St. Joseph’s Health System, Niagara Health launch innovative COVID Care @ Home model
Niagara Health is a partner in a new model of care that connects COVID-19 patients to care wherever they are, whenever they need it.
COVID Care @ Home is delivered by St. Joseph’s Home Care, in partnership with St. Joseph’s Health System, Niagara Health and community partners.
Starting at St. Joseph’s Healthcare Hamilton and Niagara Health, with rapid expansion to Kitchener, the new model of care for COVID-19 patients will provide 24/7 access to high-quality care from one integrated team in the home and in community settings such as retirement homes, shelters and hospices.
Health officials said COVID Care @ Home is a uniquely designed program intended for those with a confirmed COVID-19 diagnosis who do not require hospitalization.
Complementing existing local COVID-19 initiatives, the program will support integrated care at home, early discharge from hospitals with supports, and help to prevent hospitalization.
“We’ve learned a tremendous amount about COVID-19 over the last several months,” said Tom Stewart, president and chief executive officer of St. Joseph’s Health System and chief executive officer of Niagara Health.
“This new program builds on partnerships and learning by increasing our focus on virtual care and specialized COVID care teams that crosses normal silos of care. This will help us through the second and future waves of the pandemic, as well
as prepare us for system transformation needed in health care.”
It’s also intended to help prevent outbreaks by providing infection prevention and control, and coaching support for community congregate settings.
Patients will be assessed to determine what level of service will be provided. Vulnerable patients who are at risk of hospitalization, and who require additional supports and services, will have access to an integrated clinical care team, remote monitoring and at-home and visual visits to support a safe recovery at home.
This same model of care will be available to patients discharged from hospital so they can safely return home sooner.
The innovative, flexible model would provide COVID-19 patients access to services that may not typically be within the scope of traditional home and community care supports.
Patients will be cared for by one integrated team representing a variety of providers whose clinical decisions are empowered through the use of a single electronic patient record to support patients in many ways.
Those include virtual care (phone, video and remote patient monitoring), one number to call 24/7, one clinical team, one electronic record, system navigation/connection to social supports, access to specialists, and infection prevention and control support.
The program is designed to support older adults who are at greater risk of physical and mental health decline, said officials. Patients will be enrolled by the clinical teams at the time of their COVID-19 diagnosis.
The new model will also help to protect capacity in hospitals by expanding supports and services in the community through a dedicated team that will facilitate care at home, support safe discharges from hospital, and limit unnecessary emergency department visits, said officials.
This will help hospitals to maintain capacity and services during a second wave, as well as continuing scheduled surgeries to reduce wait lists and backlogs.