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Healthc Q. 2019 Jul;22(2):40-46. doi: 10.12927/hcq.2019.25906.

Keeping Long-Term Care Patients Out of Hospital During Acute Medical Illness: Proposal for Common Elements of an Integrated Healthcare Delivery System for Long-Term Care.

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A general internal medicine specialist with an interest in improving access to care for vulnerable older adults. She led the development of the Integrated Long-Term Care Program in East Toronto and the Complex Care Hub program in Calgary and is currently the medical lead for the Seniors' Palliative and Continuing Care portfolio in Calgary for Alberta Health Services. Dr Grinman can be reached by e-mail at:
A clinical nurse specialist and a passionate proponent of transformative, collaborative, integrated healthcare. She is a palliative educator and mentor and currently is the director of the Palliative Pain and Symptom Management Consultation service for Toronto.
A care of the elderly physician with an interest in providing home-based geriatric assessment and palliative care for medically complex and frail older adults. She is currently the medical director of long-term care and supported living for the Brenda Strafford Foundation in Calgary and co-medical lead for the Home Care Geriatric Consult Team and Seniors Health Outreach Program in the Calgary Zone. She also serves as a medical consultant for the community paramedics from the Mobile Integrated Health Services Program in the Calgary Zone.
A primary care nurse practitioner with 11 years of clinical and quality improvement healthcare experience working in a variety of health settings, from acute care to community. She currently works as a nurse practitioner providing palliative care in the community with a continued focus on quality improvement.
A registered respiratory therapist, advanced care paramedic and certified project manager with expertise in improvement science and application of high-reliability organizational theory to healthcare teams. He was previously the project manager for the Integrated Long-Term Care Program in the East Toronto Health Link.
A clinical nurse specialist with an interest in quality improvement and capacity building in long-term care homes for the provision of enhanced palliative care. She previously worked as a palliative pain and symptom management consultant in Toronto and currently works for the Palliative Integrated Long-Term Care Program based at Michael Garron Hospital in east Toronto.
A care of the elderly specialist providing acute care geriatric consultation, spanning outpatient clinics and home-based and facility-living patients. She leads quality improvement and research projects to optimize transitions of care aiming to reduce avoidable hospitalizations for frail older adults and facilitating aging in place. She is currently the section chief in seniors care for the Department of Family Medicine at the University of Calgary and medical director of facility living in the Calgary Zone for Alberta Health Services.


Integration of acute and palliative care services for long-term care (LTC) residents reduces the morbidity and mortality associated with avoidable hospitalizations while contributing to healthcare system sustainability. This paper explores patient, provider and system factors contributing to potentially avoidable emergency room visits from LTC homes, based on our clinical and quality improvement work in the Greater Toronto Area and Calgary, as well as reviews the existing literature. Commonalities are used to identify key elements for developing an integrated healthcare delivery system to manage acute medical changes in LTC residents and minimize the need for in-patient hospitalization.


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