Support in the home to limit emergency room visits

Agence de la santé et des services sociaux de la Montérégie


The Challenge

For functionally dependent seniors, the hospital (emergency) is often considered to be the gateway to the network, in particular for residential services. In many cases, hospital stays contribute to reducing independence, so it is essential that we limit hospital stays for our senior clientele. Morover, most of the institutions in the Montérégie have high rates of applications for residential placement initiated while the individual was in hospital. The number of persons reaching the end of their active treatment and who are occupying short-term beds while awaiting long-term beds is rising, and the Montérégie has a serious shortage of residential spaces.

The Improvement Project

Make use of evidence to promote the development of services in the home, while expanding and diversifying the services offered. More attention needs to be focused on developing the preventive aspect in order to delay the residential placement of clients who are losing their independence. Some of the strategies to be adopted in an integrated fashion include: identifying clients at risk, managing waiting lists in optimal fashion (accessibility), bringing in case managers (continuity) and providing support to family caregivers.

The Impact: 

This process could be applied in the region, in order to identify the tools that would promote the adoption of new ways of doing things. It would also be advisable to develop incentives to induce the institutions to make the necessary changes. Once proven successful, the project could then be exported to other regions.