Wait times for seniors suggest health-care crisis

Swift action by governments needed, says Morris Maduro.

For over two years, a group of seniors and professionals representing seniors’ care, health policy, community services, and seniors’ organizations have been working with different stakeholders to ensure that growing numbers of seniors can count on a comprehensive, integrated seniors’ care program.

It would result in more effective and personalized care, more effectively address the chronic and complex medical needs of seniors, especially those with frailty and dementia; and would likely result in cost savings by achieving higher quality service and effectiveness. It would modify the existing fragmented health system and its overlapping and duplicating areas, and stress the critical areas of community, home care and aging-in-place.

A number of European and Scandinavian states have adopted variations of such a system with great success. This effort is in response not only to the increasing number of seniors and the fragmented health system, but the fact that Canada has consistently been last among the OECD countries in wait times for specialists and surgeries, averaging now 21.5 weeks.

The Fraser Institute reports average wait times in Alberta in 2017 of 26.5 weeks after a general practitioner referral. For the increasing number of seniors with complex medical conditions, this is a serious state of affairs.

The concept of a comprehensive integrated care system for seniors with stress on community and home care has received positive reaction from government, and stakeholders.

However, change is very much resisted, and we need to look at ways to use existing avenues to advance the concept. In Alberta, the concept is moved forward somewhat by the system of Primary Care Networks (PCNs).

PCNs are groups of doctors working collaboratively with teams of health-care professionals, such as nurses, dietitians, and counsellors, normally placed within family clinics.

However, the PCN goal has not worked well in practice. In July 2016, the Alberta government released an extremely critical report on the many problems with PCNs in terms of delivery and governance, including lack of clear objectives and expected outcomes. The PCNs are now being reorganized.

While a main function of PCNs is to provide integration of care at the community level, they can be a useful avenue for implementing a comprehensive care program for seniors that would function along the entire continuum of care.

However, PCNs are devoted to primary care; hence, the critical element of specialist care does not form part of their mandate, except in referring patients to specialists. There is no workable system in place through which PCN physicians can carry out the critical task of following up on the referral itself to ensure the patient is being seen as well as ensuring that the results are sent promptly by the specialist to the PCN physician for followup. This is especially critical given the average 26-plus weeks of wait times.

An extensive 2016 study of the Alberta health system by the Health Quality Council of Alberta concluded that, “Alberta’s health-care system is actually a patchwork of disconnected processes that fail to communicate with each other.”

It argues that a major gap exists in “transitions within and between primary, specialist, hospital and continuing care,” with “patients and providers perceiving primary care as too disconnected … from community, hospital, specialists, and continuing care.”

This is a sobering indictment.

My family has been fortunate to now count on model family physicians and specialists who carefully monitor referrals and their results for us. But this is the exception to what most families and individuals encounter as they try to deal with the current complex system and egregious wait times.

We Canadians are extremely fortunate to have a universal care system, where individuals and families are not financially crippled by medical costs. But this is not a reason to accept less than excellent care, and certainly not “a patchwork of disconnected processes.”

If our health system cannot do better than consistently rank last among developed countries in access and wait times averaging five-six months, especially for serious and life-threatening matters, we are facing a serious medical crisis, especially as seniors become a larger segment of the population, and growing older, many with chronic and complex illnesses and dementia.

The time for the government to act swiftly was yesterday.