LTC-CARES (Consults And Recommendations for Emergencyand Support Services) Hamilton
Frequently Asked Questions
What is the purpose of this program?
This program is designed to create improved access to hospital level acute care resources for Long-term care (LTC) residents from their homes, ultimately enhancing care for residents while reducing unnecessary transfers to the Emergency Department (ED). This initiative recognizes that not all transfers to ED can be avoided and that emergencies still require a 911 call to access paramedics and transport to the ED.
Who can access the program?
This program is intended for LTC physicians or nurse practitioners (NPs) to obtain consultation from an ED physician and provide access to other resources. If a LTC nurse feels that a resident would benefit from a LTC-CARES physician consultation, they should follow their usual process and connect with the resident’s LTC physician or NP to determine whether a LTC-CARES physician consultation would be beneficial. The LTC nurse can assist in setting up the consultation once the decision to proceed has been made.
How do we access LTC-CARES?
A simple telephone call to 905-521-5030 will get you in touch with paging; ask for the LTC-CARES physician and you will be connected with the LTC-CARES team. Depending on the time of day, your first contact will either be directly with the LTC physician or the LTC-CARES nurse who will gather some information prior to connecting to the LTC physician.
When is this service available?
The LTC-CARES program is available 12 hours a day/7 days per week, between 9 a.m. and 9 p.m. (including holidays).
The call schedule is shared between St Joseph Healthcare Hamilton and Hamilton Health Sciences, however, the process for connecting with LTC-CARES is the same for both, simply call paging at 905-521-5030.
How does LTC-CARES work?
Most often, a simple telephone call connects the LTC physician or NP with the Emergency physician.
We ask that information including patient demographics, past medical history and a medication list be faxed to the LTC-CARES program prior to completing the consultation. This will help ensure the Emergency physician has the information necessary to provide advice to help develop a patient specific care plan.
The consultation may be as easy as the LTC physician/NP connecting with the LTC-CARES physician by telephone and can proceed as soon as the patient is registered. If preferred, the consultation can occur through teleconference to loop in the bedside nurse or set up as video conference (OTN or Zoom Healthcare) to include the nurse and resident directly. Whenever possible, the LTC-CARES nurse will join the conversation to assist.
Once the consultation has occurred, a plan of care will be agreed upon by the physicians/NP and if there is follow-up that needs to be coordinated through the LTC-CARES program, the LTC-CARES nurse will organize and communicate all appointments back to the LTC team.
It is critical that the results of the consultation are communicated back with resident/SDM by the LTC physician or NP to obtain consent and advise if they agree to move forward with the new plan of care.
What kinds of situations can I use LTC-CARES for?
Anytime you have an acute concern about a resident and especially if you think there is a specific need that would otherwise require a trip to the ED, a call to LTC-CARES will connect you with an ED physician for consultation and support in developing a plan of care that could include referrals to specialty services that typically can only be accessed on an urgent basis through the ED.
Resident, substitute decision maker or power of attorney consent is required along with LTC primary physician or NP agreement for a virtual consult with the LTC-CARES ED physician.
Resident’s experiencing an obvious medical emergency should be transferred to the ED via 911 call and ambulance. You DO NOT need to call the LTC-CARES team to make this decision.
Some examples include:
- An acute exacerbation of a chronic illness (COPD, diabetes, heart failure) that could be managed in LTC if more frequent labs and/or an expedited specialist follow-up appointment could be arranged
- An acute illness (possible pneumonia, UTI or other infection) requiring consultation regarding acute management
- Low hemoglobin, in a patient without active bleeding, that may require transfusion, but could wait to be arranged in a medical day unit within a few days
- An upper extremity fracture that could be managed with a splint or sling and a virtual fracture clinic visit within a few days
- A fall with no significant injuries to determine whether an ED visit is needed for a CT scan or other imaging
- A G-tube concern that could be managed through an outpatient appointment in Interventional Radiology
Please note that follow-up consultations or appointments may be done virtually or might require an appointment; both options would avoid ED visits and long waits.
Aside from an ED consultation, what other services are available?
LTC-CARES Hamilton is a 12 hour/day (9 a.m. – 9 p.m. including holidays) service that is supported by local ED physicians with expedited local specialty service follow-up including: Internal Medicine, Cardiology, Respirology, Geriatrics, Orthopedics, Radiology, and Palliative Care. In addition, expanded access to mobile and expedited investigations is available through our partners at LifeLabs and STL Diagnostics (X-ray and ultrasound).
How much involvement does the on-call LTC Physician have with the care planning?
The LTC physician, on-call LTC physician or NP are required to participate in the consultation and care planning with the LTC-CARES physician as they continue to be the resident’s most responsible provider. They will be connected by phone or through OTN or Zoom.
Do I have to use video technology to access LTC-CARES?
No, most times a telephone call is all that is required. We also have conference line capability to allow multiple health care providers, patients and/or family (as appropriate) to participate on the call. If video technology is preferred, our LTC-CARES team can walk you through the process.
What is the call back time like after we have called paging?
Once you call paging, you will usually be connected immediately with the nurse or the on-call physician. In the event an immediate connection does not occur, the call back time should be within 30 minutes. If you have not heard back within 30 minutes, something has gone wrong, please call paging again!
What information do I need to have ready when I call?
Resident information including: Name, date of birth, Health Card #, health concern, vital signs and your assessment, and the medication record. Additionally, have the resident’s chart available during the call to help answer any additional questions about medical history.
LTC site information including: LTC home name, address, telephone number, email address (in case video conference is required), and physician/NP contact name and number.
Having the LTC transfer record readily available is a good idea, as it will generally have most of this information already prepopulated on it and the transfer record along with your assessment, vital signs and the medication record will need to be faxed to the hospital site on call, once the initial telephone call to LTC-CARES has been made.
Who is responsible for the resident when LTC-CARES is called?
The LTC team remains responsible for the resident while the resident remains in the LTC facility. The LTC-CARES physician will collaborate with the LTC physician/NP to help develop a plan of care and the LTC-CARES team will help expedite any hospital-based follow-up appointments.
Is there a different phone number we call for the weekends?
The centralized telephone number is the same 7 days a week and is accessible between 9 a.m. and 9 p.m. daily (including holidays): 905-521-5030
Would we be able to try a “Practice call” to help prepare for an actual call?
Yes! We encourage “Mock Calls” – we all learn from them!
If you are interested in arranging a Mock Call, please email our team of nurses at HHSLTCVirtualCare@HHSC.ca with some dates and times that would work for you and one of our nurses will assist you with setting this up.
Will this program only be available during the pandemic?
The LTC-CARES program was rapidly developed as a result of COVID-19, although plans for this program had already been started. We hope that LTC-CARES will be an ongoing program to help support our LTC residents in their home, when appropriate.