Provincial health-care systems are struggling to place Canadians in the appropriate continuing-care settings they need, potentially adding to wait times and barriers to care, according to a new report.
The Canadian Institute for Health Information (CIHI) report found one in five seniors who have lower-priority needs could have delayed or even avoided admission to residential care and instead received care in their own home or in home-like settings.
This would open up bed spaces for those who desperately need the service and allow seniors to stay in their communities longer. CIHI defines residential care as support provided in a specialized facility that includes 24-hour nursing supervision.
"If we continue as we currently are, there will be a lot of pressure on the health-care system with an increasingly aging population," said Georgina MacDonald, CIHI's vice-president for Western Canada, who oversaw the work on the report. "I am hoping that this report will shed light on areas that people can be paying attention to, including partnering with community services and exploring innovative programs to ensure people are receiving the care they need."
The report said within the next 20 years, the population of older seniors – those 75 years old and above – is expected to more than double, from 2.6 million to 5.7 million. Ms. MacDonald said with this growing population, the health-care system needs to adapt to address reality and cannot afford to place people in the wrong levels of care.
People normally enter residential care after an initial assessment, which considers, among other things, a patient's need for physical assistance, their cognitive impairment, whether or not there is an issue of wandering, and if a patient is living alone or has a caregiver who is unable to continue providing care.
The report suggests demand for residential care might be offset by developing or expanding home-care services to address these factors, and by further bridging the gaps between hospitals and continuing care sectors.
According to Health Quality Ontario, the median wait times for long-term care homes are 92 days. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network hospitals, said he sometimes sees people waiting months and, in some rare cases, years to access residential care at his hospital.
"The data in this report by CIHI is showing that there still is a disconnect between our home and community care system and our hospitals in terms of really trying to understand what it would take to support an older person to return back home," Dr. Sinha said.
The report found seniors who received their initial assessment in hospital were six times more likely to be admitted to residential care than seniors who received an initial assessment in the community.
This likeliness may be caused by the fact that hospitals sometimes are not aware of the support systems and continuing- care services available in different communities, Dr. Sinha said.
At Mount Sinai, they have hired community social workers who have deep knowledge of the services available for long-term support in the different communities where patients are coming from.
Although the number of older patients being treated at the hospital increased by 53 per cent, Dr. Sinha said over the past five years they have reduced the length of stay for patients by 24 per cent and reduced re-admissions by 14 per cent – this, he said, speaks to the success of their programs.
"They have lots of complex needs but it's really important to work with these patients and to spend that extra time," Dr. Sinha said. "It helps the hospital, the community services and the patients who would like to remain in their homes and communities a little longer."
The report notes that while only approximately 9 per cent of seniors ages 75 and older are currently living in residential care, the expected doubling of this population over the next 20 years will place unprecedented pressures on the country's continuing-care systems.
With the increasing number of seniors in Canada, hospitals and long-term-care organizations need to act fast, said Candace Chartier, the chief executive officer of the Ontario Long Term Care Association.
"If we are to fix this growing concern we have to immediately," said Ms. Chartier. "I think we definitely need more beds, we need more transitional models of care and we need to move on this now."