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|Shirin Vellani & Lesley Krempulec|
|St. Paul’s L’Amoreaux Centre & Carefirst Seniors, Canada|
|Keynote: J Gerontol Geriat Res|
|The aging of the Ontario population is occurring at a rapid rate. By 2030, older adults will represent 20% of the total population in Cental East Local Health Integration Network ( CELHIN) . While majority of people manage independently with the normal physiological changes of aging, between 10-15% are considered frail with multiple co-morbidities requiring specialized geriatric services. Twelve GAIN teams in an interorganizational network have been created to address this need. These NP led, interprofessional and in some cases, multilingual, teams provide standardized approaches to comprehensive clinical assessment and intervention to frail older adults. Teams include passionate , creative and skilled geriatric professionals who work with older people to create personalized care plans to help them remain in their home. In addition, intensive case management is provided to isolated and unattached frail older adults including those who experience responsive behaviours, elder abuse, mental illness and addictions. Community teams face multiple challenges such as coordinating primary care for unattached home-bound seniors and lack of effective communication between institutions. Benefits to this service model include; high level of patient and caregiver engagement and satisfaction, increased Primary Care collaboration in a “shared care” approach, and effective use of technology to link home based care. However, focused efforts are needed to improve the ability of the GAIN teams to work at full potential including, creation of virtual wards, direct admissions to in-patient hospital (rehabilitation and behavioral units) and participation in discharge planning to help improve integration of services from hospital to home.|
Shirin Vellani is a Masters prepared Nurse Practitioner with a vast experience in critical care and geriatrics. She played a significant role in initiating CELHIN’s NPSTAT program in Scarborough area. After which she moved to work at The Scarborough hospital emergency department as a GEM Nurse Practitioner. She got the opportunity to work with seniors in Mombasa, Kenya for 2 years in voluntary capacity before joining the St Paul’s community GAIN team, where she currently works as a Clinic Lead Lesley has enjoyed a rich mix of both clinical and administrative experiences and currently functions as a Program Director at Carefirst Seniors Community Service Association. She has expertise in mental health and geriatric health. She completed her BA in Psychology at University of Waterloo and a BSc in Occupational Therapy from University of Toronto.
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