Client First.......
Fiorito: Abused, but not enough to qualify for refuge
Michelle heard a knock at the door. She looked through the peephole. She reached for the handle of the door. The next thing she saw was a pistol in her face.
Putting the elderly, not the system, first
She brought that attitude – plus a couple of postgraduate degrees – to her job as senior director of client services for the Toronto Central Community Care Access Centre.
It is one of 14 regional hubs in the health-care system, responsible for providing non-hospital services – ranging from post-operative rehabilitation to palliative care – to thousands of Ontarians. Children who need an attendant at school, families who need home care, patients who need medical equipment and seniors who need long-term care are served by their local community care access centre (CCAC). They are the gatekeepers of the non-institutional health-care system.
Toronto's CCAC serves approximately 21,000 people a year. It organizes post-acute care for 18 hospitals, arranges placements in 36 nursing homes, provides home care to 16,000 clients and employs 500 health professionals.
Daub, who oversees all these services, is one of the least bureaucratic health administrators in Ontario.
She has five rules of thumb:
Do what is right for the client, not the system.
Respect clients' choices, regardless of your views.
Don't waste resources on services people don't want or need.
Explain each process, as if you'd never done it before.
Above all, treat every person with dignity.
"When pressure builds, you can lose sight of the fact that everyone is a mother or a father or someone's friend," Daub says. "Over the last few years, I've had concerns about what our clients experience."
That is why Daub volunteered to participate in a study undertaken last year by the Change Foundation, a health policy think-tank. She wanted to see her agency through clients' eyes and bring their voices into its decision-making.
Throwing open the door had its risks. The researchers might find off-putting practices or publish embarrassing findings. But to Daub, these possibilities were outweighed by the potential benefits. The study offered a chance to learn and an incentive to make improvements.
Since it was completed, the agency has made a number of changes, some of which go far beyond the researchers' recommendations.
One of the biggest is its "home first" policy, designed to alleviate the pressure imposed on elderly patients and their families by hospital authorities to grab the first available nursing home bed.
"The hospital is not the right place to make a life-changing decision," Daub says. "It's stressful. You know they want you out because you're using a bed someone else needs. We take patients home and provide whatever services and supports they need."
Since this policy was implemented last December, 50 per cent of seniors have found they didn't need to go to a nursing home. They are now receiving care in their home or living in a retirement residence.
A second important change is that the agency now organizes its workload by need, not neighbourhood. Frail high-risk clients, for instance, are served by care coordinators with smaller than normal caseloads so they can stay with their patients through their hospitalization, ensure that the hand-off to their doctor is smooth, visit them regularly and provide the right mix of services as circumstances change. Other CCACs are following Toronto's lead.
Daily routines have been adjusted. A few major reforms are in the works.
"It's a journey and we're only about a third of the way into it," Daub says. "But we've come a long way. I think we are making a difference in the lives of our clients."
(Note to readers: Many GTA residents live outside the boundaries of Toronto's CCAC. North York is served by the Central CCAC; Brampton by the Central West CCAC; Etobicoke, Mississauga and Oakville by the Mississauga Halton CCAC; Scarborough, Ajax and Oshawa by the Central East CCAC).
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