Nurse Led Outreach Teams (NLOT) are nursing teams (including Nurse Practitioners & Registered Nurses) with expertise in geriatrics and seniors’ mental health who provide timely access to evidence based, quality care for older adults living with complex health conditions in the Long-Term Care (LTC) setting. NLOTs provide urgent mobile nursing services in Ontario LTC homes to respond to arising health care needs of LTC residents, and reduce unplanned transfers to emergency departments (ED) and hospital admissions. NLOTs also help to reduce the length of a hospital stay for residence by supporting early transitions between hospitals and the LTC environment.
Started between 2007 and 2010, there are currently 25 NLOT teams located throughout Ontario. NLOTs are one of Ontario’s specialized geriatric services . Data about NLOT programs is collected locally and included in the Provincial Specialized and Focused Geriatrics Services Asset Inventory.
NLOT provides integrated nursing and primary health care services to residents in the LTC setting with the goals of:
- Reducing visits to emergency departments
- Providing access to urgent outpatient services and in-home care
- Building capacity for the care of older adults living with complex health conditions in LTC
- Reducing hospital length of stay (LOS) and alternative level of care (ALC) by facilitating discharge planning and early repatriation to LTC
- Implementing best practices and innovation to optimize resident-centred care
Working in collaboration with LTC medical directors and the Home’s existing clinical team, NLOT teams may provide
- In-home clinical assessments and follow-up
- Direct comprehensive primary care, acute episodic and palliative and end-of-life care
- Advanced nursing care
- Consultations in-person or virtually
- Liaison with other system partners (e.g. diagnostic services, specialist physicians, acute care centres, emergency departments)
- Collaborative care planning
- Capacity building, education and resources to support complex nursing skills