For adults with health care needs greater than can be provided in a personal care home environment.
The Complex Continuing Care Program offers comprehensive care for adults with health care needs requiring more professional intervention than can be provided in a personal care home environment.
The Program is designed for patients who require complex continuing care. In order to establish eligibility for the service, patients are reviewed through the regional paneling process. Once eligibility is established, the WRHA Long Term Care Access Centre will advise Riverview Health Centre. The Patient Care Manager of the Respiratory Chronic Care Program will work with the referring agency and the patient’s family to coordinate admission.
Objectives of the Program
- To provide the best quality of life possible for patients through consideration of their physical, cognitive and emotional needs.
- To maintain and enhance, when possible, the functional level of the patient’s capacities.
- To apply the principles of patient focused care through the involvement of patients and family members in care planning and care giving.
Components of the Program
Patients will be assessed and provided with treatment and care by an interdisciplinary team of health professionals. Using their specialized skills and knowledge, professionals will provide treatment and adapt the social and physical environment to meet the functional, emotional and social needs of patients.
Each patient is assigned a Primary Nurse. In collaboration with the patient, their family and other team members, the Primary Nurse coordinates the plan of care for assigned patients. Family members are encouraged to contact the Primary Nurse or Patient Care Manager whenever they have questions or concerns.
About the Unit
The Respiratory Chronic Care Program is located on 2 West, a 30-bed unit with a mix of private and semi-private rooms. All rooms have their own bathroom. There is a communal dining area and lounge for use by patients and families. Programs and activities are primarily provided on the unit. The Respiratory Chronic Care Program benefits from an interdisciplinary team consisting of:
- Recreation Facilitator
- Spiritual Care
- Clerical Partner
- Health Care Aides
- Occupational Therapist
- Registered Nurses
- Rehabilitation Assistant
- Respiratory Therapist
- Service Partners
- Social Worker
- Speech Language Pathologist (on consultation)
Most residents require complex care related to complications of long-term illness and injuries. This care may include:
Specialized Wound Care, Airway Management (tracheostomy), Nutritional Support, Dysphagia Management (TPN, gastrostomy feeding) and Long Term Ventilatory (breathing) support.
How does my family member get admitted to a Personal Care Home?
We work with the WRHA’s Long Term Care Access Centre to determine who gets admitted. Prior to coming to live at Riverview you or your family member will be assessed to determine how best your care needs can be met. This is usually done by community care providers from home care and your physician. If you are in a hospital and cannot return home, members of your care team and the long term care access centre team will determine what your needs are and what options are available for discharge. The long term access centre keeps track of who is waiting. As beds become available, applications from our waiting list are sent to us by the Access Centre.
For more information on this program, contact the Patient Care Manager at: