Project 2022-IMPV-308966 / FRQS
Seniors waiting to be taken in charge by the SAPA program-services: Evaluation of the intervention of a new partner – Canadian Red-Cross
Dr Olivier Beauchet, University of Montreal
Problematic – The coronavirus (COVID-19) pandemic has (1) weakened the health status of homebound older adults (>70 years) and (2) increased the number of homebound older adults requiring supportive care services. Prior to the pandemic, it was estimated that more than 120,000 frail, homebound seniors in need of supportive care services were not receiving them. Today, this number is much higher. At the same time, the Soutien à l’Autonomie des Personnes Âgées (SAPA) programs that provide supportive services and care in the home face challenges, such as staffing shortages, that delay the care of frail seniors. This combination of factors has resulted in increased delays in obtaining home support services or care for seniors on the waiting lists of the SAPA access points. For example, at the CIUSSS Centre-Sud-de-l’Île-de-Montréal (CCSMTL), the waiting list for the access window for orphan clients (GACO) without a family physician went from 1,300 to 1,715 APs in a few months during the pandemic, an increase of 32%. This breakdown in home care services and support also relies on the vulnerability of its continuum described before the pandemic. The Institut national d’excellence en santé et services sociaux (INESSS) noted in 2019 that (1) there was a delay in processing requests at the SAPA level and that (2) this delay was an obstacle to adapted care. At that time, the INESSS emphasized the need to pay special attention to seniors on the waiting lists for SAPA access. At the individual level, the breakdown of the continuum of services and supportive care in the home can lead to a deterioration in the health, autonomy and quality of life of seniors. On a collective level, it can result in high financial costs for Health and Social Services (HSS). It is therefore crucial to put in place solutions that will both (1) restore continuity of access to supportive services and care from home for seniors who are on the waiting lists of the SAPA access points, and (2) fight against the deterioration of health and the progression of loss of autonomy of these seniors, in order to improve their quality of life and reduce the related financial costs of HSS.
The INESSS concluded in the pandemic and recovery phases that it is necessary to: (1) identify those most at risk such as seniors, (2) coordinate actors to orchestrate their efforts, and (3) promote so-called “telepractice” services to maintain the continuum of services and care. Assessing, intervening, coordinating, and obtaining the approval of seniors and community stakeholders are also 4 components identified to ensure the continuum of supportive services and care in the home. Based on this observation of combined actions, we have designed and made available to community stakeholders, as of April 2020, a clinical tool for SOcio-Geriatric Assessment and Orientation named “ESOGER”. This tool takes the form of a simple questionnaire, accessible on a secure digital platform. It allows for rapid and remote assessment and intervention during a telephone call by a community agency worker with the senior and/or his or her family caregiver by: (1) determining whether or not essential health and social needs are being met, (2) offering recommendations for interventions provided by community-based providers, and (3) referring seniors and linking them to the community agencies they need most. Research to date on ESOGER has shown that it is one of the few clinical tools: (1) first contact telehealth, (2) comprehensive and multi-domain, (3) equitable – That is, avoiding the digital divide (the senior is assessed by phone but the provider enters the information on a digital platform) – (4) avoiding the worsening of frailty, and (5) tailored to the expectations and needs of seniors and community agencies. To date, more than 10,000 seniors living at home have benefited from ESOGER. The interest and usefulness of ESOGER have been underlined by the MSSS, which has recommended its use in Quebec’s SAPA programs and services since October 2020.
ESOGER is a clinical tool that could be used to begin the management of seniors who are on the waiting lists of SAPA access points such as the GACO of the CCSMTL. However, to do this, it is necessary to involve a new actor so as not to overload the SAPA and who, by using ESOGER, could improve the continuum of services and supportive care in the home of IPs waiting for care. During the pandemic, the Quebec Red Cross set up community action programs to support vulnerable people such as seniors. It is in this context that it developed a partnership with the CCSMTL during the first quarter of 2002 to intervene with seniors who are on the GACO waiting list. The tool chosen to intervene with this elderly population is ESOGER. This new community-based program (1) is a response to the need for rapid care of frail seniors on the CCSMTL GACO waiting list and (2) should enable the restoration of the home’s continuum of supportive services and care, which should combat the frailty of seniors’ health and progression of loss of autonomy, thereby improving their quality of life and reducing the financial costs of HSS.
Hypothesis– We formalize the hypothesis that ESOGER is: (1) a clinical tool to initiate first-line care by the Red Cross for seniors who are on the GACO waiting list of the CCSMTL, which will improve their health status, autonomy and quality of life, and reduce consumption of HSS; (2) and that for a better deployment, it is important to take into account the needs and expectations of the Red Cross and the SAPA program-services, in order to amplify the benefits, and to receive a wider approval for an effective, efficient and sustainable use.
General Objective– The general objective of the project is to examine the effects of the Red Cross intervention using ESOGER and the deployment of this intervention within the GACO clientele of the CCSMTL’ SAPA. This objective addresses the specific need of “system of care efficiency including best practices for home care delivery (including telemedicine, digital health etc.)” of the call for projects.
Specific objectives – The first specific objective (SO1) is quantitative. It is to examine the effects of the Red Cross intervention using ESOGER on the health status, loss of independence, quality of life of seniors, and resource consumption of HSS services and care. The second SO (SO2) is qualitative. It consists of collecting and formalizing knowledge about: (a) how ESOGER will be used by the Red Cross and the SAPA, including characterizing the expectations and needs of these two actors, and (b) how the Red Cross will integrate into the continuum of services and supportive care of the SAPA home of the CCSMTL, including examining the perceived barriers and levers to this integration. The third and final SO (SO3) is to ensure the implementation of a successful deployment – that is, one that receives strong approval from the user community allowing for wide dissemination and sustainability of use over time – and to document it in the form of a deployment guide.
Methodology – It is based on a mixed research-action design where the progression of the project is based on constant back and forth between the Red Cross, the CCSMTL SAPA and the researchers.