Integrated Health and Social Care – CHATS Case Study

Overview:

CHATS (Community & Home Assistance to Seniors) is a not-for-profit charitable organization that provides programs and services to enhance the health, wellness and independence of >8,500 older adults and caregivers in the regions of York and South Simcoe annually.

Challenge:

In the past 12 years the provincial government has committed to decreasing inappropriate acute care utilization, in which hospitals experience high levels of avoidable emergency room visits and alternate level of care (ALC) patient days through its Ending Hallway Medicine and Ontario Health Teams (OHTs) initiatives.

Solution:

Integrated health and social care is a collaborative approach that CHATS has undertaken with its hospital and other community support service agency partners to enable older adult patients to return home and into the community sooner from the hospital. CHATS is involved in three integrated initiatives with its partners. Home-At-Last, Southlake@Home and MackenzieHelps are three initiatives, that comprise of key integration features that support service collaboration. These initiatives include team-based approaches to discharge planning, shared vision and goals to ensure seamless transition for patients/clients, joint accountability and leadership structures and shared performance metrics on acute care utilization, readmissions and client care satisfaction.

Outcome:

As a result of these integrated initiatives, CHATS and its partners have experienced a number of benefits:

• Decreased ALC patient days (approximately 490 days avoided, estimated at $0.5M in hospital savings)
• Greater client satisfaction (85% and higher for all integrated care partners involved in care journey)
• Greater partner and worker satisfaction (100%)
• Strong inter-organizational collaboration between CHATS and its community partners

This case study forms a key component of our upcoming online workshop on integrated health and social care.

CHATS CEO – Christina Banz – will present on the how the organization and its partners were able to engage in effective services integration as well as the challenges and lessons learned.