Janice Paul and Heather Higgs - crncc

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Reasons for ReferralActivitiesPercent (#) ofHoursMD / RN concern; Recommendation f/up 58%Social isolation 52%Recent hospital or ED visit 50%Caregiver burden / lack of support 42%Complex needs 40%Resistance to service / support 24%Service access issues due to finances 10%Frequent use of ED 6%Cultural / Language barrier 4%Miscellaneous 1%Carrie McAiney &Loretta Hillier 2010
Client CharacteristicsAge• Mean• RangeGender• Male• Female80 years48 – 95 years36%64%Marital Status• Widowed• Married• Divorced / Separated45%30%12%• Single 9%No family physician 5%Not involved with CCAC 16%Carrie McAiney &Loretta Hillier 2010
Page 1 and 2: Facilitating Integration fromthe Co
Page 3 and 4: What is an integrated system?‣ A
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: Referral Sources250208Numbe er of R
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

Janice Paul and Heather Higgs - crncc

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