Imagine a world where long-term care (LTC) and acute care are integrated. Where hospitals are on-call to respond to emergent situations in homes, and LTCs are equally alert to hospital needs. Where staff from both arms join exchange programs, to teach and learn.
UHN has a vision for how to support seniors in LTC in the future, and Donna Lee, UHN's Long-Term Care Practice Lead, is its newest ambassador.
With experience in both LTC and acute care settings to draw on, Donna will advise and support both teams, as UHN continues to build a seniors strategy.
"I am excited about this role because it will help enable unprecedented, cross-boundary collaboration," says Donna.
Building a community of practice
Since early in Wave One of the COVID-19 pandemic, UHN has taken an active role in supporting 13 LTC and five retirement homes.
Using a hub-and-spoke model, UHN has been providing the resources many homes can't acquire on their own. This has included access to personal protective equipment, redeployed teams to offer Infection Prevention and Control (IPAC) education and implementation structure. In one case, it also included the fulfillment of a voluntary management order, where UHN took over operations.
While UHN is not alone in having an impact in the LTC community over the past year, what sets the organization apart from many other hospitals is that at UHN the work is seen as just beginning.
"We envision a community of practice, where we come together with LTCs to meet the needs of residents and patients," says Dr. Joy Richards, Vice President Patient Experience, Chief of Health Professions, who also oversees UHN's LTC portfolio.
"Where we think about what resources we have to support LTC, and ask how they can support our work, too. We see the connections they build with residents, and we can learn from that, to deliver our own patient care."
Bringing that vision to life requires someone who understands both worlds.
'Donna holds the LTC knowledge none of us in acute hold'
Donna says she was attracted to the role "because it brings together two areas that I'm passionate about – nursing and long-term care – in a hospital that will actually be able to drive this type of change."
Donna began her career in LTC as a unit charge nurse and then a psychogeriatric registered nurse, eventually becoming Director of Care (DOC) for a small, 30-bed LTC interim unit in a hospital operated by Extendicare. With a dream of raising the status and attractiveness of nursing in LTC, she went on to accept a number of other DOC roles, and eventually the Executive Director (ED) role at Lakeside, a UHN-owned, Extendicare-operated, LTC.
"Lakeside will always be special to me because the hospital partnership and the collaborative work around clinical best practices and research was my roadmap to becoming an effective leader." Donna recalls.
"The influence and support of the hospital senior leadership also propelled me to pursue a graduate degree in leadership."
From there, Donna moved on to become Director of Long-Term Care at Universal Care, where she oversaw eight different facilities, and, when COVID first hit, she re-joined Extendicare as Manager, Quality & Risk.
"My first question to the hiring manager was, 'can I go into the homes that have COVID? I know I can support their leadership,' '' says Donna.
"Going in and supporting the COVID outbreak homes was very rewarding, because I was able to act as the bridge between LTC and hospital teams who were coming in to support us."
Since beginning her role at UHN earlier this year, Donna's focus has been on supporting the leadership teams of LTC homes in outbreak.
She guides conversations around goals of care and palliation of residents, proper staff and medical coverage, and oxygen supplies. She also ensures each home is connected with the resources available.
"Donna holds the LTC knowledge none of us in acute hold," says Dr. Richards.
"She understands their regulations and their reporting. When she goes into homes and asks, 'how can I help,' they're thrilled, because she speaks their language."
"As I was watching her take command and control in her most previous role at Lakeside, I thought, 'if we are going to build this community of practice, Donna needs to be our ambassador.'"
A Healthier World for LTC residents
As the pandemic evolves, so will Donna's role, as UHN continues to work with LTCs to define what A Healthier World means for seniors.
For some seniors, it will mean the ability to be cared for in place, with minimal transitions between home and hospital.
"We'll have gotten it right when we've built a partnership with LTC, where we don't need to send residents to the Emergency Department as frequently," says Dr. Richards.
"We'll find a balance, across the continuum of care, where we're able to move acute care into LTC, and bring LTC approaches into acute."
Picture teams of IPAC practitioners, nurses, and dieticians, ready to support residents who have been destabilized, from the comfort of their own beds.
It also includes such things as proactively teaching LTC staff how to pick up early warning signs of urinary tract infections, pneumonia, and other conditions that are more common in seniors, before the symptoms escalate. And, inviting LTC staff to spend a few months at UHN, strengthening assessment and leadership skills, and asking our staff to spend time in their homes, too.
"Personal support workers in LTC know their residents best, and we, in acute, have a lot to learn from them," says Dr. Richards. "If they could teach us how to be even more client-centred, engaged with families, and relationship-driven, we'll have come a long way."
Ultimately, the establishment of a Division of LTC at the University of Toronto, would increase the profile and resources that LTC currently lacks.
Regardless of how the well-being of seniors is defined in the future, those who oversee UHN's senior strategy agree: this is UHN's work, and we're all in – for the health of residents, patients, families, and our community.
