Palliative Approach to Care – Long Term Care Initiative Expression of Interest – OVERVIEW

OPEN: October 2, 2017

CLOSE: October 20, 2017, 5:00pm

The Toronto Central LHIN is seeking expressions of interest (EOIs) from long term care (LTC) homes interested in enhancing a palliative approach to care within their facilities.


Recent trends in LTC homes show an older age of resident at the time of admission, with higher acuity and complexity of care needs, coupled with a shorter duration of stay prior to death. (Wilson & Truman, 2004; Froggatt et al., 2011). As a result, health care providers working in LTC are increasingly challenged by the need for advance care planning, changing care plans as a resident’s condition changes, and complex decision making and communication related to end of life care. For these reasons, the value of embedding the palliative approach to care in LTC has increasingly gained attention. Toronto Central LHIN LTC homes have expressed a strong desire for assistance and guidance in providing enhanced palliative care to their residents.

The Toronto Central Palliative Care Network, in collaboration with health system providers, patients/families and health system planners, have identified the LTC sector as a strategic area of focus for improving palliative care in the LHIN. The Palliative Approach to Care in LTC (“PAC- LTC”) Initiative has been developed which will offer LTC homes in the LHIN the opportunity to enhance the palliative approach to care within their facilities.

All LTC homes in the LHIN will have access to this initiative at some time over the course of 3 years.

Purpose of this EOI

The purpose of this EOI is to identify 12 LTC homes that have a willingness to work to strengthen the palliative approach to care in 2017/18 and to participate in Cohort 1 of the PAC-LTC Initiative. An EOI for Cohort 2 will be launched in the fall of 2018 for 12 homes interested in participating in the second year of this initiative.

Details on the PAC-LTC Initiative

The PAC-LTC Initiative operates from a strengths-based approach and will support LTC homes regardless of their starting point on the improvement journey. This structured initiative will:

  1. Build organizational readiness in LTC homes to provide a palliative approach to care and

  2. Develop capabilities for sustainable change in palliative care using a quality improvement approach.

Additional benefits of the PAC-LTC Initiative will be:

Residents & Families:
• Increased communication & understanding of a palliative approach to care
• Enhanced the palliative care provided to residents and their families
• Reduced numbers of unnecessary hospital transfers
• Increased resident and family satisfaction with care experience

LTC Staff:
• Increased knowledge and skills in providing the palliative approach
• Improved confidence & skills to be catalysts for organizational changes in delivering
palliative care

PAC-LTC Initiative will support LTC homes in 4 main areas:
1. Palliative care education: building the core competences and skills in palliative care;

2. Quality improvement training: building homes understanding of, and capacity to apply a QI
approach to palliative care in their homes;

3. Palliative care resources and tools: offering evidence based resources to assist homes in
making in-home improvements in palliative care; and

4. Clinical coaching/mentoring: trained experts will work with homes to support them through
this initiative via individualized coaching and via participation in the Learning Collaborative.

Participating homes will move through the initiative at the same time – receiving education and training,
completing palliative care self- assessments, developing quality improvement ideas and solutions together.

Over a 12-month period, representatives from the LTC homes will meet in a Learning Collaborative to share
their work, results and best practices, which provides important opportunities for peer learning and

LTC Home Commitments

To participate in PAC-LTC, homes will commit to the following:


  • Ensuring support from Administrative leaders
  • Ensuring involvement from LTC Physician(s)/Medical Director
  • Identifying an in-house Palliative Champion/Lead (if one does not currently exist)


  • Enabling staff members to participate in education and training (LEAP LTC and IDEAS)
  • Creating a Palliative Care Resource Team, if one does not currently exist


  • Undertaking a LTC home Palliative Care Self-Assessment
  • Supporting local improvement efforts, leveraging the Palliative Care Resource Guide
  • Engaging resident/family council in palliative improvement efforts
  • Participating in regular meetings of a Learning Collaborative comprised of teams from each of the 12 participating LTC homes
  • Reporting to the LHIN on progress
  • Participating in the ongoing evaluation of the initiative (e.g. staff surveys, family surveys, collection of performance metrics

Who can apply?

All long-term care homes in the Toronto Central LHIN are eligible to apply.

Criteria for Selecting Participating Homes: Up to 12 homes will be selected to participate in the first Cohort of PAC-LTC.

LTC homes will be assessed based on the following components:

• Organizational commitment to enhancing a palliative approach to care

• Level of support from LTC home administrator and physician/medical director to participate in the

• Organizational willingness to fully participate in the initiative

• Candidate homes (which have provided responses that successfully address the criteria for selection)
may be engaged in discussions with the LHIN about their ability to participate in this initiative.


Submit the EOI Template to by 5pm on Friday October 20, 2017.

Click Here for the Full Expression of Interest – OVERVIEW

Click Here for the EOI Application Form