Canada’s health-care providers are struggling to retool the system to meet the needs of an aging population that is often facing multiple, chronic medical conditions.
The phenomenon of the growing ranks of the frail elderly in need of different phases of care that often can be provided in the community did not exist 25 years ago. Yet the country’s health-care system remains mired in the 1950s, primarily focused on hospitals and with little in the way of community services to prevent the elderly from languishing in acute-care beds.
What Canada needs is an actual health-care system, one that makes navigating between hospital and back into the community as seamless as possible for patients, said Kevin Smith, chief executive officer of St. Joseph’s Health System in Hamilton, Ont.
“If you have one thing wrong with you, we don’t do a bad job,” Dr. Smith said. “If you have complex, multiple issues, the system is not a system.”
With little leadership out of Ottawa and budget constraints in provincial capitals, it is largely falling to health-care executives to find ways to care for seniors while keeping them from congesting primary-care centres.
In Toronto, one in every 10 acute-care beds is occupied by an elderly patient who has nowhere else to go. Nationally, the situation is just as bleak. Patients who no longer need acute care account for more than 1.7 million hospital days a year, according to a 2009 study by the Canadian Institute for Health Information.
“If hospitals are to achieve their current goals, they need to look outside their four walls,” said Bob Bell, chief executive officer of University Health Network.
St. Joseph’s has done just that. It is on the leading edge of a vertical integration trend to bring different types of health-care services under one roof, so that practitioners no longer operate in their own silos. As part of a corporate restructuring – the first of its kind in Ontario – St. Joseph’s services span home care, long-term care, complex continuing care, rehabilitation, hospice and traditional acute care through its two hospitals.
With the restructuring, St. Joseph’s can better co-ordinate primary health care through its acute-care hospitals in Hamilton and Kitchener with all other aspects of institutional and community-based care in Southern Ontario. Not only can it do so more cost effectively, Dr. Smith said, patients can be served in the most appropriate setting.
In earlier days, family doctors often helped patients navigate the system, he said. But with Canadians getting older and sicker, this is no longer possible. A better model is needed, he said, for the frail elderly patients who are battling diabetes, heart disease and possibly early dementia, and don’t want to tell their story all over again when they make the transition from one care provider to another.
“A system that isn’t more responsive to patients with multiple needs will not meet the needs of the future,” Dr. Smith said.
With the proportion of Canadians who are seniors increasing, the future is rapidly approaching. Fourteen per cent of the population is older than 65 and that will rise to 23 per cent over the next 15 years.
These changing demographics are putting enormous strains on family doctors as patients with complex conditions consume more and more of their time. Yet Canada lags behind other countries, notably the United States, in using case managers who can co-ordinate care in the community for elderly patients, often leaving doctors and family members to pick up the slack.
“We’re getting to the point where the capacity of the system as it has existed is being strained to the limit because of the changes in demographics,” said University of Alberta professor and health policy researcher John Church.
