St. Joseph’s Health Centre is strengthening its community roots as it faces the challenge of providing care to Metro Toronto’s largest senior population that still live alone in their homes.Historically, the need for seniors’ health-care services was identified in 1921 when the hospital first opened by the Sisters of St. Joseph’s according to Dr. Marica Varga, St. Joseph’s Health Centre’s (SJHC) Chief of Geriatric Services. Today, the Health Centre has expanded on that agenda by developing an entire seniors’ portfolio dedicated to aligning the hospital’s geriatric services with community organizations that share the same focus.
This two-way continuum of care is helping to bridge that service gap for not only elderly patients and their families, but also physicians and medical experts who treat them. “It’s a knee jerk reaction in our society to say, well, you’re old, you’re sick, you’re frail so you have to go to a nursing home,” said Dr.Varga. “We don’t put anyone anywhere until the informed consent process is followed through because even people who are significantly impaired should have a say in their care.”
One means of providing patients with this multidisciplinary care is through the hospital’s referral clinic, Elderly Community Health Services (ECHS). For 15 years it has been identifying the frail elderly, prioritizing their problems including medical, social or economical hardships, and assessing if they can survive outside of a nursing home by connecting them with appropriate community services. “By and large, the more you can keep someone in their most familiar environment, the better off they are,” said Dr. Varga. At the same time, it helps prioritize hospital admissions for the most urgent and emergent cases.
Between 2004/2005, patients 65 years of age and older represented 38.5 per cent of all hospital admissions at SJHC and 19.7 per cent of all ER visits. One example was an 88 year-old patient who suffered from a multitude of medical conditions – diabetes, heart disease, and kidney failure – and was referred to the ECHS by his doctor after family members noticed this man’s condition was worsening.
At first the family attributed all his symptoms to the fact he was old, said Dr. Varga. “However, after a series of assessments with our team, we identified that even though medications were being prescribed, he wasn’t taking them.” This gentleman was linked with a home care service and a simple phone call was made to the local pharmacist requesting his medicine containers be replaced with easy open lids. More than a year later, and now in his nineties, this man is still living in his home with his wife and more importantly, the family is comfortable with him being there, said Dr. Varga. “Otherwise he would have been placed (in a nursing home) which would have been tragic in this case.”
Between 2004/2005, 1,939 seniors visited the ECHS and projections to the end of fiscal 2006 show the clinic’s visits will reach more than 2,200. ECHS is open five days a week and managed by a team comprised of four doctors specialized in Geriatric medicine, two social workers, one physiotherapist and one occupational therapy and speech specialist.
Clients are referral based and the clinic can accommodate urgent assessments if needed.
Some staff members will do house calls in certain cases while others will go into nursing homes for client assessments. Staff also provides daily phone consultation with community physicians.
“There is a lot of learning in this area of medicine,” said Dr. Varga. In fact, she helped establish the clinic’s teaching partnership with the University of Toronto when the ECHS first opened. Medical students from all over the world – Europe, Asia, USA and within Canada – come to SJHC for training in this area including nursing trainees, and social workers.
One of the biggest lessons students learn in this area of the hospital is how important it is to give clients a voice in deciding what type of care they need, said Dr. Varga.
“Allowing them the time to express themselves is paramount to good professional behaviour.”
Instead of just providing healthcare, we work with community agencies and mold care to fit each elderly client’s needs, she said, without jeopardizing their dignity and taking away control over their own life.
“Your kids tell you what to do, your neighbour tells you, the nurses tell you and it’s very disempowering, and many times the first sentence of a conversation with these clients starts with the fear of ‘you are going to put me some place,” she said. “Losing your dignity is really the last horrible unpleasant situation life brings you. You lose your mind, you lose control of your bowels, your bladder, but that shouldn’t mean you lose your dignity.”