Regional Geriatric and Community Intervention Program (GEM and GEM+)

GEM team above include: (Front) Laura Wilding, (Back) Tammy Pulfer, Dr. Frank Molnar, Dr. William Dalziel

The Regional Geriatric and Community Intervention Program (RGCIP) aims to optimize the safety and independence of seniors while preventing hospitalizations. The integration of over 20 partner organizations has enabled this program to successfully implement and optimize an evidence-based model for Geriatric Emergency Management (GEM) in nine emergency departments (EDs) in the Champlain region. In addition, added resources provided by the RGCIP to community and specialized geriatric services support expanded and urgent capacity for GEM referrals – an essential component of this program.

The RGCIP GEM model includes an emergency department electronic patient screening and identification process followed by a focused geriatric assessment performed by a specially trained GEM Nurse. As geriatric syndromes are identified, the GEM Nurse initiates early referral to specialized geriatric services and community supports for further assessment, intervention and in-home services, as indicated.

The GEM+ component comprises specialized geriatric services such as Geriatric Day Hospitals, Geriatric Assessment Outreach Teams and Geriatric Psychiatry Outreach services. It also includes expanded capacity for ED referrals in community support services such as the Going Home Program and Adult Day Programs. In this way the traditional division between emergency department care and community care is defeated and more continuous, coordinated care for at-risk seniors is achieved. Cross-sector collaboration is the focus of a Project Leadership Team which convenes regularly to plan, evaluate and realize program activities.

Funded by the Ontario Ministry of Health and Long Term Care Aging at Home initiative, data reporting includes volume, target and performance measures related to hospital and ED use. This program has been found to yield a relative risk reduction of subsequent ED visit and hospital admission (30 days) of 25% respectively. ED length of stay is shorter than average for patients assessed by a GEM Nurse.

Since the programs’ inception in 1995, the Division of Geriatrics has been instrumental in supporting the GEM model. The Division of Geriatrics plays a consultative role, assists with knowledge dissemination and through its linkages with the Regional Geriatric Program of Eastern Ontario, this program has grown to represent an innovative approach to bridging the gap between acute and community-based care. This ED / Community Care interface model enhances usual ED care for seniors, thus improving the care received and the safety, quality and durability of ED discharges for seniors at high risk for hospital admission. Of benefit to EDs and hospitals, this program prevents admissions in turn impacting on Alternate Level of Care (ALC) stays and helping to alleviate hospital overcrowding.

For more information on the GEM program please contact:

Tammy Pulfer, Regional Program Manager

Regional Geriatric and Community Intervention Program

TPulfer@toh.on.ca

613-798-5555 ext. 19978