“If I need assistance, it is right here.” Ruby Neubauer, an 80 year old Duncan resident, is relaxing in her recliner at The Meadows assisted living home while she recuperates from a lengthy illness.
Prior to a six week long stay at Cowichan District Hospital, Ruby lived in an aging RV in need of repair where she found herself at the mercy of the weather. “I was cold all the time,” she says. “I kept getting sick and I couldn’t get warm.”
Given that Ruby’s living situation wasn’t ideal for her recovery, her medical team referred her to a new Island Health program in the Cowichan Valley to ensure she could recuperate in a safe, warm, supportive, home-like environment while she waits for a permanent assisted living space.
Short Term Enablement and Planning Suites (STEPS) is a partnership between Duncan Community Health Services (CHS) and The Meadows, a privately owned assisted living home.
The Meadows has set aside 10 assisted living suites, while Cowichan CHS provides staff, furnishings and equipment for patients who are ready to leave hospital but may not be able to return home for a number of reasons.
“STEPS is a novel partnership that gives clients some time, space and support to be matched to the best location of care,” explains Kristy Schafer-Blood, Manager, Duncan Community Health Services.
“Some clients require additional care at home from a family member, need to do some structural renovations or access specialized equipment. Or, if someone has had a fall, a fracture, or an illness like a stroke, they may require a little more recuperation time and are not fully ready to be on their own.”
STEPS has a dedicated case manager who works with local partners, including community physicians, to identify clients who meet the criteria for the program. Once a client is identified and settled into a short term placement at The Meadows – typically between 4 to 12 weeks - they receive 24 hour support from a team of community health workers who check on clients regularly, providing physical assistance and emotional support.
“The staff here is so nice and well trained. They help me with my medication, they support me with the household chores that I can no longer do, and often there is someone to sit with me and keep me company,” says STEPS client Ruby Neubauer. “This program is such a good idea. It’s really needed and it’s working.”
Prior to STEPS, patients would have had to wait in hospital if returning home wasn’t an option. However, it is estimated that in 2021, the program saved 2055 hospital bed-days, which in turn helps to reduce pressure on the healthcare system.
Further, STEPS clients not only receive around the clock support, they also have the opportunity to meet other assisted living residents, eat meals together in the dining room, and participate in activities, which is much more conducive to their wellness and ongoing recovery than a hospital setting.
“STEPS takes a very client-centred approach. We have many elderly clients and families who are coping with a lot and trying to decide whether to make a move to another care setting can be stressful,” says Schafer-Blood.
“A person’s health is so variable - this program gives our clients an opportunity to stabilize so we can work with them and their families to get them back home with support, or into assisted living or long-term care.”
STEPS was launched in January 2020 as a component of the Cowichan Health and Care Plan.
This is an innovative and ground breaking initiative for Island Health, complementary to the new Cowichan District Hospital replacement project, in which programs like STEPS are being designed to allow people to access enhanced health care services in the community within a "virtual ward" concept, thereby reducing the need for hospitalization, offsetting strain on acute care services, and creating a better experience of care for patients.