30 YEARS OF HIV/AIDS: Casey House to revolutionize care in response to evolving epidemic

This year marks 30 years since AIDS was first identified. Thanks to marvellous treatment advances—most significantly, the introduction of Highly Active Antiretroviral Therapy (HAART) in the mid-1990s—what was once an overwhelmingly fatal disease can now be largely managed well into old age, provided the individual accesses rigorous treatment and has the good fortune to avoid the associated illnesses that frequently accompany HIV. This “greying of HIV/AIDS” will soon be the norm throughout North America, where it is estimated half of all people living with HIV/AIDS will be age 50 or older by 2015.

But despite these treatment advances, the impact of the HIV/AIDS crisis on Ontario health care is far from over. Province-wide, over 1,000 people are newly infected each year, with one in 120 adult Torontonians now HIV-positive and facing a lifetime of challenging and costly treatments.

In response to this growing demand for HIV/AIDS treatment, Casey House this year announced plans to launch a comprehensive Day Health Program, which will be made possible through a facility redevelopment project that will more than double our capacity to provide care.

“Over a period of years we’ve participated in extensive consultations with people living with HIV/AIDS, our clients and their families, as well as health researchers, government officials and partner organizations that serve people living with HIV/AIDS in Toronto,” says Stephanie Karapita, CEO of Casey House. “They’ve told us that this new day health approach to HIV/AIDS care is truly needed in Ontario, specifically in downtown Toronto. We’re thrilled by the overwhelming support for expanded care at Casey House.”

HAART has been a tremendous gift, but the prospect of aging with HIV carries with it new and profoundly difficult challenges. HIV doubles—and may even triple—cancer risk, even in the HAART era. The ultimate effect of years or even decades of these new and powerful medications on the human body is still unknown, and the prognosis is further complicated for our clients by the damaging impacts of advanced age, poverty and disability. The clients we care for at Casey House typically struggle with five or more significant illnesses layered on top of HIV, including high rates of liver and heart disease, osteoarthritis, and a variety of cancers that may or may not be related to HIV/AIDS disease or medications. More than half experience some form of HIV-associated neurocognitive disorder, making it hard to hold down a job or to adhere to medication regimens.

Add to this mix the social isolation that builds over a long and stigmatizing illness, and many of the clients we care for at Casey House lack the social networks of caregivers and support that are so fundamental to health and well-being in senior years. Perhaps unsurprisingly, depression and addictions are also common amongst our clients.

“The people we care for at Casey House typically come to us in the advanced stages of HIV/AIDS, with very complex care needs,” explains Karapita. “These individuals have a very rough road ahead of them, and it takes a highly skilled, coordinated interprofessional team approach to get them out of crisis and back to stable health.”

The solution: The Casey House Day Health Program

Casey House is working closely with our communities to launch the new Day Health Program. Plans are underway to build a new facility at the corner of Jarvis and Isabella Streets that will more than double our capacity to provide care to the growing cohort of people living—and growing old—with HIV/AIDS in Toronto. To complement our current sub-acute care, home health care and outreach programs, the Day Health Program will offer specialized HIV/AIDS health care by an interprofessional team including registered nurses, social workers, physical, occupational and recreation therapists, as well as a pharmacist. Other key elements include case management, peer support and nutrition support. A similar program offered by the Dr. Peter Centre in Vancouver has been extremely successful, more than halving the total number of hospital acute bed days required by their clients.

Says Gael Mourant, chair of the Casey House board of directors, “Bringing a range of HIV/AIDS health care services under one roof will improve the health and well-being of a highly vulnerable population while relieving pressure on local hospitals and avoiding health care costs for the province. It’s a win for everyone.”

To find out more about the plans now underway to expand care at Casey House, along with a $10 million Capital Redevelopment Campaign, please visit www.caseyhouse.com.