Health sys­tem fails to pro­vide qual­ity care for se­niors

Times Colonist - - Islander - RUTA VALAITIS and MAU­REEN MARKLE-REID Ruta Valaitis, PhD, and Mau­reen MarkleReid, PhD, are pro­fes­sors at the McMaster Univer­sity School of Nurs­ing, in Hamil­ton, Ont.

De­spite hav­ing di­a­betes and arthri­tis, Verne was a thriv­ing, in­de­pen­dent 72-year-old who lived at home with his wife when he had a stroke. He had ex­cel­lent emer­gency care in the hos­pi­tal and be­gan his re­cov­ery there. But he didn’t ad­just well af­ter ar­riv­ing home. He started to show signs of de­pres­sion and was at risk of re-hospi­tal­iza­tion.

Verne feared he would have an­other stroke as he waited for fol­lowup ap­point­ments with neu­rol­ogy, phys­io­ther­apy and speech pathol­ogy. He had dif­fi­culty re­mem­ber­ing to take his new med­i­ca­tions and adapt­ing to us­ing a walker.

Tran­si­tion­ing home from hos­pi­tal is chal­leng­ing for older adults with mul­ti­ple chronic con­di­tions. Home-care ser­vices are of­ten not avail­able or in­ad­e­quate. And fol­lowup care from doc­tors or spe­cial­ists is too of­ten in­fre­quent or in­volves jug­gling mul­ti­ple ap­point­ments over long wait pe­ri­ods.

Add to this the chal­lenge of man­ag­ing com­plex health con­di­tions and the risks for de­pres­sion and re­cur­ring poor health and hospi­tal­iza­tion are high.

Un­for­tu­nately, Verne’s ex­pe­ri­ence is not un­com­mon.

The 2016 State of Se­niors Health Care in Canada re­port from the Cana­dian Med­i­cal As­so­ci­a­tion, high­lights a key prob­lem: Our medi­care sys­tem was es­tab­lished to deal largely with acute, episodic care for a rel­a­tively young pop­u­la­tion.

To­day, our sys­tem strug­gles to care prop­erly for pa­tients man­ag­ing mul­ti­ple on­go­ing health is­sues. We know older adults with chronic con­di­tions need more health ser­vices and have a higher risk of hospi­tal­iza­tion com­pared with those with a sin­gle chronic con­di­tion.

Adults 65 years and older are the fastest grow­ing age group in the coun­try. In On­tario, 16.7 per cent, in Bri­tish Columbia and Que­bec 18.3 per cent, and in Nova Sco­tia 19.9 per cent of the pop­u­la­tion is 65 years or older.

Mul­ti­ple chronic con­di­tions among older adults are in­creas­ing. Ap­prox­i­mately 75 to 80 per cent of Cana­dian se­niors re­port hav­ing one or more chronic con­di­tion, such as di­a­betes, asthma, arthri­tis, high blood pres­sure, mood dis­or­der and chronic ob­struc­tive pul­monary dis­ease.

Like Verne, th­ese pa­tients face sev­eral chal­lenges in man­ag­ing their con­di­tions. A lack of care co-or­di­na­tion amongst health pro­fes­sion­als com­bined with low health lit­er­acy gets in the way. Their care is piece­meal and frag­mented, with lit­tle fo­cus on the pa­tient and fam­ily as a whole. Lim­ited fi­nan­cial re­sources to cover the costs of sup­plies, ad­di­tional care and trans­porta­tion also cre­ate bar­ri­ers to self-man­age­ment.

Th­ese se­niors of­ten ex­pe­ri­ence lone­li­ness. Their fam­ily care­givers of­ten lack sup­port. Man­ag­ing many, of­ten in­ter­act­ing, med­i­ca­tions is also dif­fi­cult.

So what can be done? We asked se­niors to find the an­swers.

As re­searchers with the Ag­ing, Com­mu­nity and Health Re­search Unit at McMaster Univer­sity, we’re work­ing with older adults with mul­ti­ple chronic con­di­tions and their fam­ily care­givers to pro­mote op­ti­mal ag­ing at home.

Com­mu­nity As­sets Sup­port­ing Tran­si­tions is a new hos­pi­tal-to-home tran­si­tional care pro­gram in Sud­bury, Burling­ton and Hamil­ton that aims to re­duce de­pres­sive symp­toms, im­prove pa­tients’ qual­ity of life and self-man­age­ment abil­ity, and sup­port fam­ily care­givers. CAST is de­liv­ered by reg­is­tered nurses who sup­port pa­tients tran­si­tion­ing from hos­pi­tal to home over a six-month pe­riod through in-home vis­its, tele­phone fol­lowup and care co-or­di­na­tion.

There’s also a com­mu­nity-based di­a­betes self-man­age­ment pro­gram in On­tario, Que­bec and P.E.I. that was de­vel­oped for older adults with di­a­betes and mul­ti­ple chronic con­di­tions. The pro­gram in­cludes monthly well­ness ses­sions, and a se­ries of home vis­its with a reg­is­tered nurse and a reg­is­tered di­eti­tian. They work as a team with staff and vol­un­teers from se­niors cen­tres or YMCAs to de­liver a health-pro­mo­tion pro­gram for par­tic­i­pants.

We’ve also been cre­at­ing a new way of pro­vid­ing out­pa­tient stroke re­ha­bil­i­ta­tion ser­vices for older adults with stroke and mul­ti­ple chronic con­di­tions liv­ing in the com­mu­nity. We pro­vide reg­u­lar in-home vis­its for the pa­tient and monthly in­ter­pro­fes­sional care con­fer­ences for the providers. We also de­vel­oped a new web-based app, MyST (My Stroke Team), to sup­port com­mu­ni­ca­tion and col­lab­o­ra­tion among the in­ter­pro­fes­sional stroke team.

Clearly, the sta­tus quo isn’t meet­ing the needs of our ag­ing pop­u­la­tion and fails to pro­vide qual­ity care for se­niors. Cre­at­ing in­no­va­tive pi­lot projects to im­prove the tran­si­tion from hos­pi­tal to home will help us pro­vide a bet­ter sys­tem that’s both more ef­fi­cient and cost-ef­fec­tive, and will im­prove the stan­dard of care to se­niors like Verne.

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