for the best possible patient care. The increase in the senior population over the next decade is staggering. NPSTAT will help to alleviate ED visits, length of stay for patients transferred to the ED, reduce admissions for conditions that may be treated out of hospital and reduce the overall length of inpatient stay in an acute-care hospital in LTC residents. Now that’s a much prettier picture! Ashley Callaghan is a communications specialist at The Credit Valley Hospital.

Hospital News, April 2009

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Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Technology enhances home care By Francois Couillard


ictorian Order of Nurses (VON) Canada nurse Bernice Little viewed Mrs. McCrane’s open wound with concern. The wound simply didn’t appear to be healing as she knew it should. As she considered dressing the wound she wished she could get more information on the patient’s file or confer with a colleague. A new agreement between VON Canada and IBM will mean that Bernice Little will have that opportunity in the future. It may even mean that she’ll be able to show the wound on a monitor to another health provider. Currently, most home care nurses travel several kilometres a day and work in isolation from their peers. This makes it difficult for them to seek even the most basic advice. Contrast that situation to hospital settings where a range of peers and other experts are readily available and the challenges of effectively delivering home care become apparent. With the introduction of this new technology Bernice and other VON nurses will eventually get the information they

need when they need it. As the largest national not-for-profit home and community care provider in the country, not only will this better serve patient needs, but it will make the overall health-care system more efficient, potentially eliminating needless trips to the doctors or hospitals while ensuring a high standard of care. Home health care is the fastest growing sector in health care and as the Canadian population ages, demand will increase. Approximately 900,000 Canadians regularly access home care. Between 1995 and 2002, the number of Canadians receiving home care increased by more than 60 per cent. VON Canada is under going a transformation to help meet this demand and as the nation becomes interconnected through technology, the technology will continue to play a key role in the evolution of health care. Perhaps one of the most significant aspects of this is the need for home health-care organizations to understand the long term goal of integration within the larger health sector. Today the home and community care

sector, much like Bernice Little, operates in isolation from other segments. By creating an electronic platform that will be compatible with provincial systems VON Canada will be poised to contribute to a future electronic health record. VON Canada is also leveraging the latest technology to provide staff much needed data on best practices, health outcomes and patient satisfaction. By comparing the data gathered on practices in various provinces the organization and provincial governments will be in a better position to develop improved standards of care and delivery and more effective policy creation. So while this initiative represents a significant step for VON Canada, it also represents the first necessary steps for the sector and the health care system in general. In the current economic climate investing to make this a reality makes perfect sense. Homecare organizations cannot continue to deliver care in the ways that we have in the past. Not only is it not sustainable, but it’s not what Canadians want. Institutional care is meant for acute cases, yet hospital

beds are often occupied by people who could easily receive care at home if the right supports were in place. In some instances, those supports do not even require a health professional, yet a much needed hospital bed is occupied because there are no resources available outside of the institutional setting. At VON Canada we know that records are only as good as

the information put into them. When you consider the rapid growth of the home and community care sector combined with the increasing desire of Canadians to live, age and die in their homes it seems obvious that integration will soon become a necessity. Francois Couillard is the National Chief Operating Officer of VON Canada.

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Hospital News, April 2009

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Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Dying is a fact of life

By AnnMarie Nielsen


he one undeniable fact of life is that we will eventually die. The only questions are when, where and how. In Canada, each year, over 259,000 of us die, and that number is increasing every year as the baby boomers age. By 2020, more than 330,000 Canadians will die each year. By themselves, these numbers are not alarming. We have all heard the message so often by now, it seems a cliché: Canada’s population is aging, even while it is increasing. We are living longer lives as medical knowledge and skills increase. In 2005, 27.8 per cent of all deaths occurred at age 85+, compared to 16.3 per cent just 30 years ago. Yet because we hear it so often, we are in danger of overlooking its significance to our health-care system. We may be living longer lives, true, but the later years are more often than not spent in declining health, increasing the burden on the healthcare system. In 2007, 37 per cent of Canadians reported

that they have been diagnosed by a physician as having a chronic condition or illness. Further information gathered by Statistics Canada shows that the leading causes of death in Canada are: diseases of the circulatory system (about 35%), neoplasms (tumours or cancers) (about 28%) and diseases of the respiratory system (about 10%), totaling approximately 73 per cent of all Canadian deaths. When asked, most people have indicated that they would prefer to die at home in the presence of loved ones, yet almost 60 per cent of Canadian deaths occur in a hospital, exacerbating problems with hospital wait times. Even those who have long been in decline due to chronic illness often end their lives in an acute care bed, spending their last days undergoing intensive and expensive medical interventions. Hospice palliative care programs and services can help to alleviate the demand for acute care beds, as well as ensure that patients get the care they need to be comfortable in their final days, without placing undue strain on an already heavily-burdened

health-care system.

Hospice palliative care: The details Hospice palliative care is a set of services offered in a variety of settings including acute care, long term care facility/ complex continuing care, residential hospice, or the home. It can look different based on the needs of the patient/family and the setting of care. Hospice palliative care aims to relieve suffering and improve the quality of living and dying. It strives to help patients and families: • address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears • prepare for and manage selfdetermined life closure and the dying process • cope with loss and grief during the illness and bereavement. Hospice palliative care aims to: • treat all active issues • prevent new issues from occurring • promote opportunities for


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meaningful and valuable experiences, personal and spiritual growth, and selfactualization. Hospice palliative care is appropriate for any patient and/ or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/ or needs, and are prepared to accept care. Hospice palliative care may complement and enhance disease-modifying therapy or it may become the total focus of care. It is most effectively delivered by an interdisciplinary team of health-care providers who are both knowledgeable and skilled in all aspects of the caring process related to their discipline of practice. These providers are typically trained by schools or organizations that are governed by educational standards. Once licensed, providers are accountable to standards of professional conduct that are set by licensing bodies and/or professional associations. The Canadian Hospice Palliative Care Association (CHPCA) is the national voice for hospice palliative care in Canada. Advancing and advocating for quality end-of-life/ hospice palliative care, its work includes public policy, public education and awareness. Established in 1991, its volunteer Board of Directors is composed of hospice palliative care workers and volunteers from Canadian provinces and territories as well as membersat-large. The CHPCA believes that all Canadians have the right to die with dignity, free of pain, surrounded by their loved ones, in a setting of their choice. It is crucial that the Canadian healthcare system have the programs and services in place to provide the quality end-of-life care that Canadians need. For more information visit AnnMarie Nielsen is a Communications Officer at the Canadian Hospice Palliative Care Association.

The Origins of “Hospice Palliative Care” Dame Cicely Saunders first conceived of the modern hospice movement in the United Kingdom in the mid 1960s to care for the dying. Balfour Mount coined the term “palliative care” in 1975 so that one term would be acceptable in both English and French as he brought the movement to Canada (from Latin palliare = to cloak or cover). Both hospice and palliative care movements have flourished in Canada, and internationally. Palliative care programs developed primarily within larger health-care institutions, while hospice care developed within the community as free-standing, primarily volunteer programs. Over time, these programs gradually evolved from individual, grass roots efforts to a cohesive movement that aims to relieve suffering and improve quality of life for those who are living with, or dying from, an illness. To recognize the convergence of hospice and palliative care into one movement, and their common norms of practice, the term “hospice palliative care” was coined. While hospice palliative care is the nationally accepted term to describe care aimed at relieving suffering and improving quality of life, individual organizations may continue to use “hospice”, “palliative care”, or another similarly acceptable term to describe their organization and the services they are providing.




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Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care


Improving access to care for frail seniors By Michelle Tadique


Mrs. S is an 85-year-old woman who lives on her own. Although for most of her life she has been healthy and active, she is now facing an increasing number of health challenges. Her physical health and cognitive abilities are declining and she is finding it more and more difficult to manage her basic activities of daily living. Mrs. S feels frustrated that her independence is slipping away and calls on her daughter more often for assistance. Her daughter is becoming increasingly worried for her motherâ&#x20AC;&#x2122;s safety since her motherâ&#x20AC;&#x2122;s condition is worsening and she has already had a fall. She wants to speak to health-care professionals who can help her manage her motherâ&#x20AC;&#x2122;s complex care. The number of seniors is growing steadily in the Toronto Central LHIN. It is expected that by 2016, seniors will make up 14.5 per cent of the population, with the greatest increase in those seniors over the age of 85 years. Current estimates tell us that the fastest growing age group â&#x20AC;&#x201C; people 85 years of age and older â&#x20AC;&#x201C; will increase by 48.5 per cent from 2005 to 2015. Although many seniors enjoy good health well into the oldest ages, the fact is, seniors are at risk of getting sicker with eventual loss of independence. They may become frail, with greater risk of falling, and are more likely to need community supports. With complex medical needs, frail seniors can benefit greatly from coordinated services that promote abilities and independence. St. Josephâ&#x20AC;&#x2122;s Health Centre (SJHC), Toronto is committed to deliver more comprehensive and innovative programs to meet the needs of the increasing number of seniors within the population we serve. The BMO Ambulatory Care Centre includes several specialized care areas to address some of these complex needs. One such service is the Elderly Community Health Services (ECHS) clinic. The ECHS has been operating for 12 years and has evolved into an interprofessional team that is focused on assisting seniors whose independence in the community is at risk. Frail elderly individuals with complex medical conditions like Mrs. S, receive expert consultation, assessment and treatment through this outpatient clinic.

The clinic offers an interprofessional approach to caring for patients, through the services of geriatricians, a geriatric psychiatrist, nurse clinician, social worker, physiotherapist, occupational therapist, and speech language pathologist. â&#x20AC;&#x153;At the clinic, patients and their families receive services from a variety of health-care providers who may not always be readily available in the community,â&#x20AC;? says Catherine Cotton, Administrative Program Director, for Medicine, Ambulatory and Seniorsâ&#x20AC;&#x2122; Health at SJHC. â&#x20AC;&#x153;It is a great benefit to have all of the care providers in one location for patients and families.â&#x20AC;? â&#x20AC;&#x153;The goals of the clinic are to provide comprehensive, coordinated service to maximize the patientâ&#x20AC;&#x2122;s independence in the community and avoid unnecessary hospital visits or re-admission to hospital,â&#x20AC;? adds Carla Curto-Correia, Patient Care Manager, Ambulatory Care Centre at SJHC. The clinic staff and physicians also work to advance the success of the primary care model, to assist and co-manage patient illness and to provide patients and families with education and the resources they need to be successful in managing their health issues. Through its dedication to keeping seniors independent, the clinic is also continuing to look at ways to improve access to services through ongoing liaison with community resources. Typically, patients are referred to the clinic from the emergency department, community referrals (i.e. the patientâ&#x20AC;&#x2122;s family doctor), or within the health centre (i.e. they may have been admitted to another department in the health centre and referred to ECHS). â&#x20AC;&#x153;An individualized care plan is determined based on the patientâ&#x20AC;&#x2122;s needs and goals. The assessment may include a number of interviews with the patient and their caregiver to gain a better understanding of the issues they are facing,â&#x20AC;? says Curto-Correia. Patients at the clinic could have a number of aging-related concerns including: â&#x20AC;˘ Loss and/or decrease in mobility and physical functioning â&#x20AC;˘ Reduction in ability to perform the basic â&#x20AC;&#x153;everydayâ&#x20AC;? activities (i.e. getting out of bed, self-care, shopping, social components, etc.), leading to a loss of indepen-

dence â&#x20AC;˘ D  ecline in cognitive abilities and the psychosocial issues associated with the decline in cognitive abilities â&#x20AC;˘ Multiple and challenging medical conditions (i.e. heart disease, osteoporosis, arthritis and other chronic diseases) â&#x20AC;˘ Managing many medications (polypharmacy) One of the key areas of focus for the staff and physicians within the ECHS is in helping seniors manage their multiple medications. â&#x20AC;&#x153;As we age, physically there is greater risk of developing chronic conditions such as heart disease, osteoporosis, and arthritis â&#x20AC;&#x201C; conditions that will impact a personâ&#x20AC;&#x2122;s ability to remain independent. As these conditions manifest, patients need a number of different medications to manage so the issue of polypharmacy arises. The clinic helps to â&#x20AC;&#x2DC;re-jigâ&#x20AC;&#x2122; some of

the medications to ensure that medications are taken safely and side effects are minimal,â&#x20AC;? says Cotton. As with many of the clinics and services offered at St. Josephâ&#x20AC;&#x2122;s, the ECHS is moving towards a more defined chronic disease management model. â&#x20AC;&#x153;A chronic disease management framework is a priority for us as many of the medical conditions we see are not stagnant. There will be changes to the patientâ&#x20AC;&#x2122;s condition and we can try to anticipate and put plans in place to assist with that and help prevent or decrease loss of independence for our patients,â&#x20AC;? adds Curto-Correia. The ECHS clinic is just one of many services offered at SJHC to help seniors at risk. To meet needs of seniors in the community, St. Josephâ&#x20AC;&#x2122;s also has a large and active geriatric service with five full-time geriatricians and a geriatric psychiatrist. In addition to assisting patients with many aging-relat-

ed issues, our geriatric services also allow us to provide care to seniors with mental health and addictions challenges. â&#x20AC;&#x153;Our focus on senior care is a priority in our strategy to put patients first and enhance the communities we serve, with seniors being one of the largest populations for whom we provide care,â&#x20AC;? says Cotton. Through the ECHS clinic, St. Josephâ&#x20AC;&#x2122;s is making it easier for seniors and their caregivers, like Mrs. S and her daughter, to access coordinated and seamless services, helping seniors to continue living independently in their home for as long as possible. For more information on the ECHS clinic, please contact 416-530-6770. *Description of a typical patient seen in the ECHS clinic. Michelle Tadique is a Communications Associate at St. Josephâ&#x20AC;&#x2122;s Health Centre in Toronto.






Hospital News, April 2009

Natural Path

Reduce side effects of medication with naturopathic geriatric care By Sana Abdullah


he side effects of prescription drugs can often cause discomfort and stress, but for geriatric patients, these complications may produce severe reactions requiring further medication, and on rare occasions, hospitalization or complete bed-rest. Fortunately, reducing the side effects of medication does not have to be costly, time-consuming or difficult to implement – simply incorporating healthy lifestyle choices such as proper nutrition and exercise into one’s daily routine can boost overall health in a geriatric patient. It is even possible to minimize the use of drug therapies altogether; naturopathic medicine, in conjunction with prescription drugs, can provide welcome and long-term relief from the adverse reactions that are common with many medications. “This is especially true in the case of geriatric care,” says Rena Zambri, naturopathic doctor (ND) and a clinic supervisor at the Robert Schad Naturopathic Clinic (RSNC). “What we ultimately wish for, as NDs, is to educate our patients on the importance of maintaining a healthy and active

lifestyle that includes complementary natural therapies that can treat their health concerns.” On average, Zambri sees four to eight geriatric patients per week, and about 16 to 32 per month, ranging in age from 65 to 83 years young. The most common health issues among this population include high blood pressure (hypertension), high cholesterol (hypercholesterolemia), diabetes, gastroesophageal reflux disease (GERD), arthritis and/ or osteoarthritis, osteoporosis and benign prostatic hyperplasia (BPH) in men. To ease the side effects of medications used to treat these health problems, she always starts with recommending the most basic of naturopathic therapies – diet and lifestyle changes. “I advise my patients to increase their water intake, and incorporate more fruits, vegetables and fibre into their diet. I also emphasize the importance of low-impact exercise, whether it is walking, swimming or light cardiovascular workouts at the gym - this also allows geriatric patients to meet and set up a network of friends, which can be lacking in this age group,” Zambri says. Side effects from prescrip-

tion drugs commonly taken by geriatric patients are numerous and varied, but typically cause the same physical responses in the users. Medication used to lower cholesterol levels (called statin drugs) elevate liver enzymes and deplete co-enzyme Q-10 in the body. In addition, many patients often experience fatigue, muscle pain and increased perspiration due to statin drugs, and according to Zambri, “These reactions lead many patients to terminate the use of these drugs altogether.” A common health concern for geriatric patients, high blood pressure is often treated with anti-hypertensive medications, but in some cases, blood pressure levels can drop too low. Zambri states that fatigue, lightheadedness and dizziness/vertigo can result from this. Metformin, a drug typically prescribed to diabetic patients, can cause gastrointestinal imbalances such as diarrhea, abdominal bloating, nausea and vomiting. “If Metformin is taken in too high a dosage for the patient, hypoglycemia may develop. In addition, this medication diminishes vitamin B-12 in the body which already tends to be lower among geriatric patients,”T:9.875” Zambri claims.

Gastrointestinal side effects, such as bleeding, are also typical of anti-inflammatory medications used to treat arthritis and osteoarthritis. Because NDs view each patient as an individual, Zambri endorses a host of naturopathic treatments that assist in achieving and supporting optimal health for geriatric patients with specific health concerns. “Fish oils have remarkable antiinflammatory properties and possess mild-to-moderate bloodthinning effects, both of which are very important for overall cardiovascular health,” says Zambri. “In terms of high blood pressure and high cholesterol, certain nutritional supplements and botanical medicines, such as co-enzyme Q-10, garlic and hawthorne, have been wellresearched to improve these conditions,” she adds. For diabetic geriatric patients, the mineral chromium may prove effective in regulating blood sugar levels. An increase in dietary calcium from sources such as green leafy vegetables and nutritional supplements containing calcium (preferably in citrate form), in addition to magnesium, vitamin D, boron and strontium, are well indicated for helping

patients with osteoporosis. Glucosamine sulphate can be an effective treatment for patients with osteoarthritis, and demulcent botanicals can lessen the unpleasant symptoms associated with GERD. Other naturopathic modalities can help to decrease side effects from medications; the determination of which modalities to use is dependent upon the needs of the individual patient. “As treatment progresses beyond lifestyle modifications and nutritional supplements, we can begin using botanical medicine, acupuncture and homeopathic medicine, if appropriate for the condition. We may also choose to integrate other therapies such as hydrotherapy, peat baths and infrared saunas as necessary.” Ultimately, what Zambri and the NDs at the RSNC hope to accomplish is to maximize the life experiences of each patient, and provide geriatric patients with the knowledge, skills and tools they need to maintain a healthy and active quality of life. For more info visit www. or call 416-498-9763. Sana Abdullah is the Communcations Officer at the Canadian College of Naturopathic Medicine.

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Hospital News, April 2009

Financial Health Matters


Making Sense of it All By Brian Singer


e are in the midst of a deep recession, the depth and length of which we have not experienced in over a generation. Though not as bad as the “Dirty Thirties” it will be harsh enough to modify consumer investment and spending patterns for a long time. I would like to examine the U.S. experience because they are our biggest trading partners and “when they sneeze, we catch a cold.” Before we look south of the border, let’s understand why this recession is different from prior recessions. First of all, the measures being taken to re-inflate world economies amount to an historic experiment - many of these measures have never been used before. The speed and ferocity of the decrease in global trade and economic activity and drop in global stock markets has been extremely fast and furious. Usually a recession starts with slowing consumer spending which leads to lower business activity and inventory being worked off by businesses. This time the problems started

with the shaking of the foundations - namely the Financial Institutions themselves. True, the problems started with a bursting of the U.S. housing bubble and problems with subprime mortgages. But the loss of confidence among the banks caused credit markets to freeze up. Again we have never witnessed this before, ever. Major global pillars of the financial world have crumbled and institutions are being nationalized faster than you can say United Soviet Socialists Republic or USSR. Let’s now look at the tools U.S. policymakers are employing and what this means to you the investor. U.S. policymakers can say that (with apologies to Monty Python’s The Spanish Inquisition), “amongst their weaponry” are such diverse elements as: monetary policy and fiscal policy. Economists view monetary policy as the first line of defense against economic slowdown because a Central Bank can act more quickly than the politicians can adjust fiscal policy. Often with fiscal policy, it takes time to legislate a spending increase or decrease

taxes as well as to implement those changes. Large budget deficits can undo part of the direct stimulative effects of say lower taxes and higher government spending and actually cause longterm interest rates to rise due to large government borrowing. Now we are getting an idea of what fiscal policy can do: increase government spending and lower taxes. Where to spend and whose taxes to lower is another story. The Obama administration wants to stimulate everyone from homeowners to businesses to car buyers to farmers to the unemployed. The idea is to get money into people’s pockets so they spend it. So what does monetary policy accomplish? The Central Bankers have the ability to manipulate the money supply by adjusting interest rates. The most important one the Fed uses is the Fed Funds Rate. By lowering the cost of borrowing for the big banks it helps to initiate a spiral of decreases in other key borrowing costs. If money is cheaper, more businesses and people will borrow and then spend and that will help stimulate the economy.

So how has it worked thus far you ask? Well, the Fed Funds rate is now at zero (another historic first and one for the grandchildren to hear about) and banks aren’t lending. They, in fact, are hoarding the cash they are receiving from the Treasury and Fed. In addition the U.S. Treasury is guaranteeing various poor quality “Toxic” financial instruments held by the banks and injecting money into the financial institutions themselves. So given that it doesn’t appear to be stimulative to the economy, the new President and Congress needed to make big fiscal policy changes and stimulate the economy by spending (along with huge borrowing). The Federal Reserve’s moves to increase the money supply reminds me of what Milton Friedman, the recently deceased Nobel Laureate in Economics said, “inflation is always and everywhere a monetary phenomenon.” Many pundits see a return to the high inflation of the 70’s and 80’s, which means high interest rates are also coming. With all this I also see a resurgence in Gold prices as many investors lose

confidence in the U.S. dollar and flock to the oldest known safe haven - the yellow metal. I will wrap this up with some actionable items for you to consider depending on your circumstances: 1. Variable rate mortgage holders should lock in rates at these historic low levels, 2. Have at least 10 per cent of your investment portfolio invested in Gold (I recommend Exchange Traded Funds), 3. Finally, stay short-term in your bond portfolio and have cash available to invest at the higher bond yields --they will be here faster than you think. Brian Singer is a Financial Advisor with Raymond James in Toronto. The opinions expressed are those of Brian Singer and not necessarily those of Raymond James Ltd. Statistics, data and other information are from sources believed to be reliable but their accuracy cannot be guaranteed. This document has been prepared to assist individuals with financial concepts and is for informational purposes only.


Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care

Excellence in care a priority for Humber River Regional Hospital’s geriatric program By Kearie Daniel


ighty-three year-old Adelle Howe is carefully applying her lipstick and make-up. After spending three months in Humber River Regional Hospital (HRRH), she is finally able to leave, albeit only on a day pass. Today, she is preparing to visit a local nursing home, where her family believes she will continue to get the long term care she needs. But for Adelle, who walks with a spring in her step despite being hospitalized for a stroke, leaving HRRH is bitter sweet. “Everyone here has been really good to me,” says the CubanCanadian, her voice soft and shaky. “I’ve had no problems at all.” Indeed, staff members on the geriatric floor have been equally taken with Adelle, greeting her by name and commenting on how well she looks as she walks down the hall. Even Dr. Adam Krajewski, Head of Geriatrics at HRRH, who has been with the hospital

Dr Adam Krajewski with 83 year-old HRRH patient Adelle Howe over 10 years, has a special fondness for Adelle. “She is a wonderful lady” he says, “All of our patients are special and we provide them all with the best care, but sometimes you meet someone that touches you.

Adelle has a dignified grace and peacefulness about her that connected with all of us.” Adelle’s story is typical of many of the older patients for whom HRRH provides care. She was independent and liv-

ing on her own, but plans and social activities she had organized, including a cruise trip with a friend, fell by the wayside after a sudden stroke. Geriatric patients require a unique blend of medical expertise and emotional support. Like Adelle, many are formerly active and independent adults. According to Dr. Krajewski, taking a multi-disciplinary approach to their care is a key aspect to the continuation of excellent treatment provided to elderly patients. “We are a community hospital, and I think the care that we provide and the involvement and effort that is made to ensure that patients are well looked after is very good” Dr. Krajewski believes that one of the key components of continued excellence in care for HRRH’s Geriatric patients is the Geriatric Rounds that take place monthly. The rounds are a lively affair full of debate and discussion. The speaker’s are often from HRRH or other hospitals in Toronto. All staff including Social Workers, Chaplains, Clinicians, Dieticians and even the hospital’s Ethicist attend to share their experiences and gain and give advice. “We all really work together,” says Annette McLean, Resource Nurse for the Six West Geriatric floor. We had a team of different experts looking after Adelle for example. It was all part of a holistic approach to her care.” That holistic approach means that even the Chaplains play an essential role in delivering care to elderly patients. “We facilitate bereavement and grief for loss of home, mobility and life as they knew it,” says

Laura Sutton, one of HRRH’s two Chaplains, “We also provide social support. I have often arranged or gone myself to pick up their walker or even feed their pets.” For patients, social support can also take place in unexpected ways. “As Adelle got better, she would come by the nursing station and ask what she could do to help,” explains McLean. “She would fold towels and would even help the other patients make their bed. This helped her rehabilitation and also helped to keep her active and alert. And it helps provide a more normal social experience.” In HRRH’s emergency department, dedicated Geriatric Emergency Management (GEM) nurses deal exclusively with elderly patients in the ER, providing vital care and helping to facilitate the hospital’s older patients’ care needs. Once on the floor, a Geriatric Assessment Unit means that patients suffering from severely limited mobility, agitation, confusion or who are in need of consistent pain control do receive specialized care in one area. A Geriatric Psychiatrist and two full time Palliative Care Physicians are also part of the team that contributes to the continued excellence of HRRH’s Geriatric program. “We’ve also done exceptionally well with wound-care and fall prevention,” says Dr. Krajewski. “It is an area that we have all worked very hard to raise awareness in and with a Wound Care Specialist on board, it has really helped to reduce the prevalence.” A Geriatric Out-Patient Clinic that runs four days a week ensures that even after they are discharged, HRRH’s elderly patients can return to get the care they need from familiar faces in a familiar setting. But, for Dr. Krajewski and the rest of the Geriatric team, what is important is the team effort that is made to get elderly patients better. Nurse McLean sums it all up by saying: “The men and women on our floor have lived their lives, they have contributed to society and worked hard. They deserve to be well taken care of and that’s what we try to do everyday at HRRH.” Kearie Daniel is a Communications Specialist in Humber River Regional Hospital’s Public and Corporate Communications Department.

Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care


Caregivers can make health system more efficient By Jerry Amernic


wo seniors, both 85, were recovering from hip surgeries in different communities. After rehabilitation in hospital, they were candidates for going home – with home care – but only one did. The other remained in hospital until a long-term care bed became available. It’s no wonder the health-care system is overburdened with ALC (Alternate Level of Care) patients occupying acute-care beds. The family of the woman who went home hired a private home-care provider for seniors - one of many service options mentioned when the woman was being discharged. As for the second senior, her family was referred to a publicly funded community program,which could only provide a limited number of hours of care per week. It wasn’t enough, so the woman stayed in hospital waiting for a long-term care bed. Today, with an aging population, the first Boomers being a mere two years away from turning 65, and health-care budgets strapped for funds, there is a problem with ALC patients

occupying acute-care, hospital beds. A report released in January by the The Canadian Institute for Health Information entitled ‘Alternate Level of Care in Canada’ stated: “Most Canadians have never heard the phrase ‘alternate level of care,’ or ALC. Yet since the mid1980s, the public consciousness has embraced the idea that hospital beds are being occupied by patients who no longer need acute services, using limited, expensive resources while they wait to be discharged to a more appropriate setting.” The report found that, in 2007-2008, more than 74,000 hospital stays were taken by ALC patients in Canada (excluding Quebec and Manitoba), representing over 1.7 million hospital days. Dementia accounted for almost one-quarter of ALC hospitalizations, and more than one-third of ALC days. “The single biggest challenge facing Ontario hospitals is the number of ALC patients waiting in hospitals for alternate levels of care,” says Tom Closson, President and CEO of the Ontario Hospital Association.

He added that Ontario has one of the highest percentages of ALC hospitalizations in the country. The OHA wants major investments in health services, outside of hospitals, and creative interim solutions to help hospitals bridge the capacity gap until longer-term investments have effect. The idea is to free up beds occupied by ALC patients who could be better cared for in a long-term care facility, supportive housing, or at home with caregiving services. Sharon Galway offers a unique perspective on this. A registered nurse who has been a case manager in hospital responsible for discharging patients home, she is a former consultant with the Ontario Strategy to Combat Elder Abuse. She also operates Home Instead Senior Care in North York; it was her office that provided a caregiver to the senior who was discharged after hip surgery. “A geriatric nurse specialist is available in most emergency departments,” says Galway. “There are also excellent programs to help ease the burden on emergency departments

across Ontario, but it isn’t enough. More home-support services that allow seniors to remain safe at home are needed to prevent the revolving door from hospital to home, and back to hospital again.” She thinks hospitals should provide patients with the full range of non-medical, support options and services available, but sometimes they aren’t aware of all the services. “Data shows how many hospital beds are occupied by ALC patients. After an operation or hospital stay, a senior may be in a weakened state, but that doesn’t mean they must remain in hospital,” explains Galway. “A caregiving service, public or private, takes pressure off the health-care system. Home-care providers can keep people healthier, and for longer, at home.” She points out that many seniors fall between needing what community programs provide with limited home care, and the 24-hour care provided in hospital. According to a report from the Central East Local Health Integration Network, the occupancy rate for non-acute patients in acute care beds in

that region’s hospitals was 18 per cent, representing over 165 hospital beds. Thus, nearly one in five hospital beds in the region were occupied by ALC patients. Ontario currently has an Aging at Home strategy designed to help seniors live healthy, independent lives in the comfort and dignity of their home. While this will improve the lives of many seniors, it will also help get ALC patients out of acute-care, hospital beds. “Still, a lot of people get missed,” says Galway. “The health-care system is looking for ways to be more efficient, and it’s not cost-effective to have ALC patients occupying acutecare beds when they don’t have to be in hospital. Opening up these beds and partnering with caregivers is a way to do it.” Jerry Amernic is a writer with Freedman & Associates, a firm that specializes in marketing and communications services for professionals, and for health care and senior care organizations. He can be reached at 416-868-1500 or

Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Improving the functional health of at-risk seniors By Alex Russell


rovidence Health Care (PHC), one of Canada’s largest faith-based health-care organizations, operating 14 health-care facilities in Greater Vancouver, is known for its leading Elder Care Program. The program provides a wide spectrum of services for elderly British Columbians, including residential care, acute geriatric medicine, geriatric psychiatry and rehabilitation. Each year, 25 per cent of all patients admitted to St. Paul’s Hospital and 50 per cent of those admitted to Mount Saint Joseph Hospital are over the age of 70. Of these, the Elder Care Program’s multidisciplinary teams’ expertise assists complex geriatric patients with acute health-care needs. “There are critical challenges facing hospitals for the care of seniors nowadays, especially for those at-risk seniors over 70,” says Dr. Janet McElhaney, PHC Physician Program Director for Elder Care. “For that population, we are seeing an increasing number of admissions and related inpatient days,” she adds. Many of these older patients have chronic diseases and multiple complex medical issues and live alone with little support. One in three patients over 70 years of age admitted to hospital ends up being discharged at a higher level of disability. In response to this concerning trend, in September 2008, PHC began implementing an innovative and unique approach to enhance the care and flow of vulnerable, at-risk elderly

patients admitted to the emergency department at St. Paul’s Hospital. The aim of the Goal Responsive Acute Care for Elders (GRACE) initiative, which spans multiple programs within PHC, is to prevent increasing disability and functional deterioration of at-risk elderly patients as a result of hospitalization. “The GRACE initiative is a key strategy for reducing the significant deconditioning affects in hospitalized elders associated with bed rest and to support older patients in returning to the setting in which they lived prior to their hospital admission,” says McElhaney, who is the initiative’s physician lead. “This approach allows us to create a near-seamless flow through the patient’s hospital stay by closing existing gaps in access to needed services.” An inter-professional collaborative practice team was established at St. Paul’s Hospital as part of the broader GRACE initiative. The GRACE clinical team initiates timely patient identification, evaluation, early rehabilitation and effective discharge planning for the target patient population. The team works closely with the emergency department, acute care staff, community services and family physicians to establish practice links and to facilitate integration of the team’s recommendations into the senior’s ongoing care plan. Though this practice model has been applied elsewhere in Canadian hospitals, this initiative is unique in Canada with respect to the breadth of the

GRACE physiotherapist Anne Leclerc performs a strength test with patient Filip Taylor.

GRACE clinical team. The team includes two geriatric emergency nurses, a physiotherapist and six geriatricians. The team reviews a patient’s previous admission records and checks to see if they have been receiving home support or care at the community level. They perform complete medical, functional and social assessments and tests that include screening for common geriatric problems. Frail patients with mobility issues will have tests to determine if they need a walking aid, are at a higher risk of falls, and whether they need help with daily activities such as getting up and down stairs or in and out of the tub. The team communicates with ED staff and physicians in decisions about care plan-

ning, and makes recommendations regarding admission or discharge. If the patient is admitted to hospital, the team prepares a care plan with recommended treatments and liaises with appropriate geriatric services within the hospital, such as the Geriatric Medicine Outpatient Clinic or the Geriatric Day Program. For patients who are discharged from hospital, they can arrange further assessments by community physiotherapists, occupational therapists or home nurses, who can refer them to services such as the Falls Clinic at St. Paul’s Hospital and advise on choosing and purchasing appropriate mobility aids. The team members use a patient-centred approach, involving the patient in dia-


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logue around the nature of their hospitalization, recommended treatment options, and goal setting. “Since the GRACE initiative began, we’ve heard from patients who are grateful for the individual approach our team takes to providing comprehensive care,” McElhaney says. For one such patient with unsteady gait and leg pain, GRACE physiotherapist Anne Leclerc arranged the purchase of a walker and referred her to the St. Paul’s Hospital Geriatric Day Hospital where she is now regularly monitored. The patient continues to live independently and is very pleased to be monitored so closely. The team members enjoy the satisfaction of helping seniors maintain their independence by working to return them to the setting in which they lived before coming to hospital, thereby avoiding the need for residential care. “I feel I can make a real difference with this group, in helping them maintain or improve their functional mobility and ultimately, their quality of life,” says Leclerc. Alex Russell is a Communications Specialist at Providence Health Care in British Columbia.

Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care


Supporting the wellness of seniors By Mark Palmer


upporting the wellness of seniors has always been a high priority at Toronto’s West Park Healthcare Centre. Thanks to a unique partnership, West Park is continuing that attention to the care of seniors outside of its walls in some high-priority seniors’ communities in Toronto’s West end. The Supportive Housing Project is one of 12 initiatives funded in 2008/09 through the Toronto-Central Local Health Integration Network (TC-LHIN) from the Ministry of Health’s Aging at Home Strategy – which focuses on prevention initiatives that help seniors continue to live healthy, independent lives in their homes. Close to $1M was invested in the project, which focuses on four Toronto Community Housing buildings situated in the former City of York and involves five partners - St. Clair West Services for Seniors, York West Senior Citizens Centre, Toronto Community Housing, VHA Home Healthcare and West Park Healthcare Centre Seniors Mental Health Service. This program is providing services for 115 marginalized seniors - including help with activities of daily living; intensive case management for at-risk seniors; wellness and health promotion; and chronic disease management. The supportive housing team consists of personal support workers, case managers, nursing services, mental health services and partners with the Toronto Community Housing staff in addressing safety, nutrition, health, mental and social needs. The Supportive Housing Services project is only six months old, but already great strides have been made in reaching its goals, which include decreasing emergency room visits, long-term care placements and hospital stays. Mental health services are an important component to the program as well, and West Park’s Seniors Mental Health Service is working to address the mental health issues that seniors deal with in these communities. “The issues facing these communities are complex,” says Sharon Bieck-Shangrow, a Mental Health Consultant at West Park. “Low income, disability, frailty, cultural/ linguistic barriers and isolation significantly impact a senior’s state of mental health and quality of life.” Bieck-Shangrow works with seniors using a variety of meth-

Residents of Louise Towers on Vaughan Road came out in March to hear about “Brain Fitness” – one of the many group presentations that West Park’s Senior Mental Health Service provides in the community. ods – ranging from individual intervention to group presentations on such topics as “Brain Fitness” and “Beating the Winter Blues.” This partnership expands on the prior outreach work of the Seniors Mental Health Service, a program that was established in 1979 and is one of the longest standing geriatric outreach services in Toronto. In-home assessments with seniors and their families to assess early cognitive loss, depression, stress, anxiety and other mental health disorders are part of the daily routine for the Seniors Mental Health

Service, and speak to West Park’s ongoing commitment to the surrounding community. “Seniors’ wellness is growing as a priority as our population ages,” says Anne-Marie Malek, West Park’s President and CEO. “Programs like the Ministry of Health and LongTerm Care’s Aging at Home Strategy recognizes this and enables organizations like West Park to carry out its mission to help individuals live the fullest lives possible, especially in communities facing great challenges.” St. Clair West Services for Seniors co-ordinates the project

and sees West Park’s involvement as invaluable. “Seniors Mental Health Service has identified seniors who we normally would not be able to reach,” says Leigh Judson, manager of the Supportive Housing Project. “They have built trust with these tenants and have made it possible for us to provide them access to all our services.” In addition to the core services the 115 seniors in the program receive, the project makes other services, including presentations, available to the entire tenant population at each building. Monica Clarke, 79, is one such tenant and recently

took in a session on “Brain Fitness” that Seniors Mental Health Service presented with the Alzheimer’s Society of Toronto. Clarke also feels the service provided by the Supportive Housing Project is invaluable. “I really appreciate the service and what they are doing for the people who really need help,” says Clarke. “When I go out and see my friends I always tell them about the service. It’s so helpful.” Mark Palmer is a Communications Specialist at West Park Healthcare Centre.

Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Vision screening in elderly reduces falls By Judy Owen


he elderly man was walking back to his room after church services, gently gripping the hand of his health-care aide as she guided him down the hallways. When he arrived at his room an optician was there with his new pair of glasses.“He put the new glasses on and he looked at the health-care aide and put his hands on her cheeks and said, ‘So that’s what you look like.’” It’s a story Sandy Bell enjoys telling as she proudly talks about the results of a unique three-year pilot project and associated research study on vision screening for the elderly. The director of quality, patient safety and education at Winnipeg’s Misericordia Health Centre (MHC), Bell began the Focus on Falls Prevention initiative in the spring of 2006. The study looked at establishing a vision screening program for residents in long-term care facilities. Results showed that such a program detected eye problems, and that by providing appropriate treatment, falls and fractures could be prevented and quality of life for the residents improved. “There have been lots of studies looking at the prevalence of visual deficits in longterm care settings linked with referring these people for intervention,” Bell says. “But I’ve never come across a study like ours where once the resident was referred, we followed them up, saw them through their intervention and then after they had their vision intervention we assessed them three months later to see whether they did

Education facilitator Karen McCormac performs a vision screening with Misericordia Place resident Julian Rentz. fall and sustain a fracture and what were their quality-of-life indicators.” About 900 residents underwent vision screening during the project, with some startling results. The associated research study focused on 92 participants from MHC’s personal care home, Misericordia Place. After the vision screening and assessment by an optometrist, 53 residents were referred for treatment and 17 agreed to have it. The treatments varied from glaucoma drops to new glasses to cataract surgery to vitamins for those with macular degeneration. “All 17 residents who agreed to an intervention, three months post intervention did not fall, did not fracture and had improvements in at least one of their quality-of-life indicators,” explains Bell, who’s


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been a nurse for 33 years. The 36 other residents who were also referred for treatment refused for a variety of reasons, including family members who said it was unnecessary because of the person’s age. Of that group of 36, 18 experienced falls (three months post vision screening) and eight of those had fractures. They included five hip fractures, two broken wrists and one resident who broke their ribs. “Three of the residents who broke their hip later died. These statistics are startling as patient safety in health care moves forward,” says Bell. It was also discovered during the research component that 74 of the 92 residents’ health records didn’t indicate vision problems. However, after the vision screening and assessment it was discovered 72 of the 74 residents actually had visual deficits.

etrists used to go to personal care homes when the homes requested it, but the service is now limited due to lack of programming,” Bell says. She’d also like to see regular clinics in the community for elderly people who are living on their own. “We want to detect and treat visual deficits in seniors prior to an emergency room visit to prevent falls and fractures,” Bell adds. “It’s a health-promotion, patient-safety strategy.” Another key need is education – for the elderly, family members and health-care professionals. Regular eye clinics for people in long-term care homes and in the community would also save the healthcare system money. “Cataract surgery might cost the system about $1,200, compare that to an elderly person who breaks their hip. That could be about $38,000 for the emergency

Regular eye clinics for people in long-term care homes and in the community would also save the health-care system money. Bell has started presenting her findings to the boards at the MHC and its senior management team. She’ll be doing the same to senior management of the Winnipeg Health Region. She has also presented at numerous gerontological and other conferences in Canada. She’s been lobbying the provincial government, with the help of Dawn Ridd, policy analyst, Manitoba Health, to make a vision screening program a regular service at personal care homes. “A group of optom-

visit, surgical procedure and rehabilitation. And that has nothing to do with the implications of the possibility of (the person) being admitted to a personal care home and all the costs associated to that,” she points out, adding 40 per cent of seniors who visit an emergency room for a fall and fracture never return home. Her personal experiences were a catalyst for the project. When Bell was a resident care manager in one of the interim units at MHC, many people

were admitted because of falls and regular eye appointments weren’t provided. Even her elderly mother, who was living in the community, had a fall and fracture. It was discovered she had cataracts, which were then surgically corrected. Bell decided to go back to school in 2003 to get her masters in nursing. She geared all her university work toward looking at vision deficits and falls and fractures and admittance to long-term care facilities, focusing on three streams: policy, vision screening and health promotion. “While limited literature indicated that visual interventions could prevent falls and fractures, there wasn’t current research anywhere in the world to help prove it,” Bell explains. She decided to provide it. After getting her masters in 2005, Bell linked up with principal investigator Dr. Pamela Hawranik, then an associate professor of nursing at the University of Manitoba. She received a $3,000 grant through the Royal Canadian Legion Poppy Fund to cover expenses for the first year’s research component. She met researchers from Aberdeen, Scotland at an international conference in Winnipeg and they decided to look at vision care in personal care homes in both cities through surveys. What was revealed was a lack of education on the importance of vision care and the lack of vision care services for this population group in both countries. Bell also received $200,000 from the Manitoba government and $5,000 from the Manitoba Association of Optometrists to establish the Focus on Falls Prevention project. The first two years involved holding vision screening clinics in 21 of 39 personal care homes in the Winnipeg Health Region. The third year of the project also included training professionals in the Winnipeg Health Region, Brandon and Selkirk regions and Vancouver, B.C., on how to use the vision screening tool. “The Vancouver Coastal Health region is developing a program because of the research data and the simplicity of improving vision and the impact on falls and fractures,” Bell says. She hopes to publish her findings this spring. “It’s been remarkable to actually have people listen to a concept, support it and help move it forward and be excited.” For more information, please visit Judy Owen is a Winnipegbased freelance writer.

Hospital News, April 2009


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Hospital News, April 2009


Patient Safety

By Darrell Horn


s a group, geriatric patients are a population uniquely vulnerable to medical error. This is for a wide variety of reasons, not the least of which being simply the number and frequency of medical procedures they undergo as well as the complexity inherent in treating numerous underlying conditions in multiple domains. Numerous international studies have confirmed that the elderly are disproportionately involved in adverse events in the health-are system. In fact the rate of adverse events increases significantly with age, a 65 year old being twice as likely to experience harm related to medical error as someone 16-44 years old. One recent study in the USA found that the highest rate of harm from adverse events in the entire patient population was in patients between the ages of 65-74. Unintentional injuries related to falls are among the leading causes of mortality in the elderly population. Complications related to a variety of underlying issues, notably delirium, dementia, and frailty, when added to the cumulative effect of other impairments, increase patients vulnerability and exacerbate the consequences of injury. There are a wide variety of measures to be applied in a comprehensive falls management strategy, and their effectiveness proven. Programs for strengthening and rehabilita-

The right to fall?

tion are one method. The use of devices like mobility aids, visual aids and hearing aids another. Padding and positioning devices are used. The safe design of the physical environment is crucial. The removal of obstacles and the placement of objects in a safe manner in familiar positions for the patient will help. Well lighted spaces increase safety and considerations like lowered beds can be helpful.  There needs to be particular attention to the patient’s physical and personal needs. Toileting routines are vital. One of the most human, personal and dignifying activities of daily living is self-toileting and yet after a great deal of cognitive function has been lost, this human need has launched patients on many unsafe journeys, unassisted. There also the other basic needs like hunger and thirst to be attended to. Socialization and activities, especially those geared to an individual’s current abilities and past interests will not only enhance quality of life, but will ultimately aid in fall prevention as well.   Facilities also need to be designed to accommodate the close observation of patients by staff.  Isolated television rooms are an invitation to problems and falls. Continuity of care in terms of staffing will reap many benefits and will increase the potential for improved patient function and decrease behaviours that might otherwise require the application of restraints. Spaces that are sooth-

ing and comfortable with minimal noise and visual and aural stimulations like a pleasant view or music will ease the propensity for wandering. Bed and chair alarms are often essential measures to alert staff about the unsupervised movements of patients when they can’t be

Unintentional injuries related to falls are among the leading causes of mortality in the elderly population. in sight. Roam alerts worn by the patient and door alarms are good measures as well. Knowing that optimal falls prevention measures are successful places the occurrence of nearly every fall in the category of medical error, that being a preventable adverse outcome of care. Unfortunately, at the extreme end of the range, concerning patients with significant cognitive impairment, the proven safety measures present a number of ethical issues related to patient safety for discussion. After all the best falls management practices have been applied to patients suffering

from various types of cognitive impairment there remains, for an ever growing group, only two ways to keep these patients safe; either restraint or continuous one-on-one care. The issues around restraints, either physical or chemical are huge. Concerns related to the fundamental human rights of personal movement, quality of life and the individuals’ sense of dignity create a moral minefield around the application of restraints. Most facilities providing care to the elderly in Canada have adopted a policy of absolute minimal or no restraints in response to these concerns. Most institutions will employ every measure to ensure that the application of restraints takes place only as a measure of last resort in emergent situations with even stricter guidelines for their ongoing use. The restraint used will be ensured to be the minimal amount possible, and to be used for the shortest time. Often then, the only safe alternative to restraint will be the provision of individualized care with a constant monitoring by a one-on-one personal attendant. In the context of our aging population, the needs within the demographic have produced huge demands on facilities already overtaxed for human resources. The difficulties in staffing 24/7 constant care for high risk patient are multifold.  The demanding nature of the work requires a very specific skill set and a suitable personal disposition by attendants for the work. And of course the costs are huge. Sometimes the

patient’s family can be included as part of such a care plan, but this may prove only a partial solution and in many instances simply impossible. Many patient families will be unable or unwilling to bear the costs associated with privately provided attendant care, when the facilities themselves are unable to bear the burden either. So we return again to the increasing scenario where restraints are the only absolutely safe measure for patient safety possible. If this is moral anathema; what do we do? Does the patient simply have the right to fall if restraint is refused and constant care not possible? The decisions made about such extreme interventions should be perhaps considered in the same context as many other measures necessary for the preservation of life. As decisions concerning measures such as resuscitation, intubation and other such invasive or heroic measures are part of an advanced care planning process, could we not consider as well the question if, in the circumstance of deteriorating cognitive capacity, it is only possible to keep a patient safe by means of restraint, if when and how will such restraints be applied and will the consequences of a fall be accepted should those restraints not be applied? Does the patient simply have the same right to fall as they may have to place a DNR order on their chart? Like any other decision in health-care directives and advanced care planning, these decisions should be made well in advance, ideally when the patient’s participation is still possible and their wishes known. Many individuals will have an answer to the question “If the only way to keep me safe one day is to restrain me, do I so wish or will I accept the potential consequences of a fall?”  The quality of life in a restrained environment and, potential alternatives like the costs of attendant care can be weighed and measured in the same light as many other decisions made regarding care in the difficult circumstances of any other degenerative condition.  Patients For Patient Safety Canada believes every medical decision should be made under the guiding principle of Patient and Family Centered Care with the ever present and full participation of patients and their family members in every step of the decision making processes for the health care provided them. Darrell Horn is the Communications Co-Chair of Patients for Patient Safety Canada.

Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care


Home care a key component to midwifery services By Joanna Zuk


aby Violet is having her umbilical cord examined by her midwife. She’s having her temperature taken, her breastfeeding latch checked and her heart and lungs assessed. But Violet hardly notices because she’s nestled in her mom Jordan McCormack’s arms while they sit together on the cozy couch in their living room. “I just loved being in my PJ’s and robe, relaxing and nursing my newborn when the front door squeaked open,” says McCormack. “In comes my midwife ready to cuddle my new baby to make sure she is growing and eating well. Nothing beats having a check-up, then going right back to snuggling under a blanket in your own bed.” Ontario Registered Midwives provide clinical home care to all clients after birth, whether the baby was born in the hospital or at home. Normally, midwives visit clients six times at home in the first few days after the birth, then follow up at the clinic at two weeks, four weeks and six weeks. Midwives provide complete care for mom and baby during pregnancy, birth and the first six weeks after birth. Registered Midwife Lisa Weston says postpartum home visits provide a multitude of benefits for both infants and mothers. “Healing is facilitated by home visits because our clients really get a ‘laying-in’ period,” she says. “It is better to keep the baby home, out of inclement weather and in familiar surroundings to minimize their exposure to unfamiliar germs and over-stimulation. Many of our clients do not have transportation and having a new mom take a brand-new baby on public transport is not ideal. At home visits, we check both baby and mother in terms of vital signs, breastfeeding and everything involved with recovery from the birth.” Weston says a large part of her visits involve early parenting support, reinforcing selfcare for moms and supporting the family unit to adjust to life with a new baby. “Clients always have many questions about their bodies, their babies and parenting that we can answer for them,” says Weston. “For new parents, many normal situations may cause them alarm. They know that we are available by pager 24-7 and can

Registered Midwife Leslie Viets listens to baby Patrick Zhou’s heart and lungs during a home visit in Ottawa while big brother Mitchell watches intently. Photo Credit: Natasha Moine

assess their situation and advise as to whether the baby needs additional care.” Most times, the midwife can go and check that the baby is well, reassure the parents and save them the time and worry of having to go to emergency unnecessarily, which also saves

the health-care system money. Conversely, sometimes midwives find a baby to be unwell and advise the parents to take him or her in for Paediatric assessment, catching illness or other situations early. Often, midwives can also spot signs of postpartum depression in

the first few weeks and get the mother the help she needs early. In addition, feeding is an important part of the transition, and moms and babies may need help to be successful. “Home visits allowed my midwives to offer personalized after-care according to my home environ-

ment,” says McCormack. “For instance, when my midwife watched me latch my daughter to nurse, she noticed the rocking chair I was sitting in was rather high. She recommended using a foot stool to correct my posture and help prevent stress on my abdomen.”  McCormack knew about the home care that midwives provide because her sister had her baby with the same midwifery practice in Pickering three years ago. “Home visits are definitely a bonus to having midwives,” she says. “Having a brand new baby is overwhelming enough without having to pack up and head to the clinic when we both should be resting and enjoying our ‘babymoon,’ at home together.” Midwives are experts in normal pregnancy, birth and infant care. In Ontario, midwives are paid by the Ministry of Health and Long-Term Care, which means care is free to clients. There are over 400 Registered Midwives in Ontario and over 85,000 babies have been born under midwifery care since 1994, including over 20,000 births at home. To find a midwife in your community, visit Joanna Zuk is the Senior Communications Officer at the Association of Ontario Midwives.

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Hospital News, April 2009

Nursing Pulse

Life and death in the NICU By Olivia Gerardi


t was an ordinary night shift, characterized by the kind of silence that makes you want to doze off, but charged with a sense of uneasiness that at any moment my preceptor – a neonatal intensive care (NICU) nurse – might be paged down to labour and delivery for an emergency. As a student, this sense of being on the verge of something big was unsettling but exciting at the same time. At 2:00 a.m., when it seemed the rest of the world was fast asleep, the pager started buzzing. As we ran down several flights of stairs towards the emergency, I realized I was fully awake and prepared. Well…that’s what I thought anyway. We reached the resuscitation room and found a group of awaiting health-care professionals discussing what would come next. Some were anxiously peeking in on the doctors performing the C-section in the next room, attempting to gain sight of the little girl who was in trouble. Finally, a nurse brought the baby into the room. The chatter stopped. She was not crying. She was motionless and breathless. A scene of controlled chaos followed as the Neonatal Resuscitation Team (or NRT) pulled out their stethoscopes, suctioning tubing and other monitoring equipment and began to save her life. I anxiously watched for what seemed much longer than 10 minutes.

What relief I felt when the little girl began to cry, and turned pinker and pinker with each passing second. As I stood in the corner, away from the crowd of healthcare professionals who held the life of this little girl in their hands, many thoughts and questions streamed through my mind. Was this baby going to die in front of my eyes? Were her parents going to have the chance to hug, kiss and love her? Does she feel any pain? How would I feel if I was the mom in post-op, not knowing what was happening to my baby? Ten per cent of newborns need help to breathe post-delivery. One per cent need ventilation or other special measures to help them survive their first hours of life. Knowing this now, I realize my questions were reasonable and warranted. The NRT team looked nervous but they were highly

focused on what needed to be done and how they were going to do it. I’m almost certain they were not thinking about death the way I was at that instant. Survival was their focus and they wanted to hear that baby cry. I felt scared during this first experience in a critical situation. I thought about the devastated parents and also the health-care professionals. How would they feel if the baby didn’t survive? How would they deliver the message to the parents? Would they reflect on this ‘close call’ if the experience ended badly? Or are some health-care professionals immune to tragedy in the workplace? I feel troubled to think about those parents losing out on the opportunity to adapt to their child’s cues. No chance to form the initial bonds between mother, father and baby. To this day, I have witnessed my own parents shedding tears when they

see me hurt. Though my family provides me with strength, they also break down with me when they see me sad. If parents are capable of feeling hurt for their living children, I cannot even begin to understand the hurt that parents feel over the loss of their child. My sister and I have brought joy to our parents’ lives and, fortunately, the baby that was resuscitated that day will also bring joy to her family thanks to the NRT team and their efficient and orderly action. With an interest in pediatrics, especially the NICU, I reflect on this experience and wonder if I may one day become desensitized and ultimately lose the feelings I have today. There is a life behind every breathless body. There is a family. There are awaiting parents and grandparents. And there may be awaiting siblings. There is a lifetime of ups and downs, wrongs and rights, and hopes and dreams. No matter how many times

as health-care professionals we find ourselves in critical situations and wonder if our patients will survive, I only hope we always realize that we’re not just caring for a body, but a life. As my placement continues, I hope to learn more about the RN role on the NRT team. I think it was important that I was a bystander in the resuscitation room that day because the experience allowed me to stand away from the incident and reflect on my own life and how important and fragile it is. Thanks to this experience, I’ve decided to complete the Neonatal Resuscitation Program (NRP) to obtain my certification. I want to be of assistance in neonatal resuscitation and the training will allow me to be a more confident and skilled professional. Albert Einstein once said: “Only a life lived for others is a life worth living.” As a health-care professional, helping patients through tough times in their lives makes me feel useful and energized. I feel honoured knowing I’ve monitored neonates in the NICU. Olivia Gerardi has her bachelor of science degree and is currently in her 4th year of nursing in the accelerated stream of McMaster University in Hamilton. This article originally appeared in the January/ February issue of Registered Nurse Journal, the flagship publication of the Registered Nurses’ Association of Ontario (RNAO).

Impact of differing beliefs among palliative care providers LEG013_Legate6B_HospitalNews_Jan09:Layout 1



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eath, although inevitable, is a topic few enjoy discussing. Researchers in Aging, Rehabilitation and Geriatric Care at Lawson Health Research Institute (Lawson) in London are demonstrating the benefits of having these difficult discussions with patients in palliative care and their families. In the first phase of an ongoing research focus on palliative care issues, Drs. Maggie Gibson and Iris Gutmanis examined the beliefs of service providers in a residential care facility. Differences of opinion among staff about the importance of different components of dying could lead to inconsistent care delivery. In turn, this could reduce the quality of life experienced by the dying person and their loved ones. The goal of their research was to identify differing opinions among the care providers in a residential

care facility. This information lays the groundwork for assessing what affect these differences may have on patients who are dying, and their families. The research team distributed a validated survey instrument designed to measure components of a “good death” to staff working in a residential care facility that serves Canadian war veterans. Respondents were asked to indicate how important the components were to their personal conception of a “good death”. Care providers agreed on which components were important or essential, and which were unnecessary. Importantly, however, there were some components on which there was not a consistent majority opinion. For those surveyed, differing opinions were expressed regarding the following: • importance of a short dying period; • that death occurs without

technical equipment; • that the person lives until a key event; • that the ability to communicate be present until death; • that death occurs in sleep. The reasons for these differing opinions and how they may impact patient care warrants further inquiry. The study team will use the research findings to inform ongoing quality improvement activities aimed at enhancing palliative and endof-life service delivery within the Veterans Care Program at St. Joseph’s Parkwood Hospital. Since the completion and publication of the survey study in the August 2008 issue of the International Journal of Palliative Nursing, the research team has turned their attention to collecting additional perspectives from family members in a focus group study, and to looking at the specific needs of a subgroup of patients who have Continues on page 32

Hospital News, April 2009

From the CEO’s desk


Operating budgets are just half of the struggle By David Musyj


uring the last fifteen years there has been unprecedented restructuring, renovation and growth in the Ontario hospital sector. Throughout this period of time there has also been considerable government funding available to hospitals in order to offset some or most of the severance costs associated with restructuring and previously a two-thirds government and one-third “local share” funding for renovation and infrastructure growth. However, the timing of your hospital’s restructuring, renovation and growth in the Ontario hospital sector had to coincide with the government’s funding announcements. If your organization was too early or late in its efforts it could face having to fund most, if not all of these costs itself. Windsor, as a community, was one of the first in the province of Ontario to embark upon hospital restructuring in 1994 with the release of the Final Report of the Steering Committee on Health System Reconfiguration in Essex County, also referred to as the “Win/Win Report”. It resulted in the merger of four hospital corporations into two and five physical hospital sites into three. When Windsor Regional Hospital (WRH) was formed in 1994 it had a positive working capital position of $1.7 million and a current ratio of 1.08. Working capital is defined simply as current assets minus current liabilities. Current ratio is current assets divided by current liabilities. The time, cost and effort to implement the Win/Win report was grossly underestimated both at the time of writing of the original report and then again by the Health Services Restructuring Commission (HSRC). The implementation of the Win/Win report was delayed until 1998 pending HSRC validation. In its final report in 1998 the HSRC estimated that hospital restructuring would be completed by 2001 and that the final cost of facility development at WRH would be $46.4 million. This compares to completing facility redevelopment at WRH by the year 2011 at a total estimated cost in excess of $230 million – 12 years longer and $170 million higher cost! Due to the above timing the following occurred at WRH: • restructuring cost reimbursement program during the 1998 to 2005 period came

David M. Musyj is the President and CEO of Windsor Regional Hospital.

too late for WRH since a majority of its restructuring occurred in 1995; • the creation of Infrastructure Ontario occurred after the $105 million Met Campus redevelopment • the “local share” change from 1/3 to 10 per cent currently “cost” WRH approximately $20 million for the Met Campus redevelopment • from 1998 to 2008 WRH’s operating budget went from $90 million to over $275 million dollars. The hospital experienced astronomical growth in all patient areas and programs. As of March 31, 2008, WRH’s working capital deficit stood at $57 million dollars. This working capital deficit creates a major strain on operations. Currently, WRH spends over $1 million dollars per year on interest costs incurred to finance this deficit. In addition, WRH forgoes additional savings by not paying its vendors in a timely fashion to take advantage of prompt payment discounts. If the hospital was to enter into longer term funding for

this deficit the payback of principal amount would increase this obligation to close to $4 million a year. In addition to the cash flow struggle the working capital deficit has on the hospital, it makes reinvestment in new capital equipment next to impossible. A failure to replace older equipment leads to patient and staff safety concerns or the possibility of reducing services as a simple result of not having the necessary equipment. WRH is not alone with this working capital deficit problem. However, WRH has one of the poorest current ratios in the Province. In the early spring of 2008, being proactive in its approach and before the world wide economic meltdown occurred, WRH embarked on a rather innovative and inclusive process to enhance patient and staff safety, patient quality and financial efficiencies. WRH needed to take a “step back” and assess its operations after a period of substantial growth. Also, the hospital has taken the position that it had to get “its own house in order” before it could make any request from

the government for assistance. The process was entitled its Zero Based Budgeting (ZBB) Process. The ZBB process is a technique of planning and decisionmaking which reverses the working process of traditional budgeting. In traditional incremental budgeting, departmental managers justify only increases over the previous year budget and what has been already spent is automatically sanctioned. No reference is made to the previous level of expenditure. By contrast, in ZBB, every department function is reviewed comprehensively and all expenditures must be approved, rather than only increases. This process requires the budget request justified in complete detail by each program starting from the Zerobase. The Zero-base is indifferent to whether the total budget is increasing or decreasing. With zero-based processing one can forget about last year, pretend that the program is brand new, and see if one can provide a detail of expenses for what one would need to fully accomplish the program. This technique will help one to develop a complete picture of what the program actually needs to cost and not just what it has been costing. The ZBB process involved over 300 front line staff including physicians. It was a “bottom up” and not a “top down” exercise. Over 250 performance improvements resulted from the process. At WRH we live by the saying “if you want to talk to the experts talk

to your front line staff”. The ZBB process followed a very successful strategic planning process that involved over 100 front line staff including physicians and resulted in them creating the new Vision of the hospital – Outstanding Care – No Exceptions! As a result of the ZBB process WRH is projected to have a balanced operating budget for 2009-2010 at a time when many hospitals are struggling. We owe this achievement to our front line staff. In addition, WRH has been honoured to receive many local, provincial and national awards for patient and staff safety and patient quality initiatives over the past 18 months. These range from having three of the top eight best practices and the best overall at Ontario Hospital Association’s 2008 HealthAchieve conference to being recognized nationally as a Level 2 – PEP by the National Quality Institute. In order to continue to sustain and build upon the clinical and non-clinical success and to achieve its Vision of Outstanding Care – No Exceptions, WRH’s working capital deficit needs to be addressed and resolved. WRH continues to work positively with the Ministry of Health and Long Term Care, the Erie St. Clair LHIN and the Ontario Hospital Association and on developing a solution to this issue. David M. Musyj is the President and CEO of Windsor Regional Hospital.

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Hospital News, April 2009


Focus: Gerontology/Palliative Care/Home Care

Stopping the ripple effect and improving patient flow By Simone Dalton


hen a hospital has a high number of patients who have finished the acute care phase of their treatment yet remain in an acute care bed, bottlenecks begin happen, making it difficult for staff to admit patients from emergency departments (EDs) to the hospital. Many patients in an acute care bed are often candidates for home care or rehabilitation, but cannot be discharged because the appropriate level of care is not available. In February 2008, University Health Network (UHN) launched the start of a 15-month Alternate Level of Care (ALC) project, looking at ways to improve patient flow through the hospitals’ EDs and ultimately ensuring equitable access to services. As part of the initiative, a multidisciplinary team of clinical leaders and staff from UHN as well as project management experts and technical specialists from Shared Information Management Services (SIMS) worked with multiple external stakeholders to build community partnerships in the interest of patient-centred care. Building on a long-standing referral relationship, UHN

Once stabilized, patients who no longer require acute care can be safely transferred back home or to an alternate level of care (ALC) facility to continue their treatment. University Health Network’s ALC project is helping to identify these patients sooner.

worked collaboratively with the Toronto Central Community Care Access Centre (CCAC) to transfer patients safely and more efficiently back into their home communities with CCAC supports. By working alongside social workers, physi-

cians and nurses in EDs, CCAC Care Coordinators can identify suitable clients more quickly, which can mean fewer unwarranted hospital admissions and shorter stays in the ED for those needing care. Gayle Seddon, a Client

Services Manager for the Toronto Central CCAC describes the ALC situation being faced by hospitals as a “ripple effect.” “One person sitting in a bed where they don’t need that level of care totally blocks the system for the person who is coming in through the ED who needs acute medical care,” explains Seddon. “As a result, the client in the ED now has to wait longer before he/she can be moved into the hospital to continue treatment.” More than just moving one person out of a bed, ALC is about the impact of patient/client care allocation on the entire health-care system. UHN’s Surgeon-in-Chief, Dr. Bryce Taylor considers community partnerships crucial to the long-term success of the project. “Relationships with referring organizations are the key,” says Dr. Taylor. “Whereas, the collection of data is the first step, the next steps and the most important ones are those relationships, those collaborations that we develop with other organizations so that we can get the patient into the right place.” Simone Dalton works on the communications team for Shared Information Management Services.

UHN’s Steps to Alternate Level of Care ALC Electronic Documentation UHN is now using a standardized definition and method for identifying and tracking ALC patients in the electronic patient record. The result is improved ALC data tracking and quality in terms of accuracy, timeliness and access.

Discharge Planning Optimization Using a process improvement methodology and a grassroots approach, a multidisciplinary clinical team in Neuroscience identified ways of improving communication on the units as a discharge planning optimization priority. Another key component to this step included educating patients and their families about the discharge process. Discharge planning optimization also involved improving UHN’s current discharge planning policy.

Community Partnerships To ensure patients received the most appropriate level of care, partnerships were developed to support the safe and timely transition of UHN patients to post-acute care destinations.

Transforming care: Supporting vulnerable seniors


By Dipti Purbhoo and Kathy Hay

Maria, an 82 year old mother of three and grandmother of eight, was in hospital for the third

time in the last six months and this time the hospital team felt Maria should go to a nursing home. Maria and her daughter agreed, as it had become very difficult for Maria to function

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at home even though she lived with her daughter. Maria was thankful for the Toronto Central CCAC Waiting at Home program which allowed her to go home while she waited for a long-term care bed to become available. Maria received daily personal support and nursing care twice a week. The CCAC Care Coordinator, Judy, provided Maria and her daughter with needed support including arranging for physician care and access to an adult day program. After a month at home, Maria felt healthier and, with the support she was receiving, she decided she no longer needed to go to a nursing home. Supporting frail and vulnerable seniors like Maria to remain independent at home and out of hospital is an important priority for the Toronto Central CCAC. We know through the Balance of Care (a research initiative with Toronto Central CCAC, the University of Toronto and Ryerson University) that approximately 40 per cent of seniors waiting for long-term care can be supported at home through an integrated and targeted service delivery model. This year, through pilot proj-

ects such as Waiting at Home, the Toronto Central CCAC has been able to test a new service delivery approach to care for frail seniors, specifically those: • at-risk for an unexpected visit to the local emergency department or a hospital admission as a result of a crisis • at-risk of an avoidable placement in a long-term care home • at-risk of remaining in a hospital bed (inpatient or alternate level of care) when care could be provided in the community

Building a new program for frail seniors We are creating a new program for frail seniors building on what we have learned from our clients, the pilot projects we have undertaken and the best practices in seniors’ care in the literature. The goals of this program are to: • Support at-risk seniors to remain at home for as long as possible • Delay placement in a nursing home • Reduce the use of emergency departments and hospitals

• E  nhance the client and caregiver experience • Help clients make a supported transition to another care setting when living at home is no longer possible Our new program will include the provision of intensive case management and support services. It involves working closely with community partners to provide effective community-based care and support that transcend organizational boundaries. The program will improve the quality of life of seniors and their caregivers through the provision of integrated care from an inter-professional team and the development of service plans that meet the needs of seniors in the community. The integrated team approach: ensures support for eligible clients; creates choices for clients and caregivers; facilitates enhanced learning for care team members; encourages better communication; and utilizes available expertise. The integrated team may be different for each client depending on their needs, and may include: the client and caregiver, the Continues on page 31

Hospital News, April 2009

Focus: Gerontology/Palliative Care/Home Care


Getting and staying active is an ageless issue By Libby Norris


rofessionals working in health-care and in the wellness industry know that fitness and activity decrease the risk of major health diseases, while increasing energy and strength. This can be life-altering for seniors. A senior’s fitness level is often the difference between a vibrant, independent retirement and one faced with limitations and dependence. How do we get seniors more fit and active? With a proactive approach. Most of us struggle to find the time and motivation to start a program, and keep working out and eating properly. Seniors are no exception, and have additional challenges. Here are ways to help seniors increase their strength, spirit, and independence:

Make it meaningful Most people who are 60 plus didn’t grow up with Jane Fonda and the fitness club craze. Indeed, setting aside time for a workout and paying for it wasn’t the norm. For seniors especially, exercise must be meaningful. Success increases when you can relate the program to the person, which is best done through an interactive consultation process. Find out the daily tasks a person performs, ask about their hobbies, and learn the little things in life that are becoming more challenging – playing with grandchildren, caring for pets, doing personal errands. If you can identify activities someone wants to keep up with, and offer them a solution and hope for accomplishing it, then you might convince them to add exercise to their day.

Mimic everyday life One of the best ways for seniors to exercise is to mimic daily movements – repeat things they do in a day as a way of ‘sport-specific’ training. This could be taking the stairs an

extra flight each day, pushing out of a chair two or three times before getting up, pressing on the arms of a chair and pausing when getting up, even walking twice to the mailbox.

Progress at a gradual pace Gradually add easy steps and exercises. Regardless of time available, new and healthy habits are tough to incorporate into a daily routine. Seniors don’t really have ‘all the time in the world’ because everyone has a normal daily routine, and adding anything new takes time and effort. So start small and gradually increase the amount of time and intensity of exercises.

Promote a positive balance Each of the four main components of fitness – cardiovascular, strength, flexibility, and balance – should be part of a balanced fitness program. But cardiovascular often gets most of the press and priority. However, research now shows that strength is just as important, not only for bone density, but also for maintaining strength and metabolism. People think metabolism automatically slows down as we age. This is only partly true because the slowing of metabolism is primarily caused by muscle atrophy – losing it because we’re not using it! Keeping or building muscle on our bodies helps maintain resting metabolic rates (RMR). With seniors it’s never too late to work on those muscles. Strong muscles become increasingly important as we age, and merit equal time and priority with cardiovascular activity. Muscles are also critical for balance, which becomes an increasingly important component as we get older.

Multi-task fitness programs

Traditional fitness programs can sometimes be time-consuming and boring. Being creative with ideas and options for fitness will accomplish a number of goals: • Target multiple fitness components. Swimming, bowling or Nordic walking all involve cardiovascular activity, strength, flexibility, and balance • Make it fun. Incorporate activities the senior enjoys, along with or as an option to traditional fitness training. People stick with things that are fun. • Make it social. Fitness should be interactive, social, and fun. It should be an ideal opportunity to keep seniors active and engaged with their family, friends, and community. • Make life more active. Create ways to incorporate activity into everyday life – walking for the mail or doing squats

Transforming care: Supporting vulnerable seniors Continued from page 30 CCAC Care Coordinator with advanced training in geriatrics, CCAC service providers, CCAC Pharmacist, Advanced Practice Nurses in Geriatrics, the client’s primary care physician and local community support providers. Members of the team will support clients and caregivers as they move across care settings.

Making a Difference to Clients One of our clients in this pilot said: “I’m 88, and that’s

old, and sometimes I fall, and everyone thinks I should be in a nursing home, but I much prefer being at home. I feel so grateful for the help I get from the CCAC, because I can stay home.” Most seniors want to stay at home and remain independent as long as possible. Our new program will help make this possible by supporting seniors to achieve their goals, stay out of hospital and, when they are ready, help them make a supported transition to a nurs-

ing home. We will be piloting this program during the Spring and Summer of this year with the goal of a full rollout in Fall 2009. To learn more about our new program contact the Toronto Central CCAC at 416-506-9888. Dipti Purbhoo is the Director of Client Services-Community Programs and Kathy Hay is a Communications Specialist at the Toronto Central CCAC.

in a chair. It makes exercise convenient and requires no special time or equipment. It’s also meaningful and rewarding when seniors see how these exercises provide daily benefits. Getting active is an ageless issue and yet, it becomes more critical as we age. The World Health Organization recognizes that sitting or lying for long periods of time poses a serious health risk. The Surgeon General’s Report in the U.S. said inactivity is a greater health

risk than smoking. When 60 per cent of seniors are inactive, it’s clear that promoting activity should be a high priority. Thus, increasing fitness is a low-cost solution that offers valuable benefits and outcomes – energy, health, and independence. Libby Norris is the Chief Energy Officer of Inspired Energy. One of Canada’s fitness consultants, she leads an organization that delivers corporate fitness programs. For more information, go to www.


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Hospital News, April 2009

32 Continued from page 28

Focus: Gerontology/Palliative Care/Home Care Impact of differing beliefs among palliative care providers

cancer. According to Statistics Canada, the average age at death for Canadians is rising. From 1990 to 2005, the average age at death rose 3.5 years for men (71.1 years) and by 3.2 years for women (77.4 years). “With advances in medicine Canadians are living longer lives,” says Gibson. “The ideal situation would be to get as close to death as possible in fairly good shape, and die with minimum discom-

fort in a supportive environment. A lot of attention is being focused on the challenges and opportunities for staying healthy and active despite increasing age, which is important, but we need to be more willing to look at the end point – a “good death” – as well.” The results of their research about the components of a “good death” serve the interests of quality improvement at the local level and increase under-


standing of end-of-life care issues in residential care services in general. “It is our hope that by understanding the beliefs of care providers, we will be able to improve current practice models to benefit those whose deaths will occur in our care,” says Gutmanis. “Quality care should be the priority – at the time of death as in life.” About the Researchers Dr. Maggie Gibson is an Associate Scientist in Aging,

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Rehabilitation and Geriatric Care at Lawson Health Research Institute, Psychologist in the Veterans Care Program at St. Joseph’s Parkwood Hospital and Adjunct Clinical Professor in the Department of Psychology at The University of Western Ontario. Dr. Iris Gutmanis is an Associate Scientist in Aging, Rehabilitation and Geriatric Care at Lawson Health Research Institute, Director of Research

and Evaluation in Specialized Geriatric Services at St. Joseph’s Parkwood Hospital and Assistant Professor in the Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry at The University of Western Ontario. Melissa Beilhartz is a Communications Consultant at the Lawson Health Research Institute.

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The May 2009 issue of Hospital News will be honouring National Nursing Week in Canada (May 11th – 17th) with a special pull-out feature showcasing our “Nursing Heroes” contest winners as well as highlighting outstanding leadership and stories from the nursing frontlines!

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Hospital News, April 2009




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Multiple opportunities One organization

THE NIAGARA HEALTH SYSTEM (NHS) brings together the specialized services of six hospital sites and an ambulatory care centre that span numerous communities within the beautiful Niagara Region. Only a 1.5 hour drive from Toronto, Niagara Region is highlighted by affordable housing, winery tours, bike paths, hiking trails, numerous golf courses and convenient cross-border shopping.

Physiotherapists FULL-TIME, PART-TIME and TEMPORARY If you thrive on change and are eager to take your career to the next level in a supportive team environment, it’s time you join the Niagara Health System!

Proudly providing quality home healthcare in the communities of York Region, South Simcoe, Peel and North York, for over 24 years.

Manager Nursing and Clinical Services Manager CQI/Risk As an integral member of our senior management team, you will play a key role in contributing to our strategic development initiatives. We require a well respected innovative leader who holds a univeristy degree and profressional nursing designation. Previous professional community involvement preferred.

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We thank all applicants in advance; however, only those selected for an interview will be contacted. We are an equal opportunity employer.

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Creating a Healthier Future


Hospice Palliative Care Network Coordinator Using your superior strategic and business planning knowledge, you will direct the development and implementation of activities that enable the Network to successfully address its vision, mission and strategic plan as outlined in its Terms of Reference. Providing leadership, guidance and administrative support, you will ensure consistency with the model and norms as outlined by the Canadian Hospice Palliative Care Association Model and promote the principle activities of Person & Family (Services Delivery), Advocacy/Communication, Education and Research/Evaluation. Collaborating with other Provincial Hospice Palliative Care Networks, Associations or related organizations will also be necessary. Motivated and results-oriented, you possess a baccalaureate in a health-related discipline, health administration or relevant field from a recognized university (Master’s preferred), or the equivalent of education and experience. A minimum of two to five years of progressively responsible administrative expertise in the health care field, as well as in management/project management is also required. You must have a valid driver’s licence, insurance and vehicle. Oral fluency in both official languages is an asset. Salary is negotiable. Work schedule is 4 to 5 days per week.

For more information or to apply, please visit our career website at Or, contact: Alison Gollob, HPCN Administrative Assistant E-mail: Only those applicants selected for an interview will be contacted. Orillia Soldiers’ Memorial Hospital is located in the City of Orillia ~ a beautiful community nestled along the shores of Lake Simcoe and Lake Couchiching. Orillia offers an environment where a healthy work/life balance is easy to achieve as exceptional urban amenities, natural resources, points of interest, and recreational opportunities abound.

Manager• Maternal, Child & Youth Dedicated to creating a supportive working environment, you will provide leadership for Child and Family Services, foster partnerships with internal and external stakeholders, and coordinate departmental planning, evaluation, budget development, resource allocation, utilization management as well as safety and risk management. A master’s degree in a regulated healthcare profession, health administration or related field is preferred and a current Certificate of Registration with the College of Nurses of Ontario are complemented by a minimum of five years of relevant clinical experience. A minimum of three years of progressively responsible leadership experience within the healthcare sector is required and additional management/leadership courses would be considered an asset. Our employees enjoy a professional practice environment, a collaborative atmosphere with emphasis on teamwork, wellness initiatives, continuing education grants, employee recognition and assistance programs, a competitive salary and benefits package, paid holidays and vacations, and opportunities for growth and development. We encourage interested applicants to apply by Wednesday, April 15, 2009 to: Human Resources Department, Orillia Soldiers’ Memorial Hospital 170 Colborne Street West, Orillia, ON L3V 2Z3 tel: (705) 327-9120 fax: (705) 327-9170 e-mail:


Hospital News, April 2009


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Occupational Health & Safety Consultant for the Health & Community Care Sector in the GTA The Ontario Safety Association for Community & Healthcare (OSACH) is the designated health and safety association under the Workplace Safety & Insurance Act, for Ontarioâ&#x20AC;&#x2122;s health and community care sector. As a non-profit organization, we guide community and health care organizations in workplace health and safety best practices and are their expert resource in assisting them to prevent and reduce workplace injuries, accidents and occupational diseases. Our 15 regional consultants provide consultation, training, education and contribute to the development of sector specific resource products to assist our clients in achieving healthier and safer work environments. OSACH is seeking two health and safety consultants (one fulltime and a one year contract) who can assist our community and health care clients with their development and implementation of safe and healthy workplace programs and practices. As the regional resource person for GTA area, you will be accountable through communication, teaching and problem solving to guide and influence the development of a health and safety culture leading to reductions in workplace injuries, illnesses and occupational diseases. In providing hands-on expertise, you must be comfortable with people at all levels of an organization, have excellent knowledge of occupational health, hygiene and infection control practices. Comprehension of the Ontario Occupational Health & Safety Act and the Health Care and Residential Facilities Regulations is essential. Working independently from a home office, flexibility to travel within Ontario, good organizational, time management, writing and computer skills are required to respond effectively to client requests. (Access to a vehicle is also a requirement). A Masters degree in Occupational Health & Safety combined with, allied health professional (Occupational Hygiene, Environmental Health, Kinesiology or Ergonomics);3 to 5 years experience in Health or Community Care setting is preferred. Professional health care degrees with related experience will also be considered. Additional skill requirements include: Driverâ&#x20AC;&#x2122;s license, excellent communication skills, client relations, group facilitation, project management, writing and computer skills (Microsoft Word, Excel, PowerPoint and Outlook). A Canadian Registered Safety Professional (CRSP) Certificate would be an asset and/or is required within three years of hire. Visit for more information about our organization. OSACH is an equal opportunity employer and encourages applications from all qualified individuals. If you are interested in this position, please submit your resume to before May 15, 2009.

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community AT ITS BEST

Stevenson Memorial Hospital, an accredited 32-bed acute care community hospital, is located in Alliston, a fast-growing, vibrant community less than an hourâ&#x20AC;&#x2122;s drive north of Toronto and from cottage country. By focusing on continuous improvements, networked health delivery, and innovative services that enhance patient, family and community well-being, we will be the model small community hospital in Ontario.

V I C E - P R E S I D E N T, F I N A N C E & INFORMATION SERVICES (CHIEF FINANCIAL OFFICER) Make the most of your strengths as a leader, your strategic thinking abilities and your 3 to 5 years of management experience, with proven fiscal success in the health-care field. Become the senior financial resource for our organization. Lead and direct our financial and accounting activities while contributing to the achievement of hospital goals and objectives as a member of our senior management team. As partners with Southlake Regional Health Centre, we also offer you the opportunity to work on joint projects at both facilities. An outstanding, results-driven team player and a confident communicator, you will provide advice to our Foundation and be supported by our exceptionally knowledgeable Board of Directors, whose members have extensive financial credentials. You must be proficient in management information systems (MIS) and CIHI-MIS guidelines, and conversant with Ministry of Health and Long-Term Care policies, direction and vision, specifically relating to health-care funding and case costing. Naturally, you hold a professional accounting designation (CA, CGA or CMA). If youâ&#x20AC;&#x2122;d like to experience â&#x20AC;&#x2DC;communityâ&#x20AC;&#x2122; at its best, please send your resume to: Stevenson Memorial Hospital, Human Resources, 200 Fletcher Crescent, P.O. Box 4000, Alliston, ON L9R 1W7. Fax: 705-434-4847. E-mail:

Stevenson Memorial Hospital is committed to Employment Equity.



Hospital News, April 2009



Stonegate Community Health Centre Stonegate Community Health Centre is a multi-service centre providing primary health care, community support and community development activities for all age groups of diverse cultures. The Centre is located in the south east corner of Etobicoke â&#x20AC;&#x201C; 15 minutes from downtown Toronto. The community we serve consists mainly of families who have been in the area for a long time and immigrants from Eastern Europe and Central/South America. Presently, the Clinical Team is made up of 2 Nurse Practitioners, 2 Family Physicians, a Chiropodist, an Asthma Program Coordinator, an RN/Clinical Team Manager and a part time Dietician. Also, we share in a partnership with the West End Toronto Diabetes Program.

Manager â&#x20AC;&#x201C; Clinical Services (RN)

Family Practitioner(s)

Here is an opportunity to mix your nursing and management skills in a full time position.

Here is an opportunity to work in the non profit sector where you can practice health care the way you have always wanted.

If you are an individual with a strong clinical background who is proactive, creative, innovative, strategic, detail oriented, organized and an excellent communicator who would enjoy leading and managing the day-to-day primary health care and allied health services of the Centre, then this job is for you. Responsibilities include nursing activities (eg. triage of phone calls, chronic illness FU, venipuncture, health education etc), case management, coordination of the clinical team functioning, policy/ procedure development, budget monitoring, representation of Stonegate clinical services in the CHC sector, participation in and support of electronic charting, and monitoring of performance indicators. All this is in a milieu of an established CHC, always open to new ideas, with staff and management teams who are there for support of personal and professional growth.

If you have good interpersonal skills, enjoy working with other disciplines, sharing and consulting with your colleagues of family physicians, nurse practitioners and registered nurse, providing excellent comprehensive primary care for clients, providing mentoring to medical and nursing students, acting as resource to the allied programs and services then you will enjoy joining our clinical services team. Each Clinician has extensive experience in primary health care and also has time to pursue his/her own specific interests (eg.respiratory health, MSK, smoking cessation, e-health) which raises the quality of the care given at the Centre. In addition to excellent salary and benefits, time and funds are provided for Professional Development. The Centre is open weekdays and closed on weekends with an after hours on call rotation shared with other CHCâ&#x20AC;&#x2122;s.

Fax Resume and Cover Letter to: 416 231 2663 Clinical Services Hiring Committee Stonegate Community Health Centre 150 Berry Rd. Toronto ON M8Y 1W3


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2009, April - Hospital News