Complex Continuing Care

Admission Information for Patients and Families

Complex Continuing Care (CCC) is a specialized program of care providing programs for medically complex patients whose condition requires hospital stay, regular on-site physician care and assessment, and active management by specialized staff. A province-wide scoring system is used to determine patient’s needs for our services. CCC is not a final destination. This is a transitional unit; assistance will be provided for alternative living arrangements (Home, Retirement Home, Nursing Home). CCC is a resource to assist the patient in moving towards an improved level of functioning and personal independence. The team consists of Physicians, Registered Nurse Team Leader, Registered Nurses (RN), Registered Practical Nurses (RPN), Personal Support Workers (PSW), Physical Therapists (PT), Occupational Therapists (OT), Speech Language Pathologist (SLP), Nurse Practitioner (NP), Dietician (RD), Social Worker (SW), Physiotherapist Assistant (PTA) and other health professionals.

Health Care Team

Expectations of the Health Care team:

The patient will have specific goals of care with the assistance of the health care team which may include:

• OT, PT, SW and SLP as available
• Assessment for swallowing and appropriate dietary choices if required
• Social workers support patients and families as they adjust to an altered health status, changes in roles and family dynamics, financial issues and discharge planning

Leisure Activities:

• The program includes individual and/or group therapy sessions Monday to Friday excluding holidays.
• Therapies provided for patients will be based on the patient’s needs and abilities to attain goals as well as resource availability.

Expectations of the patient and family:

• Monthly co-payment fees are assessed for each patient.
• Active participation with the team to both set and work toward achieving goals (i.e. stand, transfer, strengthening, endurance, toileting, use of devices) and linkage with community resources.
• Purchase/rental of mobility aids/assistive devices as required (i.e. special wheelchairs/walkers)
• Goals will be reassessed on a regular basis.
• This is a transitional unit with an average length of stay of 90 days; assistance will be provided for alternative living arrangements (Home, Retirement Home, Nursing Home)
• Involvement in the Interdisciplinary Conferences with team members.
• You and your family are expected to participate with the team at family conferences.
• Family members are invited to participate in care and therapy.

Click here for our referral form – Complex Continuing Care Referral Package