Home, Community and Residential Care Services for Seniors

An acquired brain injury (ABI) is an injury that occurs after birth and is not related to a congenital disorder or a degenerative disease such as Alzheimer disease or multiple sclerosis. ABI may result from a trauma or externally-caused physical injury (such as a motor vehicle crash, assault, or fall) or may result from an internal medical condition (such as an aneurism, tumour, meningitis, or anoxia).

Most traumatic brain injuries occur in the younger members of the population (crashes, assault) and the older members(falls). Non-traumatic brain injuries are more likely to occur in the  mid range of the population. Severe brain injuries may result in the need for on-going support in order that the person with the injury can return to live in the community.

The Ministry of Health and Long Term Care supports a number of community programs for persons with ABI. There are Adult Day Programs for people with acquired brain injuries in a number of communities. Acquired Brain Injury Outreach Services provide support to individuals with ABI living alone or with families in the community. Acquired Brain Injury Services are also available in supportive housing where staff are available on-site 24 hours a day to help residents live independently. Other services are also available through the Community Care Access Centres to support individuals with ABI at home.

Information about local services is available through Community Care Access Centres or through the Ontario Brain Injury Association.

Attendant Services provide homemaking and personal support services to people over the age of 16 with permanent physical disabilities who require assistance with activities of daily living and have the ability to direct an attendant to carry-out pre-determined tasks that they cannot physically do for themselves.

The Ministry of Health and Long-Term Care has three programs which provide trained attendants to help people with physical disabilities live independently in their homes:

• Attendant Outreach program

  The Attendant Outreach program provides pre-scheduled visitation attendant services to people with permanent physical disabilities in their own homes, workplaces or in an adult education facility where the person is pursuing a course of education leading to a degree, diploma or certificate.

• Attendant Services in Supportive Housing

  Attendant services are also provided within clustered apartments to support persons whose need for service may exceed what is available through a combination of Attendant Outreach and CCAC contracted services. Services are available on a pre-scheduled and on-call basis 24 hours a day.

Call your local Community Care Access Centre for more information about these two programs.

• Self-Managed Attendant Services

  The Self-Managed Attendant Services program provides funding to allow people with disabilities to recruit and employ their own attendants. For information on this program, contact the Centre For Independent Living in Toronto (CILT) at 416-599-2458.

Independent Living Resource Links

• Independent Living Centre London and Area
• Independent Living Centre of Waterloo Region
• Niagara Centre for Independent Living
• Centre for Independent Living in Toronto (CILT), Inc
• Ottawa Independent Living Resource Centre (OILRC)
• Breaking Down Barriers - An Independent Living Centre in South Georgian Bay
• Independent Living Centre Kingston
• disABILITY Resource Centre for Independent Living (Kapuskasing)
• Independent Living Resource Centre Corp (Sudbury/Manitoulin)
• RISE -- Resource Centre  for Independent Living (Parry Sound/Muskoka)
• Independent Living Resource Centre Thunder Bay

Between 1999 and 2004, the Ontario government implemented Ontario’s Strategy for Alzheimer Disease and Related Dementias (ADRD). This was the first comprehensive strategy on Alzheimer’s disease in Canada.  The Strategy aimed at improving the quality of life of people with ADRD and their caregivers in Ontario, involving education for health care providers, caregivers and the public; service enhancements and expansion; and research activities and knowledge exchange.

The implementation of the four-year Alzheimer strategy was successfully completed in 2004 and an evaluation of the strategy was completed in 2005. Alzheimer Services are now part of Ontario’s Aging at Home Strategy, administered by Ontario's 14 Local Health Integration Networks.

The Ministry continues to work to ensure that more seniors with psycho-geriatric needs, including seniors with Alzheimer Disease and Related Dementias (ADRD), will receive timely assessment, treatment and support services, by supporting:

• The Alzheimer’s Knowledge Exchange (AKE) is a network of individuals and charitable organizations dedicated to improving the quality of life for persons, and their families/caregivers, who are living with Alzheimer’s disease and related dementias.
• 39 Alzheimer Society Chapters of Ontario which provide individual support, referral services, support groups, educational workshops and information resources.
• Specialized Geriatric Programs (SGPs), which are hospital- and community-based health care services that diagnose, treat and rehabilitate frail elders with complex medical, functional and psychosocial problems. SGPs are provided on a consultative basis by an interdisciplinary team of health professionals in a variety of home, ambulatory, long-term care and in-patient hospital settings. The goal of SGPs is to reduce the burden of disability by detecting and treating reversible conditions and optimizing management of chronic conditions.
• Regional Geriatric Programs (RGPs) (in Ottawa, Hamilton, London, Kingston and Toronto) that are anchored in Academic Health Science Centres across the province.  These programs are not specific to Alzheimer’s disease and Related Dementias (ADRD) but provide a comprehensive network of specialized geriatric services which assess and treat functional, medical, and psychosocial aspects of illness and disability in older adults who have multiple and complex needs.
• The Neurological Health Charities of Canada (NHCC), which has working with MOHLTC to improve the policies, programs, and practices related to care for those suffering from neurological conditions such as dementia. 

For more information on services in your area for persons with Alzheimer and related dementias, contact your Community Care Access Centre.

Children's Treatment Centres provide a range of services for children and youth up to 19 years of age who have physical disabilities or communication disorders.

If you or a loved one requires end-of-life care, there are many programs in Ontario that can assist you through this difficult period. The Ontario government has put in place programs to improve end-of-life care, and funds many ongoing services.

Home Care
Community Care Access Centres (CCACs) arrange for nursing, personal care, and professional services, medical supplies, laboratory and diagnostic services, hospital and sickroom equipment, arrange for transportation to other health services, and authorize access to drug cards for eligible clients who receive in-home services, including palliative/End-of-life clients.

As part of the EOL Care Strategy, certain residential hospices were provided with funding for nursing and personal support services based on a 10-bed hospice model via CCACs.

Community support services (CSS)
CSS agencies provide a range of support services including caregiver support, volunteer hospice services, transportation, adult day programs, interdisciplinary education and pain and symptom management and bereavement support.

Non-residential hospices as they exist in most communities are meeting places and counselling facilities where support groups, quality of life enhancement activities and bereavement programs are provided. They typically provide in-home visiting and respite by trained volunteers, not health care professional services.

Pain & Symptom Management
These specialized programs support direct care providers by offering specific expertise in palliative pain and symptom management through pharmaceuticals, positioning, physiotherapy, and other techniques.

Day Programs
Offered by some hospices, day programs provide an opportunity for the person requiring end of life care to participate in activities, therapy or discussions with others in the same situation.

Palliative Education Programs
28 Palliative Education programs and 3 Physician Palliative Care Education programs increase the capacity of service providers, including primary care physicians, to provide quality palliative services to their clients and caregivers.

End of Life Networks
There are currently 14 Regional Hospice Palliative Care / End-of-Life Care Networks with boundaries corresponding to the boundaries of Ontario’s health regions.  The membership of each network is broadly based with general membership made up of individuals / organizations with interest in palliative care.  The purpose of the networks is to encourage collaboration and information-sharing, with the goal of better coordinated client care.

Cancer Care Ontario
Cancer Care Ontario has primary responsibility for palliative care for Ontario cancer patients. In December 2009, CCO developed recommendations for a Regional Model of Palliative Cancer Care. The goal of the regional model is to ensure safe, equitable, standardized palliative care across the province of Ontario. The model outlines three levels of care (primary, secondary and tertiary) recommended for the delivery of palliative cancer care.

The Regional Model of Palliative Cancer Care is based on four underlying principles: patient-centered care; optimal care; interprofessional and intraprofessional collaboration; coordination and continuity of care. The model provides a comprehensive regional and provincial framework for regional cancer programs and inpatient hospitals to achieve high quality care and service when delivering palliative care treatment in Ontario.

Ontario Medical Association (OMA)
The Ministry of Health and Long-Term Care has taken action to recognize the importance of the physician role in supporting palliative care in both hospital and community settings by spelling out this role in the Physicians Services Agreement, and by offering out-of-office incentive bonuses for palliative care home visits.

Resources for End-of-life Care

• Community Care Access Centres
• Ontario Palliative Care Association
• Hospice Association of Ontario