A com­mon-sense ap­proach to el­der­care

Acute Care for Elders de­signed to speed heal­ing and pro­mote safe dis­charges home

The Guardian (Charlottetown) - - OPINION - BY DONNA THOM­SON

Over the next 20 years, the pop­u­la­tion of Cana­di­ans over 65 will dou­ble and the num­ber of over 85 will quadru­ple. The cur­rent hos­pi­tal treat­ment model makes the frail el­derly sicker and more de­pen­dent. There’s an ur­gent need for in­no­va­tive ap­proaches that lead to bet­ter out­comes in pri­mary care for se­niors. ACE is de­signed to treat el­derly pa­tients in a way that iden­ti­fies and re­spects their abil­i­ties and lim­i­ta­tions, speeds heal­ing and pro­motes safe dis­charges home — all good out­comes for the whole fam­ily.

Dr. Samir Sinha is Canada’s guru on ag­ing.

We should lis­ten care­fully to his ideas be­cause 42 per cent of all hos­pi­tal pa­tients in our coun­try are over 65 and they ac­count for 60 per cent of all hos­pi­tal days. Se­nior pa­tients con­sume 60 per cent of acute­care bud­gets and al­most half of all health-care spend­ing.

Sinha is the head of ge­ri­atrics at Toronto’s Mount Si­nai and Univer­sity Health Net­work Hos­pi­tals and a fre­quent con­trib­u­tor on is­sues re­lated to ag­ing on CBC’s The Na­tional Pol­i­tics of Health Care Panel.

Sinha is the cre­ator of a unique ap­proach to hos­pi­tal­iza­tion for se­niors - one that’s proven to heal older peo­ple more quickly, and put them on a safe and healthy fast track back home. The ap­proach, called Acute Care for Elders (ACE), is be­ing rapidly adopted by hos­pi­tals across Canada and be­yond.

En­abling peo­ple to age at home by re­turn­ing older pa­tients to their own homes more quickly with fewer com­pli­ca­tions is the ul­ti­mate goal of ACE. Many older pa­tients will be dis­charged quickly af­ter treat­ment, but for those ad­mit­ted, the dif­fer­ences be­tween a tra­di­tional hos­pi­tal ward and an ACE unit are strik­ing. ACE units are de­signed to care for frail older adults and that eases the bur­den of care for fam­i­lies.

Un­clut­tered hall­ways of­fer non-slip, low-glare floors and handrails, as well as oc­ca­sional padded chairs for rest­ing.

These de­sign fea­tures en­cour­age pa­tients to main­tain strength and mo­bil­ity by keep­ing ac­tive. Large clocks and in­for­ma­tion boards help keep peo­ple ori­ented. Low beds and easy-ac­cess bath­rooms pro­mote mo­bil­ity and re­duce the risk of falls.

Qual­ity sleep is a key el­e­ment of the ACE ap­proach. The Queensway-Car­leton Hos­pi­tal ACE unit in Ot­tawa has elab­o­rated on the model by cre­at­ing an overnight HUSH time (Help Us Sup­port Heal­ing).

Lights are dimmed and staff phones are set to vi­brate. Nat­u­ral care is sup­ported by flex­i­ble vis­it­ing hours and fam­ily mem­bers are wel­come to stay overnight.

Most im­por­tantly, fam­i­lies are rec­og­nized as val­ued mem­bers of the treat­ment team. Nurses in­vite calls to check in on a loved one any time of the day or night.

This care has led to pa­tient sat­is­fac­tions rates con­sis­tently as high as 99 to 100 per cent over the past year, es­pe­cially with more older pa­tients able to re­turn home.

Over the next 20 years, the pop­u­la­tion of Cana­di­ans over 65 will dou­ble and the num­ber of over 85 will quadru­ple. The cur­rent hos­pi­tal treat­ment model makes the frail el­derly sicker and more de­pen­dent. There’s an ur­gent need for in­no­va­tive ap­proaches that lead to bet­ter out­comes in pri­mary care for se­niors.

ACE is de­signed to treat el­derly pa­tients in a way that iden­ti­fies and re­spects their abil­i­ties and lim­i­ta­tions, speeds heal­ing and pro­motes safe dis­charges home — all good out­comes for the whole fam­ily.

I asked Sinha what he thought would ac­cel­er­ate the growth of ACE units and the broader ap­proach across Canada.

“Trans­form­ing our care for older adults and their fam­i­lies be­gins within our med­i­cal and nurs­ing schools,” he said. “Right now in Canada, a ro­ta­tion in pe­di­atrics is re­quired in our train­ing, but ge­ri­atrics re­mains an op­tion. Given our de­mo­graph­ics of ag­ing, I be­lieve ev­ery grad­u­at­ing physi­cian and nurse should have ex­pe­ri­ence in ge­ri­atrics. That would help change the fo­cus of health care to bet­ter serve those who ac­tu­ally use it the most and are amongst the most vul­ner­a­ble pa­tients in the sys­tem.”

Sinha’s ap­proach to el­der­care makes sense for older adults and for nat­u­ral care­givers.

We can all get be­hind it by ask­ing for an ACE unit and ap­proach in ev­ery Cana­dian hos­pi­tal.

Donna Thom­son is a care­giver, author and ac­tivist. She wrote “The Four Walls of My Free­dom: Lessons I’ve Learned From a Life of Care­giv­ing” and blogs at The Care­givers’ Liv­ing Room. www.don­nath­om­son.com.

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