Care closer to home

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The population of the Mississauga Halton Local Health Integration Network (MH LHIN) is one of the fastest growing populations in Canada placing it on the front line in the  race to meet the extraordinary and growing demand on health-care resources –  specifically for the care of seniors.

Older adults use 80 per cent of the bed days in acute care, so hospitals and associated health agencies must act quickly to coordinate and expand their geriatric abilities if they are to cope with the increased demand for care.

Dr. Barbara Clive, a geriatrician at The Credit Valley Hospital recently assumed a regional role as the Geriatric Lead for the MH LHIN to assess services, identify gaps and propose coordinated opportunities for enhancement of services for our growing senior population. The focus of her work is to create a regional geriatric program for the MH LHIN. Currently, the three hospitals share seven geriatricians which is an excellent ratio considering there are only 200 geriatricians in Canada.

In order to meet the needs of the growing senior population, the MH LHIN was awarded $282,000 in 2008/2009 to develop a strategy to deliver enhanced, specialized geriatric services to the ‘frail’ elderly. All physicians have elderly patients but the strategy is focused on the frail among them, those who can benefit from care by a geriatric medicine specialist, geriatric psychiatrist, specialized nursing and affiliated health-care providers for the elderly.

Currently, service to our seniors is spotty. Dr. Clive’s hope is to ensure a quality, efficient and accessible program to provide a continuum of services for frail seniors with complex needs in the MH LHIN. The LHIN’s health human resources plan will play a big part in that success. “There aren’t enough of us to care for all our seniors but if we coordinate a plan to grow our resources to meet the need, we stand a chance of enhancing the quality of life to keep more seniors well for a longer period of time – keeping them out of the health-care system for as long as possible,” says Dr. Clive.

The phased development of the regional geriatric program will build capacity and knowledge among our primary care professionals who care for the elderly. The patient-centred care will optimize the independence of seniors and support ‘aging in place’ (ideally at home), reducing the pressure on hospitals. The coordinated approach by hospitals, Community Care Access Centres and long term care facilities will fulfill the needs of seniors and identify those in need of services to maximize their independence.

The goal of the Regional Geriatric Program is to make the services available in a single program for all three hospitals so that seniors can access all the right services for ‘care closer to home’. The program is seen as a first step in a province-wide comprehensive, integrated system for frail elderly.

Through the program, a range of health services to diagnose, treat and rehabilitate frail elderly with complex and multiple medical, functional and psychosocial problems would be developed to serve the senior population of the LHINs three hospitals, reducing the pressure on the hospital’s emergency department and the system as a whole.

Seniors are indeed high users of hospital emergency and inpatient resources. Nearly 10 per cent of the population in the MH LHIN is over 65. In fact, 75 per cent of all emergency room admissions are for adults over 65 years of age. They account for 50 per cent of all patient days and their average length of stay is twice that of the general population.

In most cases, a patient in the emergency department presents a single complaint of an acute nature such as chest pain. Ideally, the emergency department patient is diagnosed, treated and discharged in a timely manner. Conversely, a geriatric patient in the emergency department presents with multiple medical, functional and social issues as well as an acute or sub-acute medical complaint such as a fall; often requiring admission to hospital followed by a continuum of care in the community beyond the scope of emergency medicine.

One of the enhancements Dr. Clive is excited about is the Geriatric System Navigator.  The system flags patients over the age of 75 for follow-up after discharge from the emergency department. They are contacted soon after discharge to assess their need for specialized services. The goal is to keep them well, independent, and at home for a longer period of time leveraging existing resources to develop a comprehensive, LHIN-wide program.

 The project is a huge task but it is one Dr. Clive embraces. The work is demanding and the medicine is complex and challenging. It’s time-consuming and non-remunerative in a fee-for-service structure which places the emphasis on technical procedures and single patient complaints rather than the hands-on care required for the complex medical needs a senior presents.

Still, Dr, Clive discovered her love of geriatric medicine early in her career and she’s never looked back. “I do this work because it’s challenging and interesting. It’s rewarding to care for this particular population – today’s seniors have been through two wars and a depression – there is much we can learn from them. They value most things more than most of us do today. They have been through so much that they are grateful for small victories and they are so appreciative for the ability to maintain their independence.”

The work is not always glamorous and the equipment doesn’t cost hundreds of thousands of dollars but Dr. Clive and the multi-disciplinary team members work tirelessly, dedicated to the preservation of the most precious jewels in the crown of our society – our seniors.

The work in the MH LHIN will become a model for other similar communities can benefit from it on communities across Canada.