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The HISH program focuses on Alternate Level of Care (ALC) patients in acute care hospitals with a discharge destination of long-term care, as well as home care and other patients waitlisted for long-term care residing in the community who are at risk of hospitalization.
The HISH model supports care that is more responsive to the patient's changing needs, provides continuity and consistent care providers, and access to an integrated inter-professional team intended to reduce fragmentation in care delivery through proactive wrap-around care and support services.
A team of four dedicated Registered Nurse Care Coordinators conduct timely assessments, ensure customized individual care planning to facilitate patient transition from hospital to home or congregate care, ensure comprehensive system navigation and integrated wrap-around care, keeping patients safe and at home. Specialized clinical support is provided by two Nurse Practitioners in Scarborough/Durham and the North East Cluster. HISH supports a bundled model of care from existing service providers that provides personal support services, nursing and rehabilitative services depending on patient need.
The HISH program works in partnership with regional Community Support Services organizations, Community Paramedicine, Geriatric Assessment Intervention Network (GAIN), and Hospital Geriatric Emergency Medical (GEM) teams.
For more information about the HISH program call 1-800-263-3877 ext. 5656
HISH Teams Contacts Teams are organized into four clusters with members from HCC, SPOs, CSS and Community Paramedicine. Download contact lists below:
HSP Forms and Process Documents
HISH Partner Program Summaries
Patients
