Strokes are the fourth leading cause of death in Canada. Annually, the number of stroke survivors in the GTA exceeds 11,000. Research has shown that survivors of more serious strokes are better managed in their recovery in a low tolerance, long duration rehabilitation program.
Following their commitment to providing outstanding quality and care for their patients through developing effective linkages, St. Joseph’s Health Centre (SJHC) Toronto has teamed up with a long-term care facility, Castleview Wychwood Towers, to offer the Low Tolerance, Long Duration (LTLD) Stroke Rehab program. Through this innovative model of care, SJHC is able to link severe stroke survivors with the best possible rehab care.
“Since SJHC cares for a large seniors population, this partnership makes sense because Castleview also serves the same community and they are forward thinking in anticipating the needs of our aging population,” says Sandra Dickau, Patient Care Manager, Outpatient Rehabilitation.
“In terms of rehab, severe stroke survivors is a group that really falls through the cracks,” says Dickau. “As many as 22 per cent of patients waiting in transitional care units for rehabilitation would benefit from LTLD care. Our partnership with Castleview fills those gaps in getting these patients the rehab care they require.” The objective of placing SJHC patients at Castleview and the development of this program is to allow those with severe strokes to receive the specialized care that they need in order to increase their function and achieve their goal of returning back to the community.
The program was developed through the GTA Rehab Network Stroke Consensus Panel in 2004. Recommendations were made to the Ministry of Health and Long-Term Care to formally integrate LTLD, and SJHC and Castleview Wychwood Towers linked together to develop the program, which is also supported by Toronto West Stroke Network and the Heart and Stroke Foundation. Although this was to be a two- year pilot project ending this past February, a commitment has been made by the Ministry to continue the program.
Stroke patients are usually admitted to the ICU or medicine inpatient unit at St. Joseph’s. When no longer requiring acute care, patients are transferred to the Transitional Care Unit, where they are assessed and await placement for rehab services. However, SJHC found that severe stroke patients experienced limited access to a suitable rehab destination. In addition to severity of their strokes, these patients are often older individuals and have other medical problems that require more complex care. As a result, they need less intense rehabilitation that spans a lengthier period of time, instead of participating in conventional rehabilitation programs.
Castleview dedicates 20 beds to this program, where the average length of stay for patients is 180 days. Patients receive physiotherapy, occupational therapy and speech language therapy either directly from therapists or through rehabilitation assistants. The bonus of having this program in a long-term care setting is that the clients can take advantage of all the activities being offered at Castleview. They can also participate in up to six hours a week of structured recreational activities.
“We can feel comfortable when we send a patient to Castleview, because we know the standards and policies that the physiotherapists and speech language pathologist are following are consistent with SJHC’s philosophy of care,” says Dickau. “It’s a win-win situation. Sharing resources in our health system instead of working in silos allows us to expand care and services.”
This partnership with Castleview solidifies the importance of developing relationships with community partners for SJHC. It allows for smoother transition of care from hospital to community and patients gain access to the care that they need in a timely manner. The LTLD program has a lot more to offer, since it is a specialized stroke rehabilitation program.
“There has been 100 per cent success – all the patients through the program have improved functionally. Twenty-five per cent of the patients were able to return home and the remaining patients went to live in appropriate long-term care facilities,” said Dickau. “We are confident that this partnership ensures an excellent quality of care for SJHC patients and provides maximum opportunity to return to the community.”
“It’s all about quality of life and using resources more effectively to get people to the most appropriate care, with the potential of going home,” says Dickau.