The Canadian Medical Association’s 16th National Report Card on the Health Care System in Canada, based on an online survey of Canadian adults, lists ‘expanded / improved care for seniors’ as one of the top requirements to ensure the health care system meets the future needs of Canadians. The National Report Card goes on to list ‘a Strategy for Seniors Health’ as the #1 item requiring designated funding in the new Federal Health Accord.
These findings are not surprising. Seniors account for almost 60% of acute care hospital days, the lion’s share of ALC days and nearly 50% of provincial health care budgets. These numbers will grow rapidly as the ranks of seniors swells - clearly the current model of seniors care is not financially sustainable and, if not enhanced via intelligent planning and strategic coordination, will overwhelm the health care system and threaten the survival of universal health care.
What is surprising, and highly gratifying, is that Canadians now recognize this and are speaking out. As a society we are now recognizing that better seniors care would translate into less hospital overcrowding, lower ALC rates, and would delay or prevent long-term care placement. This, in turn, will improve access to services and will shorten Wait Times for Canadians of all ages - better seniors’ care really would mean better care for Canadians of all ages.
What would better seniors’ care look like? There is consensus that more care must be provided in the community to prevent avoidable emergency department use and avoidable admissions to hospital (often leading to long lengths of stay and ALC). To accomplish this we need to ‘dehospitalize’ the system and need to create a stronger infrastructure in the community that allows specialists to practice outside hospital walls and to better integrate specialist care with Primary Care and home care. Until more specialists are integrated into community care it will be impossible to keep our most medically complex seniors out of hospital.
Sometimes hospitalization is unavoidable and appropriate. In those instances, we need to enhance in-hospital seniors’ services so that seniors at highest risk of hospital-acquired disability (driven by hospital-acquired delirium and hospital-acquired deconditioning due to inadequate mobilization) are rapidly identified, carefully followed by senior care specialists (e.g. Geriatric Medicine, Care of the Elderly, Geriatric Psychiatry) and safely returned to the community as early as possible in order the prevent hospital-acquired disability. This represents a convergence of the desires and goals of seniors and their caregivers (to stay home as long as safely possible), of hospitals (to reduce lengths of stay to what is truly needed for optimal care thereby reducing hospital overcrowding) and of provincial and territorial ministries of health (to manage the health care system in the most cost-effective manner possible to ensure sustainability) – an exceedingly rare win-win-win!
Now we need our provincial, territorial and federal governments to acknowledge this and to act by restructuring the community care and hospital systems accordingly to ensure sustainability – to create a community-centered heath care system rather than the current hospital-centered system.
So let us all remember to share the following with any decision makers who will listen – better seniors’ care means better care for Canadian of all ages.
Dr. Frank Molnar
Vice-President, Canadian Geriatrics Society
To learn more about various proposed Seniors Strategies go to the Advocacy webpage at www.canadiangeriatrics.ca