Complex Care Streams of Care

The Complex Continuing Care Program of the Brant Community Healthcare System serves those whose complex needs will best be met in a multidisciplinary hospital setting as they require skilled, technology based care. There are 4 current streams in the CCC program.

Short-Term  Complex Medical Management

Persons identified for this stream of care will require close medical monitoring with access to scheduled physician care/daily medical oversight. On admission they may have limited physical and/or cognitive capacity due to medical complexity but believed to have restorative potential. 

The multidisciplinary management of their care needs may include any of the following requirements:

  • parenteral feedings
  • suctioning
  • tracheostomy care
  • treatment for burns
  • extensive wound care
  • IV medications
  • transfusions

Low Intensity Rehabilitation

Those identified for this stream of care require a time-limited, coordinated inter-professional plan of care to achieve their maximum level of functioning following an acute episode or following an unexpected/unexplained de-compensation. 

Prior to admission a tentative discharge plan will be established as a goal for their rehabilitation Persons must be prepared to participate in an active reactivation program. They should demonstrate potential for improvement as assessed by the multidisciplinary team through a slow paced program. 

The therapeutic services include the following therapies:

  • Physiotherapy/Physiotherapy Assistant
  • Occupational Therapy/Occupational Therapy Assistant
  • Speech Language Pathology
  • Nursing Rehabilitation
  • Clinical Nutrition

Other therapeutic services may include:

  • Respiratory Therapy
  • Therapeutic Recreation
  • Social Work

Activation/Restoration

Those identified for this stream require exercise and recreational activities to increase strength and independence.  Discharge destination is to return to pre admission location. Patients are medically stable and are cognitively and physically able to participate in restorative activities. Patients are medically stable and only require weekly physician access/follow up.

The therapeutic services are consulted by a Regulated Health Professional and include both group sessions and one on one.

Palliative Care

People in this stream of care will require short term management of the end-stage of their illness. The focus of palliative care is to enhance the quality of life for those who are dying, taking into account their physical, spiritual, psycho-social and cultural needs. Their stay in the hospital is for medical intervention and 24 hour nursing care to achieve pain and/or symptom control.

 
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