It is not a good day for Alvin Graham.
Oblivious to the dazzling sunshine outside, Alvin sits hunched over and frail, looking tiny on his large black couch, exhausted by a morning trip to the dentist that deepening dementia has already erased from memory.
A fiddle, banjo and mandolin sit high on a tall bookcase, never to be touched again. “I’m wearing down,” he says.
At 92, with his dysfunctional right hand, restless, roaming nights and dementia, Alvin, by rights, should not be living at home. But there he is, surrounded by mementoes of the past and familiar family photographs.
Most of the credit goes to the loving, tireless efforts of his wife of 63 years, Sheila. But through the door comes another reason.
“Hi Alvin, nice to see you. How have you been?” It’s Jay Slater, the couple’s family doctor.
Dr. Slater is that rarity in Canada’s $191-billion health care system, a GP practising the age-old remedy of regular house calls. He does this every weekday afternoon. Almost all of his 150 patients are the homebound elderly.
This blast from the past could be critical to the sustainability of health care. It is one way to defuse the ticking time bomb – care of growing numbers of seniors – that threatens Canada’s financially stressed medicare system.
It’s not those over 65 who are the worry. It’s those over 85.
By 2050, they will comprise 9 per cent of the population. Most have significant problems with mobility, memory and the simple chores of life.
Treating frail seniors in their homes is not only good for them, it reduces their hospital trips and medication needs as well as postponing admission to long-term care – all major drivers of health-care costs.
“It’s a lovely, win-win situation,” says John Sloan, the now-retired physician who pioneered the concept in Vancouver. “As you provide better care for these people, the price of it goes down. If we do this the right way, we may just rescue the health-care system. It’s the future. It has to be.”
For 15 years, Dr. Sloan, 63, managed a roster of 250 patients he tended in their homes. The experience left him with a fervent belief that the elderly are far better treated there than in costly hospitals, where too often they are overtested, poorly diagnosed and overmedicated.
“It’s okay to die, you know. But we’re so afraid of it, we put old people into hospitals, where they die in misery,” he says.
Regular home monitoring of the elderly is designed to head off medical trouble that would otherwise land a patient in hospital.
British Columbia is helping out. The province recently doubled the fee paid for home visits to $106. “That’s pretty good,” Dr. Sloan says.
Although it hasn’t happened yet, that financial recognition could spur a recovery of the old image of the GP, black bag in hand, making his way to a patient’s front door.
“It’s amazing how few there are now,” marvels Rob Boulay, president of the College of Family Physicians of Canada. “And it’s happened over a single generation.”
Dr. Boulay says house calls fell out of favour as doctors became increasingly overwhelmed, trying to balance patient loads with the desire to lead a normal life.
Dr. Slater, 52, is one of three family doctors who have joined to take up the slack from Dr. Sloan’s retirement in 2008. Their waiting list for new patients is three months long.
At the Graham home, Dr. Slater arrives with a young medical student, Sam Wasswa-Kintu. Alvin gets a flu shot, has his blood pressure checked (“Very good, Al. Like a young man.”) and a worrisome spot on his ear looked at.
Then, it’s Sheila’s turn. If she burns out, her husband’s time at home is done. Dr. Slater monitors her closely. “Her health is his health,” he whispers.
For Dr. Slater’s last call of the day, a scene plays out as far removed from the assembly line of a GP’s office as a doctor on horseback.
Standing in an alley, he uses his cellphone to call 95-year old Anne Parkin. After a moment, she appears at a second floor window and throws down the building key. It’s the only way he can get in.
This is a long visit. Anne likes to talk, and Dr. Slater has a number of concerns about her health.
As he leaves, his work for the day done, Dr. Slater is careful to mark his next visit on Anne’s calendar. It’s in three weeks. Rain or shine.
By the numbers
23%: Proportion of the population aged 65 and older
50%: Proportion of hospital spending by provinces and territories that was devoted to people 65 and older (2008)
2,029,299: Projected increase from 2010 to 2020 in the number of Canadians aged 65 and older
352,841: Projected increase from 2010 to 2020 in the number of Canadians aged 80 and older
(Sources: Canadian Institute for Health Information, Statistics Canada)
