Keeping care close to home

For residents of long-term care (LTC) homes, a trip to the emergency department can be stressful or even frightening, particularly for those with complex health needs.  

According to the Canadian Institute for Health Information, about one in three LTC residents visit the emergency department each year, and roughly one-third of those visits are considered potentially avoidable.  

That’s where the South West Nurse-Led Outreach Team (NLOT) collaborates with LTC staff and residents.  

Comprising nurse practitioners and registered nurses with advanced training in older adult care, the team supports both residents and LTC staff through bedside coaching, clinical assessments, and timely interventions. The program helps prevent unnecessary emergency visits, while supporting LTC staff skill development.  

Operated by St. Joseph’s Health Care London (St. Joseph’s) with support from the Regional Geriatric Program of Southwestern Ontario, NLOT is funded through provincial and regional health system resources.  

“Our goal is simple: the right care, in the right place, at the right time,” says Erin Watson, Director of Clinical Programs and Regional Geriatric Program of Southwestern Ontario Operations. “We partner with LTC homes to support residents, families, and staff, share expertise, and build confidence in the care team - helping residents get timely care and avoid unnecessary trips to the emergency department.”  

Since its launch in 2023, the South West NLOT has provided support to London Middlesex, Grey, Bruce, Elgin, Oxford, Huron and Perth counties. The team visits both urban and rural LTC homes, ensuring residents throughout the region have access to specialized geriatric care.

Comprising nurse practitioners and registered nurses with advanced training in older adult care, the team supports both residents and LTC staff through bedside coaching, clinical assessments, and timely interventions.  

Operated by St. Joseph’s Health Care London (St. Joseph’s) with support from the Regional Geriatric Program of Southwestern Ontario, NLOT is funded through provincial and regional health system resources. The program helps prevent unnecessary emergency visits, while supporting LTC staff skill development.

“Our goal is simple: the right care, in the right place, at the right time,” says Erin Watson, Director of Clinical Programs and Regional Geriatric Program of Southwestern Ontario Operations. “We partner with LTC homes to support residents, families, and staff, share expertise, and build confidence in the care team - helping residents get timely care and avoid unnecessary trips to the emergency department.”

Since its launch in 2023, the South West NLOT has provided support to London Middlesex, Grey, Bruce, Elgin, Oxford, Huron and Perth counties. The team visits both urban and rural LTC homes, ensuring residents throughout the region have access to specialized geriatric care.  

A team built for impact

NLOT helps meet the growing need for specialized geriatric care by providing additional expertise directly into LTC homes. The team currently works with 32 LTC homes, offering timely assessments, treatments and bedside coaching.

Since spring 2025, the team has trained 861 LTC staff. They have also assessed and treated 130 residents in their LTC homes, working with staff to support residents in place and reduce the need for emergency department transfers.

Registered nurse and NLOT team member Bri Brown describes the experience as incredibly rewarding and has seen the impact firsthand. “I have worked as a registered nurse for 20 years and have found fulfillment in every avenue and specialty. I’ve seen that with the right support and resources, many residents can receive the care they need safely in their home.”

Partnering to bring specialized care to residents

The team offers a wide range of services, including IV therapy, drains, catheters, geriatric assessments and staff training. They work with LTC homes to ensure residents return safely from hospital, avoid unnecessary readmissions, and receive care plans tailored to their needs.

“Working alongside the skilled care providers in long-term care homes, our team offers education and support to strengthen staff skills and confidence,” adds Bri. “Keeping residents in their familiar environment helps prevent delirium and pressure injuries, improving comfort and outcomes.”

“NLOT demonstrates our commitment to keeping care close to home while supporting LTC teams and residents,” says Sandy Jansen, Vice President of Patient Care and Risk Management at St. Joseph’s. “By providing training for staff and specialized care directly to residents, NLOT fosters a more coordinated, resident-centered approach across the region.”

Bri adds, “The NLOT program is unlike anything I’ve ever seen. Collaboration is key - we work alongside LTC teams, sharing expertise and supporting each other. The passion I have for this work is hard to put into words.” adds Bri.

Impact by the Numbers

Since spring of 2025, St. Joseph’s Nurse-Led Outreach Team has:

• Supported long-term care homes in preventing more than 130 emergency department transfers.
• Only 10 per cent of residents referred to NLOT were required to be transferred to the emergency department.
• Trained 861 long-term care staff, increasing their confidence and ability to provide safe, high-quality care.
• Delivered a wide range of services, including IV therapy, wound care, geriatric assessments, support for returning home from hospital, and staff training.

Looking for more information?

Visit our public website to learn more about how St. Joseph’s Nurse-Led Outreach Team (NLOT) is supporting long-term care homes, view a full list of services, and find out how to contact the team.