January, 2024

Let’s Go Home (LEGHO) is a collaborative program offered in Oxford, designed to ease the transition from hospital to home. LEGHO specifically caters to the needs of seniors and adults with physical disabilities discharged from a hospital stay or who have visited the emergency department with concerns related to social determinants of health. The main goal of this program is to allow patients and their caregivers to focus on their recovery supported at home while reducing the likelihood of hospital readmission.

Individuals who may benefit from community support services upon discharge are identified during their hospital stay. After intake and assessment, Community Support Services (CSS) coordinate free supports based on the person’s individual needs. Services available through the LEGHO program are provided by multiple partnering agencies and include:

  • A Community Service Planner to assist with Navigation of CSS Services.
  • Home At Last: hospital discharge support, including assistance with the hospital discharge process, transportation home from hospital, light house cleaning, laundry, prescription/assistive devices/grocery pick up, meal preparation, a complimentary frozen meal entrée, and follow up calls for up to one week post discharge.
  • Meals on Wheels: frozen or hot prepared entrée, soup, and dessert (or equivalent, substitutions are permitted) delivered to client homes.
  • Transportation: pre-booked rides provided to and from follow-up medical appointments. This is a door-to-door service provided by volunteers or paid staff.
  • Home Help: light housekeeping services, which may include grocery shopping, meal preparation, laundry, and light house cleaning.
  • Caregiver Supports (intensive support is available through Dale Brain Injury Services) for those who would benefit from additional information and resources above what the Community Service Planner provides. Caregivers can receive up to 2 hours of 1:1 support, education, and resources from a trained staff member.
  • Community Paramedicine supports: wellness checks and follow ups provided by the Oxford County Paramedic team. These may include other services as required such as blood pressure monitoring, blood sugar monitoring, etc.

The LEGHO program is provided for 4-6 weeks post-discharge from hospital. However, if a person requires additional services beyond 4-6 weeks, staff will help arrange these services prior to the end of the program.

LEGHO in Oxford County

The LEGHO program is centrally led by VON Oxford in partnership with the following community support service agencies: Dale Brain Injury Services, Alzheimer’s Society Southwest Partners, Tillsonburg Multiservice Centre, Ingersoll Services for Seniors, and Cheshire Independent Living Services. The agencies providing the program work closely with system-wide partners across the Oxford OHT such as hospitals, community paramedicine, Home and Community Care Support Services, and community members to ensure the program is running efficiently and effectively.

The LEGHO program is funded to serve approximately 15 people per month. Since December 2022, the LEGHO program has served 199 people. Of those 199 individuals, 41% have continued to receive ongoing services following their discharge from the program.

Given the success of the program, LEGHO in Oxford was recently approved for additional funding from Ontario Health to accommodate an increase of 5 individuals per month until the end of March 2024, allowing the LEGHO program to serve 20 clients per month for that time frame.

Why This Matters

Being able to serve more community members means connecting more people with the programs and services that will help them remain at home. LEGHO provides an opportunity for community members to try services who otherwise may not have been able to try them due to barriers such as cost or access.

Offering multiple services from one point of contact also improves the patient experience, while building connections between partnering agencies.

Please join us in commending and congratulating the LEGHO team on their successes with the program so far. The Oxford OHT is proud to be a part of this initiative; LEGHO truly exemplifies what we can do as a community of providers to better support our citizens.

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