Creating a More Equitable and Efficient System Together for the Caregiver Respite Strategy in the Ontario Health Central region.

Access to care through reducing wait times for services has been an ongoing priority across the healthcare system, with pressures further exacerbated over the last three years during the pandemic.

For clients in their local community, the wait often includes additional referrals for other programs and services where the experience can feel like an endless labyrinth with no positive outcome in sight. This year, the Mississauga Halton Central Registry (offering centralized intake and coordinated access for networks of community health providers and their programs and services in the Mississauga Halton region) collaborated with the Adult Day Service (ADS) community service providers to breakdown the silos and uncover efficiencies through collaboration and partnership.

What are Adult Day Services (ADS)?

Adult Day Services are professionally-designed recreational and therapeutic activities for older adults to enhance well-being by providing social, physical and mental stimulation in a supportive group environment and can include the provision of personal care such as bathing, medication management, and foot care. Simultaneously, these programs enable caregivers a break from caregiving knowing their loved one is in a safe place, effectively preventing caregiver burnout and preserving informal caregiving as a crucial resource in our ‘healthocracy.’

As with any transformation agenda, 100% of all health service providers involved agreed there was a better way to do business, for clients, caregivers, and service delivery. As part of the health system’s recovery through COVID, and by discussing the cross-section of old and new gaps in the system, the community partners envisioned a solution to their efficiency paradox in delivering ADS. The results were a standardization of processes and expectations across agencies to provide an equitable and efficient system that is transparent and easy to navigate for clients and caregivers alike.

The group started by reconciling their individual waitlists into one centralized waitlist, in order to depict the accurate number of unique individuals waiting for ADS service within the region. Across agencies, there was a duplication rate of 15%, which led to an inaccurate understanding of unique number of clients. This (now) integrated waitlist provides better insight into demographic needs, availability and offering of all programs. A central team offers equitable access and information on all available ADS and respite programs to the clients in an effort to help them remain in their community, at home.

“When we initiated this work with the different providers, everyone had a unique process. It was important to take the time to build good relationships, learn from each other and coordinate everything in one place. It has saved a lot of time and phone tag for clients, and agencies alike,” says Natalia Sokolova, Respite Advisor, Central Registry.

"This program helped my mom have more independence and helped with her dementia a lot, especially with recall. I truly can't thank everyone involved enough.” 

- ADS Caregiver

A key ingredient to their solution was the group’s adoption of the same e-referral solution, Caredove, to share information and ensure there was one source of truth. A change in process meant that all referrals would be sent through Central Registry. For every referral, a comprehensive assessment is conducted to assess client and caregiver needs. By centralizing the referral, there is a one-stop shop for assessment, saving time for both clients and providers. The initial assessment in the siloed model had approximately 800 people expected to be waiting for services. The by product of the consolidation led to a list of about 450 people who are still active candidates for Adult Day Services. Where clients and caregivers may have had up to nine different contacts at individual agencies, this has been reduced to one. They know who to speak to for their support needs and questions.

“We wasted time, duplicated services and confused clients when we weren’t working together,” says Kimberly Martinez, Manager, Central Registry. “There are so many pieces to the puzzle for care that it can be very difficult to understand what information the client has been given and who they have spoken to. Having community providers be on the same platform has significantly streamlined the process where we no longer worry about everyone being on a different page and now spend our time working with clients to meet their holistic needs.”

The team learned that the amount of days between sending a client to the preferred ADS location and the time they confirmed to start the program was 21 days +. There were two significant areas that seemed to bottleneck the process: transportation and scheduling site-specific care plans with the caregiver/family. Today, Central Registry manages transportation arrangements with CANES as well as point of contact scheduling. There is a centralized calendar of all programs so that clients are told in the moment when programs begin. This process results in less delays and puts clients in programs faster with better knowledge.

“The waiting game for care is unfortunately synonymous with publicly-funded healthcare. Through collaboration, co-design, and technology, we’re changing that – we want clients and caregivers to expect more from our system – and we are working together to realize our shared vision, where clients are empowered to drive their own desires and outcomes, which includes living in their communities as long as possible,” says Laura Salisbury, CEO of Nucleus Independent Living and lead agency for Central Registry.

“On my mom’s bad days, the staff [at the ADS] have truly been a huge support. She comes home happier and more relaxed. It has completely changed our lives. I felt like I was in the middle of a nervous breakdown before my mom was accepted because things had progressed with her dementia and behaviors. I am just so thankful to the Central Registry staff for helping our family.”

- ADS Caregiver.



The sky’s the limit! The lessons learned through this initiative will be expanded to other collaborations experiencing the same obstacles. 

“At the end of the day, it’s about the family and the caregiver and showing them there are so many opportunities to help them. It is such a fulfilling job to share the programs and services that will help meet their needs and give them hope,” says Martinez.

For more information:

905-281-4443
info@centralregistry.ca