Offering innovative care for frail seniors is just the beginning

Much work is needed to provide the best end-of-life care, Akos Hoffer writes.

On Jan. 23, the Citizen published an article about something that troubles more and more Canadians: how best to live out our final days. Advances in medicine make it possible for us to live longer, although treatments often diminish quality of life. As our population ages, more and more of us will be forced to make difficult decisions about care.

Unfortunately, our youth-centric culture prefers to avoid topics such as aging and end-of-life care. As the article pointed out, families and friends are often left to struggle with the stress and guilt that comes with being forced to make decisions about the care of loved ones who have lost their cognitive capacity.

Those of us who work in long-term care are immersed in the issue. Every day, we see the inherent conflict between palliative care — which seeks to ease the pain and suffering often experienced by patients nearing the end of their lives — and therapeutic care, which aims to cure a particular disease or condition. Two years ago, the Perley and Rideau Veterans’ Health Centre introduced a new program known as PATH: Palliative and Therapeutic Harmonization. PATH is a process that helps older people and their families understand health status and make decisions that protect their best interests and quality of life.

PATH involves a nurturing and structured methodology of assessment, communication and empowered decision-making. Through regular communication between physicians, caregivers, and residents and their families, elderly people and their families make informed decisions about care. In our experience, this approach leads to better care for residents and greater comfort for family members.

Since it opened in 1995, the Perley Rideau has continually taken steps to improve quality of care. We are home to 450 people, including 250 veterans, and are recognized as one of the most progressive long-term care homes in Ontario. The Perley Rideau campus also features 139 independent-living apartments for seniors and a 12-bed Guest House providing respite care for those suffering from mid- to late-stage dementia. A growing number of clinical, therapeutic and recreational services are available on-site.

Implementing PATH is part of the Perley Rideau’s long-term strategy to become a centre of excellence in frailty-informed care. Frailty is the accumulation of health issues that leads to declines in mobility, cognition and function.

As Canada’s population ages, caring for frail seniors will become a significant and expensive challenge. To tackle one aspect of the challenge, the Perley Rideau recently began a pilot project known as SAFE (SubAcute care for Frail Elderly).

SAFE, a partnership involving the Perley Rideau, The Ottawa Hospital (TOH) and the Champlain Local Health Integration Network, addresses a significant problem for the region’s health-care system. Elderly patients admitted to hospital for acute care (usually due to surgery, accident or severe illness) remain in hospital even after their conditions have stabilized. They no longer require acute care, but are not well enough to return home and the health-care system has no suitable alternative. In many ways, the worst — and most expensive — place for a frail senior to recover is in an acutecare hospital. Studies demonstrate that their health tends to deteriorate, particularly during longer stays. Under SAFE, eligible patients will recover in a special 20-bed unit at Perley Rideau.

While PATH and SAFE are innovative, they are small in scale, particularly in light of Canada’s demographics. According to Statistics Canada, nearly one-in-four of us will be 65 or older by 2030. And while approximately 1.4 million Canadians were aged 80 or older in 2013, the number is expected to rise to five million by 2063. Much work needs to be done to ensure that elderly Canadians will receive appropriate care. Conversations about end-of-life care represent a vital first step.