Janice Paul and Heather Higgs - crncc

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Overview‣ To describe the integrated service for frail,at-risk seniors in Waterloo Wellington‣ To describe the Intensive Geriatric ServiceWorker program <strong>and</strong> highlight a successstory‣ To review interim evaluation findings <strong>and</strong>highlight lessons learned
What is an integrated system?‣ A cohesive, coordinated model ofdelivering geriatric care‣ Strong partnerships with stakeholders‣ Evidence of improvement in patientoutcome measures‣ Capacity building
Page 1: Facilitating Integration fromthe Co
Page 5 and 6: How did We Get to Where We are‣ H
Page 7 and 8: Guiding Principles Continued….‣
Page 9 and 10: Integrated Services for SeniorsDr.
Page 11 and 12: Intensive Geriatric Service Worker(
Page 13 and 14: IGSW Goals - Healthy, Happy,Safe
Page 15 and 16: Referral Guidelines (cont’d)‣ R
Page 17 and 18: Secure Web Portal for GEMreferrals
Page 19 and 20: IGSW Qualifications‣ Recruitment-
Page 21 and 22: Case ReviewED Presentation:‣ 87 y
Page 23 and 24: PLANAfter the GEM assessment, it wa
Page 25 and 26: Home in the Community‣ Client see
Page 27 and 28: To date‣ Arranged for Meals on Wh
Page 29 and 30: Currently‣ Using walker‣ Now se
Page 31 and 32: Ongoing involvement:‣ Accompanied
Page 33 and 34: Waterloo WellingtonIntegrated Servi
Page 35 and 36: IGSW ActivitiesActivities Percent (
Page 37 and 38: Referral Sources250208Numbe er of R
Page 39 and 40: Client CharacteristicsAge• Mean
Page 41 and 42: IGSW: Other ImpactsImpacts as a res
Page 43 and 44: Summary of the Ways in Which the IG
Page 45 and 46: IGSW: Other ImpactsDo you think the
Page 47 and 48: Selected Quotes“IGSW has gotten m
Page 49 and 50: Lessons Learned: IGSWsFacilitating
Page 51 and 52: Lessons Learned: IGSWsChallenges:
Page 53:
Contact Information‣ Janice Paul
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Janice Paul and Heather Higgs - crncc

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