Program puts low need clients in touch with nurses by phone

A program that helps independent seniors stay at home longer is having a positive impact in the region, according to Interior Health.

Surveillance Nurse Tina Pole

Surveillance Nurse Tina Pole

A program that helps independent seniors stay at home longer is having a positive impact in the region, according to Interior Health.

The Surveillance Nurse program uses remote telephone checks to connect nurses with clients. It was implemented six months ago.

Sharon Whitby, Home Health Practice Lead for IHA said the program helps clients remain in their own homes and avoid hospital admissions.

“It’s care management and support by telephone and connecting with these clients on a regular basis depending on their needs,” Whitby explained. “They might be calling them weekly, monthly, but they have to touch base with them every three months to see how they are doing. When they do connect with this family or their support group, they work with the client to develop a health improvement plan based on what the client feels is the greatest need at the moment.”

The idea for the program came from a similar program out of Fraser Health, which has been running for a number of years.

Whitby said the program has been successful in helping clients maintain their health at a lower level of need.

“We decided we would incorporate it into Interior Health. Based on the Fraser model we put that into place for our Health Authority,” she said.

In March 2013 they did a pilot project in Kelowna. When that went smoothly, they put it in in Kamloops. From there they hired five more surveillance nurses for Interior Health.

“They came on board for January and February time period,” she said. “Across Interior Health we have seven Surveillance Nurses. They will be covering off all the home health communities who have the lower needs clients in current case loads.”

Those clients are being shifted from the case manager that currently checks on them.

“These are great achievements for both clients and the health care system,” Whitby said. “We know most people prefer to stay in their own home to self-manage when they are able.”

Surveillance Nurses make calls to the long-term clients to check how they are doing at least once every three months, though more if required. Clients may also call the nurse when they have questions or need assistance.

Surveillance Nurses are located in Williams Lake, Kamloops, Vernon, Kelowna, Penticton, Cranbrook and Castlegar. They support approximately 280 clients.

“The regular calls ensure we are being proactive and supporting clients so they continue to be lower needs for as long as possible,” said Whitby. “For example they may need encouragement to increase their activity level, to socialize more, or to quit smoking. Or they may benefit from other support services.”

“The first phone call is usually the most crucial. It’s quite amazing how quickly we can develop a rapport with our clients over the phone,” said Tina Pole, one of the seven Surveillance Nurses. “We are able to find out what supports they have from family or friends and how they are going to be able to maintain or improve their health.”