The Evolution of HIV/AIDS care at Casey House


The changing realities of HIV/AIDS care and a health-care system in transformation required an updated model of care for Casey House, a specialty hospital for persons infected and affected by HIV/AIDS. Eighteen years ago Casey House developed a collaborative model of care to respond to the care demands at the time, and has been providing a continuum of care through that model with a comprehensive range of palliative and supportive care services in a residential and community program. Now, we have updated the existing collaborative model so that it builds on Casey House’s strengths, capitalizes on and expands community relationships, and is grounded in evidence and best practices. Most importantly, the updated model is flexible and enables us to respond to the current and future needs of persons living with HIV/AIDS, and consequently, deliver better care.

Casey House updated its model through consultation with communities, clients and staff, as well as a review of relevant literature. The result is a multi-faceted framework that facilitates person-centered care and co-ordinates across the continuum of need to achieve a meaningful life and death experience. The model sets out a philosophy of care through five guiding principles, outlines structural elements that enact the philosophy and make it ‘come alive’ in day-to-day practice, identifies core services relevant to existing client needs, proposes a range of ‘best-practice’ programs, articulates proven operational processes capable of integrating care, and recommends a care team that extends beyond the organization to embrace other community resources.

Through the design process, Casey House learned:

  • a ‘best practice’ model of care needs to exist with identifiable key elements
  • there are emerging trends that required a rethinking of current approaches
  • affected communities must be actively engaged in the design
  • there is an obligation for HIV/AIDS leaders to share their experiences to
strengthen the capacity to advance effective care and service.

“The complex and evolving nature of HIV/AIDS reshaped how we provide care, ” says Joan Lesmond, Chief Nursing Executive. “We are articulating a comprehensive model that addresses multiple populations across a continuum, consolidating the care programs, the needs of the client, and the scope of the disease into a framework. It meets the changing needs of the person who looks to us for care and services and the model can also be adapted to the international community.”

“This is an episodic, multi-system disease, whose treatment (antiretrovirals) brings a host of side effects. The shift in people living longer with HIV/AIDS, but with a diminished quality of life, makes it critical to evolve and stay responsive to the needs of those we care for,” says Lynn Muir, RN, Clinical Supervisor, Community Programs.

When Casey House began delivering services in 1988, a collaborative model of care was created, which was appropriate at that time. But, a rethinking and reshaping of the model, to complement the changing needs of people affected, occurred over the years. Because death is no longer the primary outcome – supportive care became a larger component of the care delivery – a model that addresses the individual no matter where they are along the continuum and what level of care they needed, was required.

“Our updated model is very user-friendly no matter where an individual’s needs lie along the continuum, or no matter what resource capacity they have available to them,” explains Lesmond.

The updated model looks at needs-based care and support, solid case management, interprofessional integration, and facilitating access to a truly comprehensive offering of programs and services and building capacity through partnerships with service and program delivery experts, so that individuals can access what they need, when they need it. The external partnership aspect of the model is a key feature, as this ensures the most appropriate provider delivers the service, rendering a more cost effective and efficient option.

“The Casey House model of care is an ever-evolving approach built on our core values and the commitment to deliver the most suitable care. To do so, we must anticipate and respond to the changing needs of people living with HIV/AIDS,” says Muir.

The development of the updated model of care was generously supported by Sun Life Financial. Casey House will implement and evaluate the model of care over the next three years in collaboration with affected communities. The undertaking of this model represents a step in the evolution of care at Casey House as the organization continually adapts to the changing nature of HIV/AIDS and the complex effects it has on the people who require care.

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