LTV Programs and How to Refer

This section of the Portal will include a complete listing of available LTV programs offered across the Province including admission criteria and how to refer.  
​
The Strategy will continue to update this section as we receive information from our Partners.

The Ottawa Hospital
​The Ottawa Hospital (TOH) is the Ontario East hub for the Provincial LTV Strategy. TOH is taking the lead to collaborate with and assist community partners and spokes within the eastern hub. This collaboration is currently ongoing. 
TOH and its partners in the Champlain LHIN region, are  offering the following services:

Care of long-term ventilated patients in the ICU.

• Chronic ventilator and parameters initiated in ICU
• Weaning and optimization of ventilator settings done in ICU setting
• Rehabilitative care including attempted liberation from tracheostomy and mechanical ventilation, where possible
• CANVent at the rehab center, offers assistance and advice for weaning
• Application for long-term institution is submitted by social worker in ICU
• Goals of care and daily routine established prior to transfer to wards
• Teaching for home discharges initiated by TOH RT in conjunction with Complex Respiratory care (@Somerset West) and the VEP

Care of long-term ventilated patients in the Ward

• General Campus at TOH has 2 bed capacity on medicine ward
• Patients have to be accepted by either medicine or respirology service 
• RN to patient ratio is 2:1
• RT services 24/7.  RT responsible for ventilator charting, parameter changes, cough-assist, PMV, MVP, and all respiratory related care
• External Alarm for ventilator directly connected to nursing station

Canadian Alternative in Non-Invasive Ventilation (CANVent)

• Primarily an outpatient program operating out of The Ottawa Hospital’s Rehabilitation Centre 
• Team consists of Dr. Doug Mckim (Medical Director), Dr. Karen Earlam (Neuromuscular Respiratory Management), Respirologists, RT’s and an RN
• Offers non-invasive support methods to patients with serious respiratory complications
• Pioneer of many approaches to clinical management of patients at risk of respiratory complications, including respiratory failure secondary to neuromuscular/neurologic conditions
•  Perform regular pulmonary function testing and capillary blood gases
• Introduce and educate use of LVR therapy
• Assess the effects of LVR on FVC, Peak cough flows and Maximum insufflation capacity
• Proactive overnight oximetry testing, which may:
  • prevent or reduce the need for level 1 sleep studies
  • Help identify early evidence of sleep disordered breathing
• Initiation of outpatient NIV support
• Provide advice and support to critical care units on the weaning of ventilatory support in appropriate patients. This may include weaning to NIV or to MPV
• Proactive and early education and suggestion of PEG tubes in ALS patients
• Follow close to 250 outpatients in the community requiring a mix of invasive and non-invasive ventilatory support
• Phone support by RT’s to inquiries, 5 days a week during the day
• Access to remote downloads through the VEP and CRC RT’s
• Work closely with the team at Complex Respiratory Care

    Referrals to the program are sent by primary care physician or specialist by fax to (613) 736 - 9054


Complex Respiratory Care via Somerset West Community Health Centre
Established in 2017 following a key stakeholder meeting to establish a strategy for Long Term Ventilation and Tracheostomy Care across the Champlain Region.  Hosted at Somerset Community Health Centre to integrate with an established community-based Lung Health Program.

• Outreach Services provided by Registered Respiratory Therapists 
• Referral form to be filled out and submitted by RT lead or physician at referring facility 
• Provide Ongoing Support and education to Complex Respiratory Care Clients and their Caregivers Currently Living in the Community. (This education begins in acute care settings prior to patient being discharged home).
• Facilitating the Opportunity for Clients with Complex Respiratory Care Needs to successfully transition back into the community from both acute and sub-acute care settings.

 
Program is supported by Regional Clinical Lead:  Dr. Doug McKim

The following services are offered:

• Training and education to medically stable clients with tracheotomy and/or ventilator-assisted individuals and their families
• In home tracheotomy tube changes
• Coordinate with the discharging facility to promote a safe and successful discharge to home or community living
• Comprehensive Assessments, and ongoing support to the client while in the community
• Initiation of treatments as per physician orders and titration via medical directive
• Routine follow-ups with patients and their families
• Phone/virtual consult
• Download data from client devices
• Ongoing respiratory assistance, education and assessments for patients in the community

Referrals to the CRC program are made by completing and faxing the referral form.


Bruyère Health – Saint-Vincent Hospital
Ottawa’s only complex continuing care hospital where care teams maintain and improve function for patients with complex needs. 

• 336 total bed capacity, with 30 beds dedicated for patients requiring long-term ventilation

Long-Term Complex Care: Patients who need specialized services over an extended period to maintain, slow the rate of, or avoid further loss of function. This includes patients requiring long-term ventilation who have chronic respiratory difficulties and require permanent ventilator care.

• Offer 2-3 respite beds for patients requiring LTV 
• Offer care for patient populations requiring non-invasive or invasive ventilatory support 
• Ability to actively wean patients when possible 
• Can perform overnight oximetry and has software to download data
• RT support available 8 hours a day, 5 days a week 
• Biomedical team actively involved in customizing communication devices for patients 
• Occupational therapists are involved in equipment and wheelchair customizing 
• Speech therapists assess swallowing and use of PMV 
• Physio does routine work with patients
  
  

Application is submitted by referring facility or care physician to the admissions team, which will then review the application internally and determine if patient qualifies for a bed. The admissions team can be reached at (613) 562 – 6262 ext. 4000


Providence Care 
Complex Medical Management is an inpatient program at Providence Care Hospital (PCH) in Kingston that is offered to patients who have multiple chronic diseases. The program is provided to patients as a means to:

• increase activity tolerance
• slow the rate or avoid further loss of function

Functional objectives include optimizing and ongoing maintenance of functional abilities. Patients receiving Complex Medical Management may have:

• extensive wounds, with the goal to bring the wound to a level of care that can be managed in the community
• complex respiratory needs

Referrals to this program can be sent using the referral form.

Admission Requirements

• Age 16 years or older
• Acute medical needs stabilized but requiring on-going medical/nursing support over an extended period of time at a level that cannot be met at home or in a LTCH. 

---

West Park Healthcare Centre

Long-Term Ventilation Unit (LTV)
Because of illness or injury, some individuals are unable to breathe on their own. West Park Healthcare Centre's Long-Term Ventilation Service is an 65 bed in-patient unit that provides care to people who need ongoing mechanical assistance to help them breathe for all or part of the day.

We provide 24-hour residential care for these invasively ventilated individuals, with a focus on improving their health, well-being and independence. In addition to meeting their physical needs, West Park staff members help residents develop the skills to plan and direct their own care and, in some cases, to explore independent living. 

Admission Criteria

• Patient medically stable for at least 14 days
• No constant monitoring requirements
• No inotropes for the past 14 days
• No significant medication changes  in the past 14 days
• No major cardiac or respiratory events in the past 14 days
• Supplemental oxygen less than 40% on or off the ventilator
• No hemodialysis unless patient is able to attend outpatient clinic on their own
• No NG tube (patient either takes food orally or switched to G/J/PEG tube)
• Appropriate ventilator settings
• All patients should be fully ventilated at night utilizing set respiratory rate rather than pressure support
• Suctioning cannot be more frequent than every 2-3 hours
• Suggest lung hygiene routine (i.e. cough assist, breath staking) for patients on trach mask for patients who have an ineffective/weak cough
  
  

Referral to the program is made via RMR Centralized LTV Waitlist (LTVHub) for ICU's within the Greater Toronto Area.   For referrals outside this area, please download and fax the appropriate referral form to our admitting department. 

There is a co-payment for this bed.

Transition to Home Ventilation Program (THV)
The Transitional Home Ventilation service helps patients requiring chronic invasive ventilation integrate back into the community from acute care hospitals. 

The service provides rehabilitation, training and education to medically stable ventilator-assisted individuals and their families using a variety of tools.

The 4 bed service includes 4 transitional home ventilation beds at the Centre and enables staff to address barriers to entering West Park’s traditional Home Vent Assessment and Training Service, which is reliant on individuals having adequate caregiver support and accessible homes to return to.

Candidates for THV are:

• 18 years of age and older who require mechanical ventilation for all or part of the day;
• Willing to participate in the program;
• Medically stable;
• Cognitively stable (or have a documented substitute decision-maker);
• Able to direct their own care;
• Able to return to the community with established discharge support.
• Patient medically stable for at least 14 days
• No constant monitoring requirements
• No inotropes in the past 14 days
• No significant medication changes in the past 14 days
• No major cardiac or respiratory events in the past 14 days
• Supplemental oxygen less than 40% on or off the ventilator
• No hemodialysis unless patient is able to attend outpatient clinic on their own
• No NG tube (patient either takes food orally or switched to G/J/PEG tube)
• Appropriate ventilator settings
• All patients should be fully ventilated at night utilizing set respiratory rate rather than pressure support
• Suctioning cannot be more frequent than every 2-3 hours
• Suggest lung hygiene routine (i.e. cough assist, breath staking) for patients on trach mask for patients who have an ineffective/weak cough
  
  

Referral to the program is made via RMR Centralized LTV Waitlist (LTVHub) for ICU's within the Greater Toronto Area.   For referrals outside this area, please download and fax the appropriate referral(opens in a new tab) form to our admitting department.

There is no co-payment for this bed.

Respiratory Complex Continuing Care 
For people with severe lung disease, simply taking a breath can be challenging. West Park Healthcare Centre's Respiratory Complex Continuing Care Service is a 24-hour, residential care program for people with complex respiratory disorders.

This 26-bed service is designed for people whose needs can't be met in the community or in a long-term care home. Our respiratory care team works with residents to develop an individualized care program, which may include non-invasive ventilation.
Referral is made by downloading the referral form (opens in a new tab)and faxing to our admitting department

There is a co-payment for this bed.


Michael Garron Hospital

Long-Term Ventilation Unit (LTV)
Michael Garron Hospital’s 18 bed Long-Term Ventilation (LTV) Program is a part of the hospital’s Complex Care Unit located on the 5TH floor. 

This LTV program provides a stimulating environment that enhances quality of life for medically stable ventilator-dependent patients. An interdisciplinary team of care professionals work collaboratively to support the care of individuals admitted to this program who require mechanical ventilation for all or part of a 24-hour period. 

Admission Criteria

• Patient medically stable for past 30 days
• No constant monitoring requirements
• No inotropes in the past 30 days
• No significant medication changes in the past 30 days
• No major cardiac or respiratory events in the past 30 days
• Supplemental oxygen less than 40% on or off the ventilator
• No hemodialysis unless patient is able to attend outpatient clinic on their own
• No NG tube (patient either takes food orally or switched to G/J/PEG tube)
• Appropriate ventilator settings
• All patients should be fully ventilated at night utilizing set respiratory rate rather than pressure support
• Suctioning cannot be more frequent than every 2-3 hours
• Suggest lung hygiene routine (i.e. cough assist, breath staking) for patients on trach mask for patients who have an ineffective/weak cough
  
  

Referral to the program is made via RMR Centralized LTV Waitlist (LTVHub) for ICU's within the Greater Toronto Area.   For referrals outside this area, please the appropriate referral form(opens in a new tab) to Karen Kerry (Program Manager).

Patients are responsible for a co-payment.

Prolonged-Ventilation Weaning Centre of Excellence (PWC)
Michael Garron Hospital’s Provincial Prolonged-Ventilation Weaning Centre of Excellence (PWC) holds a mandate from the Ministry of Health as a Provincial Weaning Centre of Excellence.
Our program is designed to provide care to medically stable patients who require prolonged effort to wean from mechanical ventilation. Patients will be admitted for a maximum length of stay of three months. The following resources will help healthcare providers navigate the referral and admission process.  
Any member of the care team can fill out and email or fax the referral form.

ADMISSION CRITERIA

• Adult ICU patients who remain on a mechanical ventilator for more than 14 days and have a tracheostomy in place
• Patients who can participate in and direct their own care.
• Patients who are in stable condition, apart from mechanical ventilation
• Advanced care plan and/or goals of care discussions documented
• Patients who have a feeding support in place
• Patients who do not require kidney replacement treatment PWC is  awaiting approval to provide this service
• Patients who do not have a clearly irreversible disease such as such as metastatic cancer or advanced dementia

For patients who do not immediately meet the admission criteria, referral can result in an Ontario Telemedicine Network (OTN) teleconsultation between the PWC care team and the referring ICU team.

ADMISSION PROCESS

• Care teams in referring ICUs will identify patients who have been ventilated for longer than 14 days and who meet the MGH PWC admission criteria
• The referring ICU care team completes the PWC application(opens in a new tab) form and emails it to prolonged.ventilation@tehn.ca or faxes it to 416-619-6612
• The MGH PWC team will acknowledge the receipt of the application within 48 hours
• If a bed is currently available and the patient appears to be a potential candidate, the referring facility will be notified of a decision. Additional information may be requested prior to the final decision being made.
• If a bed is not available and the patient appears to be a potential candidate, the patient's application will be placed on our wait list. The sending facility should provide bi-monthly updates.
• If the patient does not meet admission criteria for admission to PWC, OTN Teleconsultation can be arranged.

There is no co-payment for this bed.


Toronto Grace Health Centre
Toronto Grace Health Centre has a 32 bed program that provides an innovative continuum of care model for medically stable patients with chronic critical illness/multiple co-morbidities who require invasive or non-invasive mechanical ventilation for at least six hours each day.
 
Programs include:

• Long-Term Ventilation beds
• Ventilator Weaning
• Transition to community
  
  

Admission Requirements:

• Patient requiring mechanical ventilation for >14 days, and medically stable for at least 7 days prior to transfer: 
• Tracheostomy in situ/ PICC in situ
• No pressor/inotrope use in preceding 7 days prior to transfer
• No significant medication changes in preceding 7 days prior to transfer
• No major cardiac or respiratory events in preceding 7 days prior to transfer
• Supplemental oxygen less than 50% on /off the ventilator 
• Hemodialysis is possible — Patients must be pre-scheduled at referring site prior to transfer G/J/PEG tube in situ 
• Stable ventilator settings for preceding 7 days prior to transfer 
• Tracheal Suctioning - maximum frequency q 2-3 hours 
• Documented Advance Care Plan and/or goals of care discussion within 48 hours of transfer. 
• If previously infected, documented COVID negative in past 7 days. 
• For patients accepted to LTV, repeat COVID testing will be required during the 72 hours prior to transfer.
• All IPAC practices documented
  
  

Referral to the program is made via RMR Centralized LTV Waitlist (LTVHub) for ICU's within the Greater Toronto Area.  For all other areas, please contact the admission department at Toronto Grace.
Co-payments may apply depending on the program.  Contact Toronto Grace for details.


St Joseph's Healthcare Hamilton  
5-bed long-term rehabilitation unit for people who need ventilator support.  Please contact them directly for more information.


St. Joseph's Care Group Thunderbay
4-bed unit for patients requiring long-term ventilation. Please contact them directly for more information.


Sunnybrook Health Sciences Centre
The Respiratory Team at Sunnybrook Health Sciences Centre provides exceptional expertise in noninvasive ventilation and airway clearance management for patients facing chronic respiratory failure or restrictive lung disease. We also specialize in supporting patients transitioning from acute care to home or those living in the community who require noninvasive ventilation.

Our team manages a diverse range of patients, including those with neuromuscular conditions, obesity hypoventilation, chest wall diseases, and spinal cord injuries. We also conduct assessments for initiating noninvasive ventilation for patients with severe COPD.

By leveraging advanced technology for virtual visits and monitoring, we deliver personalized care, along with an academic mandate educating future health practitioners and conducting quality research in Long Term Mechanical ventilation. This approach ensures that patients receive timely and effective management of their conditions at home.

We offer in-person consultations and diagnostics at Sunnybrook, as well as virtual video assessments in the home. Additionally, we provide consultation services to various acute care facilities across the Greater Toronto Area, facilitating smooth transitions for patients moving to home-based noninvasive ventilation or airway clearance devices.
​
Moreover, we host the Sunnybrook ALS Clinic and SMA (Spinal Muscular Atrophy) Clinic, which offer multidisciplinary assessments and management for patients with ALS or SMA. Respiratory evaluations are integrated into these clinics, ensuring comprehensive care for our patients. Attached are referrals for Home Noninvasive ventilation Assessment as well as the ALS clinic. 

A copy of the referral form for long-term non-invasive assessment can be found in the resources section.

London Health Sciences Centre 
London Health Sciences Centre (LHSC) is the Ontario West hub for the Provincial LTV Strategy. LTV includes both prolonged mechanical ventilation (PMV) for patients cared for in ICU/hospital settings and home mechanical ventilation (HMV) for patients receiving this support in our communities and at home. LHSC will take ownership to organize collaboration with other partners within Ontario West to assist in the regional care of these individuals. The details of this collaboration are still in development.

Presently, LHSC is prepared to provide the following assistance within Ontario West:

Prolonged Mechanical Ventilation
We are in the development of a Critical Illness Recovery Program (CIRP) to provide rehabilitative care for patients requiring mechanical ventilation beyond 21 days in an ICU setting. This includes attempted liberation from tracheostomy and mechanical ventilation, where possible. Presently this program is delivered within the footprint of our Medical Surgical ICU (MSICU) at University Hospital. Dedicated intensivists/clinicians provide support for patients meeting criteria thought to perceive benefit from this focused care. 

​We can offer the following assistance:

1. Consultation with our CIRP clinical nurse specialist and physician on call
2. Supportive care from a distance to assist smaller ICUs

Appropriate patients for Consultation with CIRP include:

• ICU patients with tracheostomy (or imminent plan for tracheostomy)
• Invasively ventilated patients >21 days
• On NIV or Cough Assist with plan to continue beyond ICU discharge
• Patients followed in LHSC’s Home Respiratory and Ventilatory Care (HRVC Clinic) and admitted to ICU.

Home Mechanical Ventilation
We have a Home Respiratory and Ventilatory Care (HRVC) service, sited at University Hospital, that provides weekday multidisciplinary support for patients receiving HMV. This is a shared responsibility between the LTV Respiratory Care Facilitator therapist and the HRVC physician. HRVC provides access to specialized respiratory care for:

• patients with neuromuscular disease, acquired or congenital, with respiratory failure or at risk for respiratory failure (in collaboration with Neurology).
• complex medically fragile patients requiring ventilator support or at risk for respiratory failure including those with kyphoscoliosis, diaphragmatic weakness/paralysis, cerebral palsy, and spinal cord injury.
• complex medically fragile patients requiring technological assistance for respiratory secretion clearance.
• patients supported with mechanical ventilation (non-invasive and invasive), as well as cough assist devices.
• long term tracheostomy care

For consultation contact: Linda Wunnink, HRVC Administrator, at 519-663-3921


Waterloo Regional Health Network @ Chicopee
The chronic ventilator/respiratory unit provides 14 long-term ventilation beds with highly specialized care for individuals with complex and chronic respiratory conditions including those individuals who require a ventilator. 
Admission Requirements:

• Discontinue continuous monitoring of cardiovascular status including pulse oximetry
• Patient medically stable for past 30 days
• No inotropes, significant medication changes, or major cardiac or respiratory events
• Active treatment plan for all medical conditions
• Supplemental oxygen less than 40% on or off the ventilator
• No NG tube (patient either takes food orally or switched to G/J/PEG tube)
• Multiple failed attempts at weaning from mechanical ventilation
• Mechanical ventilation includes both invasive and non-invasive ventilation intended to support patient’s ventilatory needs, assuring adequate ventilation in patients who are not able to support their own respiration
• Appropriate ventilator settings (i.e. patient successfully transitioned to home care ventilator or Bilevel device for greater than 72 hours)
• Suctioning cannot be more frequent than every 2 to 3 hours
• Suggest lung hygiene routine (i.e. cough assist, breath stacking) for patients on trach mask for patients who have an ineffective/weak cough
• Code status is established and verified with patient and family

Referral Process

• Complete referral form (available on the WRHN - Chicopee website) and fax to Coordinated Bed Access 519-742-0635
• Wait list managed by Home and Community Care
• Referrals are reviewed by the multidisciplinary team to determine if the patient meets admission criteria, and is the medically stable. 

St. Joseph's Healthcare London: Parkwood Institute
The Complex Care Program at Parkwood Institute provides a clinical setting for patients requiring long-term mechanical ventilation (LTV) and has 6 beds within the Complex Care Program that can be used for the residential care of “medically stable” ventilator dependent individuals.
The purpose of transferring these individuals to the Complex Care Program is to provide a more appropriate setting to care for and manage their health, welfare and social needs. This transfer will also help increase the capacity of critical care areas across the region.
This facility is not mandated, staffed or resourced to facilitate protocols for attempting weaning from mechanical ventilation. 

Phone number 519 685-4000 ext. 44015
Fax number 519 685-4577
Email: ComplexCare@sjhc.london.on.ca


Hôtel-Dieu Grace Healthcare 
Hotel-Dieu Grace Healthcare (HDGH) has 6 permanently funded LTV beds and an addition 2 beds temporarily funded.   
HDGH is committed to ensuring that a comprehensive inter-professional team assessment is completed for every patient referred to the LTMV program. The patient’s medical, as well as psychosocial needs and goals will be considered on an individual basis. If determined that HDGH is the most appropriate placement for the patient, then arrangements will be made for a smooth transition from acute care to HDGH LTMV program.
To refer a patient to HDGH, please contact the intake department directly.

Admission Criteria
​

• Must be 17 years of age or older. *Paediatric population by exception only
• Patient must have valid OHIP coverage
• Nocturnally ventilated patients must be alert, able/willing to cooperate with care plan, able to access the call bell system and direct their own care.
• Comprehensive plan of care and disposition has been developed and agreed upon by patient/family and care team
• Medical stability: non-respiratory organ dysfunction has been stabilized
• Treatment plan for all medical conditions is in place Hemodynamically stable for 2 weeks (shorter time frame for repatriation may be considered)
• Discontinue continuous monitoring of cardiovascular status including pulse oximetry
• System assessment complete: sleep, delirium, anxiety and pain addressed.
•  Completed ENT consult and recommendations for SLP (as appropriate)
• If patient cannot have oral intake, established G-tube or J-tube in place
• Arterial line and nasogastric tube must be discontinued
• Cap or remove PICC lines (if appropriate)
• Routine blood work frequency approximately once/week. No stat labs that require special processing
• Multiple failed attempts at weaning from mechanical ventilation
• Mechanical ventilation includes both invasive and non-invasive ventilation intended to support patient’s ventilatory needs, assuring adequate ventilation in patients who are not able to support their own respiration. This includes any electrical or pneumatically powered closed system mechanical ventilator support device.
• Respiratory stability has been established: 
  • Decrease PEEP to no greater than 10 cmH2O and maintain without fluctuation for 72 hours minimum
  • Decrease oxygen to no greater than 40% and maintain without fluctuation for 72 hours minimum
  •  Patient to be on chronic care ventilator or BiPAP machine with appropriate pressure settings for 72 hours prior to transfer
  • Tracheostomy to be established in acute care
• Tracheostomy to be reviewed by NP and RT representative from HDGH re: appropriateness for HDGH
• Acute care to establish and verify code status with patient and family
• Behaviors and use of restraints to be reviewed and understood prior to transfer