Dennis Martin used to report his customers to their doctor, but now he calls the city.
The pharmacist and owner of a Shopper's Drug Mart in Niagara Falls, Ont., is part of the Gatekeeper program, a sort of Neighbourhood Watch for the elderly that was the first of its kind in Canada.
The drivers who make deliveries for Mr. Martin regularly encounter elderly customers who are confused, living in squalor or shivering in the dark after their heat has been turned off. The program encourages them, and everyone from mailmen to bank tellers and city park employees, to be on the lookout for these and other signs of dementia, and to pass the information along to municipal staff who can make sure help is provided.
For cities, recognizing which residents are struggling with dementia and offering them assistance at home is not just a matter of civic conscience. More than 500,000 Canadians have Alzheimer's disease and related dementias, a number that is expected to double within 20 years. Acknowledging them will quickly become an essential element of protecting a city's bottom line, reducing the number of people who will require a move into long-term care, preventing serious injuries and avoiding charges that city staff has ignored or abused individuals with diminished capacity.
"People always say to me: 'Are you going to lock me up?' " said Jenny Shickluna, the Niagara Region official who administers the Gatekeeper program. "The reality is, we would rather see you live at home. And we want you to do it safely."
Local volunteers started the Niagara Gatekeepers in 1996, and it became an official municipal program in 2009 through a provincial grant that pays Ms. Shickluna's salary.
Serving St. Catharines, Welland and Port Colborne, as well as Niagara Falls and Niagara-on-the-Lake, which comprise a region where more than 20 per cent of the population is older than 65, the toll-free number received 185 calls last year.
This spring, city managers in the region as well as front-line staff in the transit and bylaw enforcement departments, will undergo training for the program.
Since its creation, similar initiatives have popped up across the country, as Canadian municipalities prepare to house an increasingly aged and vulnerable population.
Last December, the ombudsman for the City of Toronto recommended that the Municipal Licensing and Standards Department develop a policy in conjunction with the Alzheimer Society to address the needs of residents with dementia.
The investigation was launched after the son of an elderly woman complained that his mother, who suffers from dementia, was treated unfairly by the property standards officer who cut down a tree on her property.
The city manager has pledged that by March he will unveil a draft dementia policy not just for bylaw officers, but for every department, an acknowledgement that countless municipal employees, from 311 operators to garbage collectors, could encounter a person with dementia in the course of doing their jobs.
"It will not be prudent to exclude any group that interacts with the public. It's something that definitely needs strong policy direction," said Lance Cumberbatch, Toronto's director of investigative services. "At the end of the day, this is going to be better for the city."
So far, most municipal initiatives dealing with aging have focused on physical infrastructure, like adding park benches and increasing the font size on city websites.
John Lewis, a professor of planning at the University of Waterloo who has applied for provincial funds to develop a checklist for age-friendly municipalities, said dealing with cognitive issues is a much more difficult problem.
"It's the intractable dimension of planning; we really don't understand how to grapple with it at this point," he said.
In Toronto, Mr. Cumberbatch anticipates that hundreds of city employees will have to attend training sessions, learning how to identify the signs of dementia and introducing them to support services.
"It probably would not be reasonable to expect a front-line staff person who's trained in enforcing bylaws to deal with this on their own," he said. "We want to establish a network where we can reach out to experts in the field when their assistance is needed."
Mr. Cumberbatch has studied programs developed by Ottawa and San Francisco to help city employees deal with vulnerable adults, and said he will continue to investigate the work of other municipalities.
The Niagara Gatekeepers model is based on an original program introduced in Spokane, Wash., in the 1970s. Long-term assessments of the Spokane program have found that, over time, it reduced the number of elderly residents requiring long-term care and also brought down the number of hospitalizations and suicides among the aged population.
In Niagara, the names of those referred to the Gatekeeper program are kept in a database by the Community Care Access Centre Niagara, which fields the calls, and within the regional department of senior services, which has 1,300 full-time employees.
Ms. Shickluna acknowledges that privacy is an issue when dealing with a health condition such as dementia, and said regional staff respect individuals' "right to remain at risk." No services are initiated, she said, without the senior's consent.
"We never go in to strong-arm them," she said. "Really, it's just a knock on the door to say, 'We're here if you need something.' "
But she has been questioned by city employees and private citizens who are reluctant to report seniors, who regard the program as a requirement to "rat them out."
At the pharmacy, where 70 per cent of the clientele is older than 65, Mr. Martin has a different take.
He knows he is the primary public contact for many of the seniors who fill drug prescriptions monthly, and feels a responsibility to speak up when his employees report that a customer is in distress.
"They come back and say, 'Do you realize this patient doesn't know what's going on?' It's disturbing, to be honest," he said. "All we could do in the past was call their doctor up and say, 'We have a problem.' "
And he also has a personal reason to believe in the power of a community support system, one that becomes more apparent to him with each passing year.
"As someone without any children, I see it as an important program," he said. "Very important."