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Nursing Home Care: Evolving to better meet patients’ needs

Dr._explaining_Rx_to_older_patient.jpgThere’s reason to be hopeful in the area of nursing home care today. The industry has been maturing to better meet the needs of increasingly frail seniors at the end of their lives, which is important as 30 per cent of seniors aged 85 or older reside in a nursing home in Canada. As a sector of care, even though it’s shrinking proportionately to other care models such as home care and supportive living, it remains the mainstay for individuals with complex care needs often associated with dementia.  

Young physicians are increasingly interested in working in nursing homes, which seems to be the result of greater exposure to long-term care during undergraduate and residency training. While certain regions across the country do struggle to find physicians willing to work in their homes, it’s heartening that new graduates are more attracted to working with vulnerable adults and seniors.

The model of nursing home care is also changing. Relationships between patients and their physicians used to be maintained from the community to the nursing home but, for varied reasons, patients are now assigned a new physician when they enter a home. This loss of continuity is unfortunate but it’s made up for by a smaller group of engaged physicians who visit their patients regularly and work in a collaborative setting with a multidisciplinary team.  

The traditional approach to medical care of nursing home patients centred on reacting to emerging medical issues such as infections and managing medications. Modern care is now more interdisciplinary with the attending physician working with the rest of the team to manage complex medical care, rehabilitation and end-of-life care. The physician is increasingly focused on the quality of life of their patients during their stay at the centre, including managing their medical conditions so that they’re comfortable and able to enjoy the last years of their lives. Enjoyment, comfort and functional independence are now seen to be better treatment goals and physicians are very well placed to steer the care plan along these lines.

In another area of care, change is occurring at a slow but steady pace in the nursing home. The move away from a traditional or institutional approach to care planning is very clear in the use of antipsychotics in the nursing home. As difficult behaviours are often associated with dementia in the nursing home, treatment used to be directed towards limiting those behaviours without really understanding the reason behind them. The medications worked to sedate patients but caused significant side effects and increased the likelihood of death. With the steady drift towards individualized care planning, there’s a greater appreciation of the need to better understand our patients and to plan their care around what is best for them and not to apply universal ineffective and unsafe remedies. Non-pharmacological interventions are safer and usually as effective or more effective than employing powerful psychoactive medications. While we still depend on these medications, we are seeing a decline in their use. In Alberta over the past two years the use of antipsychotics has reduced quarter over quarter across all regions. For example, in Calgary and Edmonton, the rate of use has gone from 22 per cent to 17 per cent and 15 per cent.

These are just two concrete examples that demonstrate how nursing home care is evolving to better meet our patients’ needs.

 

About the Author:

Dr. Paddy Quail

Medical Leader

Supportive Living Calgary Zone

Alberta Health Services