Rethinking Health Care for Canadian Seniors
“Bed blockers” and the “Silver Tsunami” are terms coined in poor taste which, according to Dr. Aravind Ganesh, are sometimes whispered in the halls of health-care centres and hospitals across Canada and the United Kingdom. “Failure to thrive,” “social admission” and “unable to cope” are phrases used to describe Canadian seniors who end up in hospital beds, sometimes because they have nowhere else to go.
Such harsh, inappropriate language was probably not coined out of a callousness, but instead to express the frustration that many Canadian health-care professionals feel working within our fragmented health-care system, a system that is not providing seniors with the care they deserve. Learn more about rethinking health-care for seniors in Canada.
Rethinking Health Care in Canada
Dr. Ganesh is a neurology resident-physician and clinical researcher, public health advocate, and Rhodes scholar who recently published a refreshingly straightforward editorial in The Calgary Herald on the current state of health-care for seniors in Canada. Dr. Ganesh is currently working with the University of Oxford’s Centre for Prevention of Stroke and Dementia and explains that Canada is not alone in its struggle to provide care for a booming group of seniors.
According to Dr. Ganesh, the problem has more to do with the design of our health-care system than the number of seniors seeking treatment within that system. Across North America, health-care systems were designed to treat emergent issues, not chronic diseases. Dr. Ganesh says that in Canada, our health-care delivery models “arose when the average Canadian was in their mid-20s, life expectancy remained in the high-60s, and the typical hospital patient came in with an emergent issue that could actually be fixed with a single admission: deliver that baby, fix that fracture, treat that pneumonia.”
With increasing advances in medicine and life expectancies, the typical patient has changed but our health-care system hasn’t kept up.
“Now, thanks to advances in medicine, we are living much longer lives, likely with a number of illnesses that have become rendered as chronic diseases,” Dr. Ganesh explains. “However, while our patients have changed, our health-care systems haven’t — the focus needs to shift from just fixing issues to keeping these patients living independently in the community with increasing levels of homecare or nursing care.”
Dr. Neena Chappell, a Professor at the Institute on Aging and Lifelong Health, Department of Sociology with the University of Victoria examines why the health-care system is failing seniors in Canada, and like Dr. Ganesh, agrees that the increase in the number of Canadian seniors isn’t the root of the problem. “There is a belief that a growing seniors’ population will result in runaway health-care costs that will bankrupt the health-care system,” Dr. Chappell explains in a recent Huffington Post article. “But a body of research shows that growth in the senior population will add less than one per cent per year to health-care costs — a manageable increase,” she says.
Where Dysfunction Lies in the System
There is no doubt that the Canadian health-care system is strained, and many Canadians — especially our most vulnerable — are falling through the cracks. In fact, the daily needs of many seniors aren’t being met, and most aren’t getting consistent management of their complex medical conditions. The result is they are unable to remain independent, causing an increase in pressure on the health-care system as well as family caregivers who are stepping in to assist with care.
Determining where the dysfunction lies is an important step towards fixing it. Dr. Ganesh, Dr. Chappell and many other health-care professionals and policy makers believe that the fragmentation of our health-care system is the root of the problem.
The issue runs deeper than a lack of communication between hospitals, physicians and public health-care workers. There is often an outright disconnect between these three critical areas. When you factor in the “fringe” areas of our health-care system (which include home care, home support, residential care, geriatric units and hospice care) it becomes difficult, if not impossible to achieve a true continuity of care. According to Dr. Chappell, continuity of care is needed to improve quality, lower costs and increase the sustainability of our health-care system. Bringing together these different areas and types of care into one integrated system of care delivery must be a goal — one that we need to achieve quickly.
Patients who “await the right ‘social’ environment for their discharge take up about 15% of Canada’s acute care beds, representing 7,500 Canadians each day and at a cost of $2.3 billion annually, with dementia alone accounting for over 30% of such hospitalization stays,” Dr. Ganesh says. “This keeps us in a near-constant state of overcapacity.”
It’s no wonder, then, that policy makers from provinces across Canada are paying close attention to the work of an Acute Care for Elders (ACE) Strategy that was pioneered at Mount Sinai Hospital. “ACE is a seamless model of care for older adults, spanning the patient care continuum from emergency to in-patient, ambulatory, and community care settings,” Dr. Ganesh explains. ACE is based on five principles – access, equity, choice, value, and quality. Through the program “geriatricians, psychiatrists, other doctors, social workers, therapists, pharmacists and dietitians worked together to provide coordinated care for elderly patients.”
Acute Care for Elders (ACE) Strategy Being Adopted Across Canada
According to Dr. Ganesh, the ACE Strategy has:
- Lowered readmission rates by 14%
- Reduced total hospital lengths of stay by 28%
- Saved Mount Sinai Hospital $6.7 million in “avoidable health-care cost in 2014 alone.”
With the success of the program, it’s no wonder that this year health organizations in five provinces and territories have “been selected by the federally-funded Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Frailty Network (CFN) to adapt this strategy to their settings.”
Without a doubt, Canadian and international health-care professionals and policy makers will be paying close attention to the success of ACE as they look for new health-care models that will provide better quality care for seniors across Canada.
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