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Dr. Samir Sinha talks with 86-year-old patient Jean about her prescribed medication during a house call visit April 5, 2011. (Moe Doiron/The Globe and Mail/Moe Doiron/The Globe and Mail)
Dr. Samir Sinha talks with 86-year-old patient Jean about her prescribed medication during a house call visit April 5, 2011. (Moe Doiron/The Globe and Mail/Moe Doiron/The Globe and Mail)

Time to lead

Integrated care benefits seniors and cash-strapped government Add to ...

Lillian Clyne is spending the afternoon knitting a scarf at CapitalCare Norwood in Edmonton, a one-stop health-care and recreational centre for the elderly with chronic medical conditions.

Twice a week, a bus picks up Mrs. Clyne at her home and takes her to the centre, where she is assessed by medical staff and participates in her favourite activities - knitting and painting ceramics.

The 80-year-old has a number of health problems, including congestive heart failure, chronic leg ulcers and arthritis that she says is "threatening to take over all my joints."

But since enrolling in the Comprehensive Home Option of Integrated Care for the Elderly (CHOICE) program two years ago, she has not been readmitted to hospital or had to visit the emergency department.

"I try and stay away from hospitals," Mrs. Clyne said in a telephone interview.

The program, modelled on a similar one in the United States, has been remarkably successful in keeping the frail elderly out of hospital. In the six months before patients joined CHOICE, they visited emergency departments 299 times, according to a one-year study of the program done by the Alberta government. In the six months after, visits dropped 30 per cent.

CHOICE is effective at keeping the elderly healthy and delaying their admission into long-term homes because medical staff get to know the patients and can quickly detect any change in their condition.

But such programs are rare in Canada. The bleak reality for most seniors is that the much-talked-about continuum of care for the elderly simply does not exist. Instead, health care in Canada remains focused on hospitals, a model that worked when most people tended to not live past age 65 and were not living with multiple chronic illnesses.

Without integrated care in the community, the medically frail have difficulty navigating the system and getting access to the appropriate services. As a result, experts say, they slip through the cracks and often lack proper care until a medical crisis hits.

For cash-strapped provincial governments, the aging population is a concern because older adults account for a huge proportion of health costs in Canada. People 85 and older consumed $21,000 of health-care spending per capita in 2008, compared with just $1,700 for those between the ages of one and 65, according to the Canadian Institute for Health Information.

"Our main problem is that while the patients have changed, our systems have not," Samir Sinha, director of geriatrics at the Mount Sinai and University Health Network hospitals in Toronto, said in a recent research paper.

CapitalCare is one of five provincially funded centres in Alberta that meet the complex needs of seniors by providing a doctor, nurse, physiotherapist, social worker and pharmacist, as well as recreational activities, all under one roof. The Edmonton site treats an average of 45 to 50 patients a day.

Manitoba has a similar program. The Program of Integrated Managed-care of the Elderly (PRIME) operates in Winnipeg, and the government plans to open a second centre in the city.

"It's a specialty working with seniors," said Judy Ahrens-Townsend, program developer and manager of PRIME. "They need holistic care and when they don't get that, they end up in the system anyway getting care that's not so effective."

There are other examples where Canada is making inroads into dealing with seniors, the fastest-growing segment of the population. Mount Sinai, the first teaching hospital in Canada to make geriatrics a strategic priority, opened an Acute Care for Elders unit in April.

As part of Dr. Sinha's new program, emergency department nurses screen all patients aged 65 and older by asking six questions that help determine if they are at risk of readmission to hospital. Mount Sinai also works closely with Toronto Central Community Care Access Centre, which helps patients make the transition from hospital to their homes.

Doctors at Mount Sinai also make house calls in partnership with a community support agency that receives $480,000 in annual funding from the province. While the funding amounts to "a rounding error on everybody's budget," Dr. Sinha said, the government gets a big bang for its buck. Every patient who remains in the community instead of a long-term care home saves the system $50,000 a year.

"We just need to keep 10 patients out of a nursing home for one year, and the program pays for itself," he said.

The program is also succeeding by having fewer patients admitted to hospital, where acute-care beds typically cost about $1,000 a day. Mount Sinai's readmission rate has dropped to 9.7 per cent from 14.4 per cent in fiscal 2010.

Stacey Daub, chief executive officer of Toronto Central Community Care Access Centre, says a study done by U.S. health firm Kaiser Permanente shows that 1 per cent of the population account for 30 per cent of total health-care costs.

"It is the 1 per cent who we fail, both in terms of integration and transitions and client experience and outcomes," Ms. Daub said.

Reader weighs in

From oldgal67 via globeandmail.com:

If communities (there must be some agency somewhere that could take this on) set up programs of volunteers who would undertake to do a neighbourhood watch on seniors in their midst, getting groceries, getting to medical appointments, hairdressers, etc., a lot of the elderly could either stay indoors more or be driven where they need to go. Family doctors could help in this by advising co-ordinators if one of their elderly patients needs help.

Clearing sidewalks should be a major priority for all towns and cities as not only the elderly but people with strollers or the wheelchair-bound need clear paths for getting around. In the old days (not that long ago) people used to be held responsible for the bit of sidewalk in front of their own property … what happened to that? It was a good idea, provided a bit of exercise for people and helped everyone get around more safely. We don't seem to do "sensible" any more … we've replace it with "selfish" which, when it comes to the elderly, is 90 per cent of the problem. People don't look after their own as they used to, preferring to offload responsibility for their very young and their very old onto social agencies and other people.

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