Over the last two and half years, COVID-19 placed an unprecedented stress on long-term care (LTC) homes across Ontario, including the Greater Toronto Area. To meet these challenges, in October 2020 the Ontario Ministry of Long-Term Care and Ontario Health asked Toronto Grace Health Centre (TGHC) along with the University Health Network (UHN) to establish a ninety-bed specialized care centre (SCC). In December 2020, the SCC was opened at the Toronto Congress Centre at 650 Dixon Road in Etobicoke, providing support to the GTA regions of Toronto, Peel, Halton, York, Simcoe, Muskoka, and Durham.
The SCC provided emergency surge capacity, allowing for the temporary relocation of LTC residents from facilities dealing with COVID-19 outbreaks or other challenges. The temporary transfer of eligible residents from LTC homes to the SCC provided the homes with the opportunity to stabilize operations more quickly. The centre, which operated as an extension of the TGHC, was staffed by the Grace’s interprofessional health care team and offered diagnostic services as well as laboratory technical services. In all of this, it offered patient- and family-centred care that followed the TGHC’s principles of quality care for frail seniors.
When the public health measures in Ontario were lifted in 2022, the SCC ceased operations and the Toronto Congress Centre was ready to resume operations as a convention facility. The operation of the SCC was viewed as successful, and so Ontario Health asked the Toronto Grace to find another transitional site that could operate like the SCC and address the challenge of hospital overcrowding resulting from the high number of alternate level of care (ALC) patients occupying acute care beds. (Patients receive an ALC designation when they no longer require the extra resources and services provided by their care settings.)
In 2021, according to Ontario Health, 80 percent of patients receiving an ALC designation were older adults (65+). As the population ages, the number of patients designated ALC will continue to rise. A September 2022 article in the Toronto Star, “To Solve the hospital capacity crisis, we need better care for seniors,” stated that Ontario had crossed a disheartening threshold: for the first time ever more than six thousand patients designated ALC were being treated in the province’s hospitals. The article also noted that ALC patients occupied “a sixth of Ontario’s hospital beds.”
The growing number of ALC patients occupying beds in acute care hospitals has been identified as one of the factors contributing to emergency department overcrowding, excessive wait times for elective surgical procedures, surgical cancellations, and patient flow inefficiencies throughout the entire health care system.
The Toronto Grace set out to find another site that could house the SCC and found Tendercare Living Centre, a complex that offers long -term care, convalescent care, and retirement living at 1020 McNicoll Ave., in Scarborough Ontario. The Toronto Grace Health Centre Specialized Care Centre (TGHCSCC) was established in early May 2022 as a transitional care unit. It provides care for frail seniors with an ALC designation waiting placement in a long-term care setting or transitioning back into the community — ideally within a period of three months. The TGHCSCC began operations with only a few beds that had become available on the fifth floor of the retirement complex; the centre now has access to fifty-one beds. The facility accepts patients not only from the TGHC but also from other hospitals in the Greater Toronto Area.
The TGHCSCC is not a facility for aggressive rehabilitation; rather, it is focused on assess-and-restore support for frail seniors, which includes light rehabilitation as well as gentle persuasive approaches for elderly patients with mental health challenges, such as depression, dementia, and Alzheimer’s. Ultimately, the rehabilitation the TGHC-SCC provides helps maintain the functional and mental independence of patients while they are waiting to transition to a long-term care facility or back to a community setting or home.
The TGHCSCC health care team, which includes physicians, nurses, and personal support workers, as well as rehabilitation staff, also provides patients with remote care service through its Remote Care Monitoring (RCM) program. This program offers a combination of in-person and virtual care, coupled with 24/7 medical and non-medical remote monitoring. Using advanced technology, caregivers can remotely monitor a variety of patient vital signs, such as temperature, heart rate, blood pressure, and oxygen saturation.
The program also utilizes monitoring technologies to address a wide variety of in-home issues, including slips and falls, problems with basic activities of living like turning off the stove, and off premise wandering. Each patient is given a “falls pendent.” It can be used as a call bell but also has the capability to identify when a patient has wandered. The pendent is monitored 24/7 by the call centre at the Toronto Grace. If a patient’s call bell is activated or a patient has wandered past their virtual geofence perimeter, the call centre receives an alert and the TGHCSCC health care staff is contacted.
Patients returning to their homes rather than to a long-term care facility can also continue to be supported by the RCM program. The TGHCSCC works with home and community care support services to provide a safe discharge for its patients.
Addressing ALC challenges permanently in a way that ensures that patients receive evidence-based care that meets their needs in the right place at the right time is essential for improving health outcomes. Doing so will also improve patient flow in the health care system and reduce the length of stay in acute care settings. Focused on appropriate integrated transitional care pathways, rehabilitation programs, and homecare, the TGHCSCC continues to support a seamless flow in the continuum of care from acute care to the community or home.