Background
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With the continued ageing of the population, the demand for long term care (LTC) beds is set to increase, where older adults have access to 24 hour/7 days a week assistance with activities of daily living and monitoring of their health. The growing demand for LTC services is not matched by the number of skilled professionals practicing in LTC as mandated by the current model of care. The majority of work is done by unregulated staff. Implementation of evidence-based interventions in LTC is complex, limited by lack of management support, structural and environmental issues, beliefs and expectations of residents, families and staff and unregulated care workers delivering care. There is a need for more rigorously designed studies to test the effects of different models of care to optimize health outcomes for residents. Resident, family and career-driven approaches have the potential to empower this vulnerable cohort. Emerging evidence supports the positive role of nurse practitioners (NPs) in reducing health service utilization, decreasing rates of transfer and admission to hospital, and decreasing length of hospital stay post-transfer for residents of LTC. NPs are recommended in other countries for the provision of primary care of residents in LTC, where current Saskatchewan legislation inhibits NPs from operating in their full scope of practice within LTC homes as they cannot independently admit, diagnose, treat or discharge in-patient residents. Other models include interventions such as increasing numbers of residents with Advance Care Planning. Primary care outreach services, hospital in the nursing home, or telephone triage may increase the capacity to treat the resident in the LTC home, avoiding transfers or admissions to the hospital. Residents may experience illness or transfer to the local emergency department (ED) for an illness which may have been avoidable or more appropriately managed within LTC. Presentation of LTC residents to the ED is common, costly and is often associated with negative outcomes. Unnecessary transfers to the ED and hospitalization for LTC residents can be disorienting, distressing and exacerbate pre-existing conditions, leaving some residents more physically and cognitively compromised. This leads to significant increases in mortality, hospital admission and death. These residents are also found to have a reduced quality of life (QoL).
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Our aim is to build innovative models of care that will improve the QoL and health outcomes for residents living in long-term care in partnership with residents of LTC, family members, staff and content experts to ensure quality care in the right place, at the right time, by the right person.