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The Hospital

Dispatches from inside one of Canada's busiest health care institutions

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Sharron Baker, shown here after knee surgery, is part of a wave of boomers forcing hospitals to rethink how they operate. (Kevin Van Paassen/The Globe and Mail)
Sharron Baker, shown here after knee surgery, is part of a wave of boomers forcing hospitals to rethink how they operate. (Kevin Van Paassen/The Globe and Mail)

The Hospital

How one hospital is dealing with Canada's aging population Add to ...

We want to hear about health care in your community: What works, what doesn’t, and what you think we should do about it. Share your experiences – and ideas for change. Follow @Globe_Health, tweet with #thehospital or email thehospital@globeandmail.com to join the conversation.

When universal health care was in its infancy, real estate agent Sharron Baker was a young woman. Now, like the health-care system itself, she is aging and in need of a refit. After cheerfully enduring a decades-long love/hate relationship with her left knee, Ms. Baker, 67, had replacement surgery at Sunnybrook’s Holland Orthopedic and Arthritic Centre in downtown Toronto in November.

To a casual observer, the two-hour surgery seemed like a small construction project – retro-fitting the back porch came to mind. The amazing part was watching Ms. Baker show off her dexterity and stamina two days later as she gamely made it up and down a hospital corridor with the help of a walker.

And then she was discharged, thanks to Sunnybrook’s Home on Day 3 initiative aimed at getting surgery patients in and out more quickly and freeing up beds in a hospital that, like many in urban Canada, typically runs at more than 100-per-cent capacity.

Leaving hospital so soon wasn’t easy for Ms. Baker. Even though she had family support, including moving into a ground-floor bedroom with adjoining bath at her son’s home, she found the aftermath gruelling. Recovering from surgery “is a slow process,” she says. “They need to spend more time on that aspect.”

It’s not perfect, but the “day three” program is one solution for the health-care conundrum about who should get hospital beds, how long they should stay in them and who looks after patients when they are released. Sunnybrook, like all hospitals, is faced with a growing number of aging patients who are living longer than ever and coping with more and more complex needs. At the same time, it is being squeezed by budget cuts. And, just like Ms. Baker, it doesn’t have much time to recover.

Ms. Baker’s short hospital stay and post-operative difficulties are symptomatic of a hospital system that is only just evolving to match the country’s changing demographics.

Back in the mid-1960s, when universal health care was instituted, mandatory retirement meant that people quit working at 65. Most of them conveniently died within the next decade.

Now, we never have to retire and life expectancy is heading into the stratosphere. A 60-year-old man in 2013 will live long enough to celebrate his 87th birthday, according to recent figures from the Canadian Institute of Actuaries. His female counterpart will likely reach 90. Whether either will be in robust health is not nearly so certain: Medical successes in combatting rapacious killers such as cancer, heart disease and diabetes means people are living long enough to be afflicted with dementia, depression and other chronic and complex diseases of old age.

In the 1960s, the average age in Canada was 27; now it is 47. “Our interaction with the health-care system tended to be in and out,” Deb Matthews, Ontario’s Minister of Health and Long-Term Care, says of the past. “If you needed your appendix out, you would go into hospital and get it out and then go home and be healthy again.”

Even “getting out,” though, meant staying in hospital longer, and there were more family members to help us recover when we did leave. Nowadays, a lot of those expectations have been passed on to patients. We are supposed to keep ourselves healthy and active, and to make arrangements ahead of time for post-operative care when we are briskly wheeled through the revolving hospital door.

Hospitals have no choice but to push more onto patients, because they are overloaded. A survey this week by the Commonwealth Fund ranked Canada last among 11 OECD countries for wait times to see a family physician, an issue that is forcing thousands of patients to head to emergency departments for routine complaints.

Seniors are another problem: Sunnybrook has them stuck in more than five per cent of its beds while they wait for a spot in rehab, nursing homes or community hospitals. And Sunnybrook is not unique. There are more than 2,500 patients, known as bed-blockers, clogging up hospitals across Ontario.

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The Globe and Mail partners with Sunnybrook hospital to explore the challenges on the ground at Sunnybrook hospital and what patients, doctors, nurses and other vital staffers think needs to be done to improve the hospital experience.

The Conversation

Do you think the current model of hospital-based care is working in Canada?



Yes, it’s fine as it is




No, we need local clinics and home care