The Ontario government is providing Windsor Regional Hospital with nearly $2 million to support a program to help patients transition safely from a hospital stay back into their homes.
Windsor Regional Hospital's 'Hospital to Home' (H2H) program provides wrap-around services for up to 16 weeks of care following discharge for patients who no longer require acute care in a hospital setting.
The goal is to reduce avoidable return visits to the emergency department and hospital readmissions, while also easing hospital pressures and ensuring beds are available for acute care needs.
Hospital team members check in with the patients over the course of their care at home, and after they complete their care, help is provided to connect with community supports provided by Ontario Health at Home, should they require ongoing home care.
82-year-old Doris Davis of Windsor was in the program for eight weeks after being in the hospital for two weeks, including a week in the Intensive Care Unit, due to low blood pressure that resulted in several falls.
Her husband, Chuck, also 82, says the program gave Doris the chance to get better at home.
"When I did get her home, it just made me feel like we weren't abandoned," he says. "It was a transition from here, where she was getting lots of attention, to home, where she was getting lots of attention also."
Davis says it's been great for him and her because she gets to sleep in her own bed.
"I'm the only caregiver for her. It's helped; it's helped me, he says. "I've been able to just handle her. I do all the cooking and everything. It's just great to be there."
Hospital 2 Home Manager Marie Lunardi says they have an eight-week and a 16-week program, based on the patients' needs at the time of discharge, and as soon as someone leaves the hospital, a 72-hour care plan is already in place.
"The service providers will be there within that 24 hours," she says. "They're actually even calling and meeting you at home on the day of discharge."
Lunardi says certain patients benefit the most from this program.
"Those that require optimization and rehabilitation. Again, optimizing you to the point where we can get you to self-care once you no longer need the program," she says.
Windsor Regional Hospital has partnered with SE Health, a national, not-for-profit social enterprise, to help connect patients with community-based services in the home and social support services, providing holistic care from nurses, PSWs, physiotherapists, occupational therapists, speech-language pathologists, social workers, and dietitians.
The funding for the program is part of a provincewide $1.1-billion home care investment by the Ontario government.
"This nearly $2-million investment ensures patients can receive high-quality care in the comfort of their own homes," says Andrew Dowie, MPP for Windsor-Tecumseh. "The Hospital to Home program strengthens recovery support, improves outcomes, and reflects our government's commitment to expanding home and community care across Ontario."