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Programs & Services

Health Links

Through the Geraldton District Hospital, a program called Health Links is offered that looks to care for patients who have high health care needs and may have trouble navigating the health care system. Our Health Links Care Coordinator based out of Geraldton supports patients by helping them organize and understand their health care needs.

Overview of the Greenstone Health Links

The top 5% of hospital users account for two thirds of healthcare spending.

These high-user patients typically have multiple complex conditions and access many areas of the health care system. A recent study found that 75% of seniors with complex conditions who are discharged from hospital receive care from six or more physicians and 30% get their medications from three or more pharmacies. This uncoordinated care from several different providers can result in both gaps and duplication in the care provided.

The Greenstone Health Links has identified these high-users and has an innovative plan to work with them to improve their health and well-being, lessen their reliance on emergency room visits, and reduce system costs at the same time.

At the Provincial level, the Ministry of Health and Long-Term Care first launched regional care networks called Health Links in 2012, with the goal of increasing communications between all members of a patient’s health care team. The program has proven to be very successful and has been rolled out province-wide. There are currently 82 approved Health Links across 14 Local Health Integration Networks.

For more information on Health Links:

Please visit the Ministry Of Health and Long-Term Care’s website:
http://www.health.gov.on.ca/en/pro/programs/transformation/community.aspx

Health Links Patient Map 

What can a patient expect as a participant of Health Links?

One of the most important aspects of Health Links is that it is completely patient-centred. This means that a Health Links Care Coordinator will work with the patient to develop a Health Care Plan that will outline their health care goals as well as strategies on how to achieve those goals.

  • The Care Plan will do the following for the patient:
  • identify their health care goals.
  • develop a plan on how to achieve those goals.
  • put them at the centre of their health care plan.
  • connect them with service agencies that will help provide the care and assistance they may require.
  • ensure communication between healthcare providers.
  • decrease their visits to Emergency Rooms and hospital admissions.


These Coordinated Care Plans become the central document in the patient's care and all members of the coordinated care team base their care upon the goals the patient has set for themselves. This document is so completely patient-centred that it is written in the first person; in their voice. This is their plan, not the primary care provider's, not the coordinator's. This is shown in the following excerpt from the Coordinated Care Plan:

Goals Chart

 

This personalized assistance will help empower the patient and enable ownership and implementation of their coordinated care plan. The care provided by the Health Links is often broader than that offered by primary care providers since it offers patients enhanced care that includes addressing not only the medical needs of the patient, but the psychosocial as well.

The biopsychosocial model states that biological, psychological and social factors all play a significant role in determining a person's health and well-being. The social determinants of health are a key focus of the Health Links.

The Greenstone Health Links is about coordinated care and services that are wrapped around the patient based on their goals. Through the Health Links, everyone in the patient's personalized care network shares information about the patient's health in order to meet the patient's goals and to improve their journey through the health care system. This marks a philosophical change in the delivery of health care, not a new program.

The Health Links and the collaborating partners believe in the importance of system change, but the patients are leading the direction of that change. The Health Links is change at the grassroots level with a team approach to care.

What Do You Need?

Supports Within the Community

A weak social safety net leaves people lost and with nowhere to turn when they face issues and problems in their life such as unemployment, illness, death, or some other crisis. This has health-threatening effects. People have better physical and mental health when they have a secure social network for living a productive life.

  • North Of Superior Counselling Programs (NOSP)
  • Greenstone Family Health Team (GFHT) Social Worker
  • People Advocating for Change through Empowerement (PACE)

 

The Ontario and Canadian Governments have several income support programs in place to assist citizens.

  • Service Canada Center
  • Thunderbird Friendship Center

Having healthy finances shapes overall living conditions, affects psychological functioning, and influences health-related behaviours such as quality of diet, housing, extent of physical activity, and habits like smoking and substance abuse. Even if your earnings are low, budgeting properly and managing your money can mean keeping your finances on track and living with less stress.

  • People Advocating for Change through Empowerement (PACE)
  • Personal Bank (RBC, TD, etc.)

 

Food is one of the basic human needs and it is an important determinant of health and human dignity. People who experience food insecurity are unable to have an adequate diet in terms of its quality or quantity. Hunger or poor diet leads to numerous illness, chronic disease, even death in children, and people of all ages.

  • Greenstone Harvest Center - Food Bank
  • Thunderbird Friendship Center

In homes where there is not enough food, people are more likely to have diabetes, high blood pressure, food allergies, and eventually chronic disease. When children live in homes where there is not food security, they are more likely to experience a range of behavioural, emotional, and academic problems.

  • Greenstone Harvest Center - Food Bank
  • Thunderbird Friendship Center
  • Ontario Works

 

Mental health means striking a balance in all aspects of your life: social, physical, spiritual, economic and mental. Reaching a balance is a learning process. At times, you may tip the balance too much in one direction and have to find your footing again. Your personal balance will be unique, and your challenge will be to stay mentally healthy by keeping that balance.

  • North Of Superior Counselling Programs (NOSP)
  • Greenstone Family Health Team (GFHT) Social Worker
  • Thunderbird Friendship Center

 

Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Even when the home construction is healthy other situations such as unemployment, financial crisis, physical safety or other factors may create the need for emergency and alternative housing.

  • Municipality of Greenstone - Town Office
  • Provincial Government - Bursaries & Grants (Senior, Handicapped, Indigenous, etc.)

 

Unemployment is related to poor health through various ways. First, unemployment often leads to poverty by reducing income and removing benefits that were previously provided by your employer. Second, losing a job is a stressful event that lowers your self-esteem, disrupts daily routines, and increases anxiety. Third, unemployment increases the likelihood of turning to unhealthy coping behaviours such as smoking, drinking, drugs, and mental health issues.

  • Ontario Works
  • More Than Words (MTW)
  • Thunderbird Friendship Center

 

Education and literacy help provide understanding of how you can impact your own health through your specific actions. With improved understanding, you may realize what might be harmful or beneficial to your health.You achieve greater ability and more resources to allow attainment of healthier lifestyles.

  • More Than Words (MTW)
  • Thunderbird Friendship Center

 

Greenstone is a rural community with no public transit. As such there are challenges for the elderly, persons with disabilities, those living out of town trying to gain access to employment, community resources, medical appointments, etc. The social impact of restricted access to transportation can have a negative impact on physical and mental health.

  • Municipality of Greenstone - Town Office 
  • Local Taxi Services
  • Kasper Transportation Service - Shuttle

 

In the old days, men hunted and women raised the kids. Then we moved out of caves, invented gender studies, and learned a thing or two about genetics. Now nothing is clear cut. While social and biological analyses of gender offend some, they have freed others to finally feel comfortable in their own skin. Whether you're male or female, gay or straight, transgender or cisgender, or just curious about why men and women treat each other the way they do, there are resources available to assist you.

  • Greenstone Family Health Team (GFHT) Social Worker
  • People Advocating for Change through Empowerement (PACE)

 

Relationships are challenging, sometimes even exhausting. People with poor relationships are more likely to suffer from depression, and loneliness is powerful enough to weaken our immune system and cause illness. Whether the relationship is with a partner, husband/wife, boyfriend/girlfriend, a child, mother or father makes it no less stressful when there are issues with someone we love or care about. And, the issue does not have to be a conflict, it can be dealing with grief or some other loss, a new relationship with a new stepchild, our own teens having adjustment difficulties in their new high school, etc. Whatever the issue, it is always best to get help to deal with our emotions before they take over and impact our health.

  • North Of Superior Counselling Programs (NOSP)
  • Greenstone Family Health Team (GFHT) Social Worker
  • Thunderbird Friendship Center
  • Greenstone Victim Services (GVS)
  • Geraldton District Hospital (GDH)

 

During early childhood a child learns through play, physical activity, and social interaction with others. The emotional, social and physical development of young children has a direct effect on their overall development and on the adult they will become. That is why understanding the need to invest in very young children is so important, so as to maximize their future well-being.

  • North Of Superior Counselling Programs (NOSP)
  • Thunderbird Friendship Center

 

Positive health practices and coping enable people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

  • Greenstone Family Health Team (GFHT) Social Worker
  • Greenstone Health Links Program
  • Local Churches/Religious Institutions
  • Thunderbird Friendship Center

 

Medical professionals are beginning to recognize the role that creative arts play in the healing process; there is a strong link between creative expression and stress reduction, pain management, and the medical outcomes of patients with chronic disease. Music and the arts have been used in traditional healing for thousands of years, so it is not surprising that it is being studied and proven as a successful healing method now.

  • Thunderbird Friendship Center
  • People Advocating for Change through Empowerement (PACE)
  • Greenstone Public Libraries

 

One of the hardest things for anyone to do is figure out their life purpose. Every one of us get wrapped up in chasing a life we think is right for us or simply falling into a lifestyle because few choices are available due to our living conditions, poverty, lack of educational options, substance abuse, mental health issues, or other obstacles that were beyond our control in our younger years. As harsh as this seems, one way of figuring out our life purpose is to fast forward our life and think of our death. It is time for our eulogy: what do you want people to think of you and say about you? What do you want to have achieved in your life? What made you happiest?

Get out a paper and pen, and make a list of all the things you have to do and change to get there.

  • Greenstone Family Health Team (GFHT) Social Worker
  • Greenstone Health Links Program
  • People Advocating for Change through Empowerement (PACE)

 

Numerous studies have found that insufficient sleep increases a person's risk of developing serious medical conditions, including obesity, diabetes, and cardiovascular disease.  We know that finding a place to lay your head a night is not always possible due to circumstances beyond our control in our life. There are a number of solutions in our community that can help out when we have no other options due to poverty, personal safety other issues in our life.

  • Thunderbird Friendship Center
  • People Advocating for Change through Empowerement (PACE)
  • North Of Superior Counselling Programs (NOSP)
  • Ontario Works

 

We have all heard the benefits of physical health, and the benefits to your health are many. Start doing some type of physical activity to: Control your weight,  reduce your risk of cardiovascular disease, reduce your risk for type 2 diabetes and metabolic syndrome, reduce your risk of some cancers, strengthen your bones and muscles, Improve your mental health and mood.

  • Greenstone Community Centers
  • Municipal Swimming Pool
  • Municipal Senior Centers
  • Municipality of Greenstone - Town Office

 

The environment you live or work in can impact your health. If your home or workplace is unsafe it can contribute to falls, or disease from polluted drinking water, chronic conditions from poor air quality. Overcrowding, mold, poor ventilation, improper temperature control are all examples of issues that may have an impact on your health and safety.

  • Municipality of Greenstone - Town Office
  • Geraldton District Hospital 
  • Geraldton Medical Clinic
  • Thunderbird Friendship Center
  • Greenstone Family Health Team (GFHT)

 

All cultures and societies have particular values and beliefs, which enable a sense of identity and meaning. Within the Geraldton community there is a strong Indigenous and Francophone community that forms the historical backbone of the region.

  • Local Churches/Religious Institutions
  • Thunderbird Friendship Center

 

Being able to reach and access health services in the community when you need them is critical to everyone's continued good health.

  • Greenstone Family Health Team (GFHT) - Walk-In Hours
  • North Of Superior Counselling Programs (NOSP) - Walk-In Hours

 

You would think condition specific habits relate to things like addictions or substance abuse. And, in certain cases that is true. In other cases it could be that there are medical conditions that require specific devices or other interventions necessary for the activities of daily living.

  • March of Dimes
  • Easter Seals
  • Geraldton Medical Clinic - Physicians
  • Greenstone Family Health Team (GFHT) - Nurse Practinioner