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Toronto Notes 2019 Health Care Institutions Geriatric Medicine GM11
Health Care Institutions
Table 8. Classification of Health Care Services and Institutions
Institution/Service Community Support Services
Rehabilitation
Residential
a) Seniors Affordable Housing
b) Retirement Home c) Supportive Housing
d) Long-term Care/Skilled Nursing Facility
e) Hospice
Description
Health care services offered at home for those who can live independently at home or under the care of family members including professional health care services, personal care and support (ADL assistance), homemaking (IADL assistance), community support services (e.g. transportation, meal delivery, day programs, caregiver relief, security checks, etc.)
Health care services offered in an institution to optimize patients’ function, independence and quality of life
Divided into short (<60-90 d/yr) and long (indefinite) stay
Seniors who live independently and manage their own care but prefer to live near other seniors; usually has accessibility features and rent is adjusted based on income
Residents are fairly independent and require minimal support with ADLs and IADLs; often privately owned
Residents require minimal to moderate assistance with daily activities while living independently; often rental units in an apartment and may offer some physiotherapy and rehabilitation services
Around the clock nursing care and on-call physician coverage; often offers occupational therapy, physiotherapy, respiratory therapy, and rehabilitation services; may be used short-term for caregiver respite or for supportive patient care to regain strength and confidence after leaving the hospital
Free-standing facility or designated floor in a hospital or nursing home for care of terminally ill patients and their families; focus is on quality of life and often requires prognosis ≤3 mo
• namesofcommunityhealthcareinstitutions,typesoffacilities,andservicesofferedvarybetween geographical locations
• factorstoconsiderwhenseekingservices/institutionsincludelevelofcarerequired,supportnetworks, duration of stay, and cost
Palliative and End-of-Life Care
Principles and Quality of Life
• support,educate,andtreatbothpatientandfamily
• addressphysical,psychological,socialandspiritualneeds
• focusonsymptommanagementandcomfortmeasures
• offertherapeuticenvironmentandbereavementsupport
• ensuremaintenanceofhumandignity
End-of-Life Care Discussions
When to Initiate End-of-Life Care Discussions
• recenthospitalizationforseriousillness • severeprogressivemedicalcondition(s) • deathexpectedwithin6-12mo
• patientrewrittenwill,spiritualwishes) • medicalaidindying
■ important to discuss grief/bereavement with loved ones
Power of Attorney
• seeEthical,Legal,andOrganizationalMedicine,ELOM10
Instructional Advance Directives
• seeEthical,Legal,andOrganizationalMedicine,ELOM10