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Better home care likely the key to better health care for all

By Dr. Cindy Forbes, President, Canadian Medical Association -- 

In Jeffrey Simpson’s column in the Globe and Mail on Jan. 28, he acknowledged the federal government’s plan to invest in a long-term funding agreement with the provinces and territories.

The key point of this agreement would, according to Health Minister Jane Philpott’s mandate letter, “support the delivery of more and better home-care services”.  This level of support for any type of health care issue is thoroughly welcomed by the provinces. It’s been a long time coming. 

Last December Deb Matthews, former Ontario minister and now deputy premier, spoke to an Ottawa summit on the state of our health care system. There, she said that Canadian health care works well for providers but not for patients. In addition, she said that Canadian health care providers don’t like change.

This came as a surprise to many at the Canadian Medical Association (CMA), as we’ve been advocating for change on behalf of our members and patients for a decade now— hardly resisting it.

Every day, physicians see first-hand the inefficiencies of a broken system trying to support our elderly.  It’s commonplace for doctors to assign patients to gurneys in the hallway because hospitals are over capacity by mid-morning.  

According to the Canadian Institute for Health Information, five to 15 per cent of acute care beds in our country’s hospitals are occupied by seniors with no place to go because we haven’t properly invested in long-term care facilities or support services necessary for home care.

It’s for these reasons that the CMA has been pushing for action on seniors care. By our calculation, the warehousing of seniors in hospital beds – seniors who do not require hospital care – is costing the system an extra $2.3 billion a year.

If that isn’t shocking enough, perhaps taxpayers would be even more astonished to know that a hospital bed costs the system about $1,000 a day, whereas care in the home costs about $55.

So if we know we’d save money prioritizing current and future investments in home, community and long-term care, why haven’t we done so?

There’s no one simple solution to these complex issues, but the answer will lie in part on the collaboration between policymakers, politicians, and health care workers.

Dr. David Naylor, in his report to the federal government on health care innovation last year, called this bureaucratic inaction a barrier to innovation.

In André Picard’s follow-up column in the Globe and Mail, he praised the report for shedding light on the federal government’s consistent lack of recognition for creative and innovative health care initiatives.

“By clinging to the status quo – the path of least political resistance – governments have created an outdated system that is ill-prepared to deal with fundamental shifts like patients demanding more engagement and the impending arrival of personalized medicine,” said Picard.

Providers and policymakers must work together to implement programs like palliative care in the home and community-based respite for family caregivers, as well as telehomecare, including home monitoring for therapies, exercise programs, vital statistics, critical responses and crisis support.

Could more strokes be avoided if elderly people could live at home with easy-to-use technology at their fingertips to track their own blood pressure?

In the town of Deep River in the Ottawa Valley, the staff at North Renfrew Long-Term Care Services have figured out a system of care that saves money and provides better care to all patients in the community.

Their services include long-term care beds, supportive care apartments, 24-hour in-home support, respite care, day programs, meals-on-wheels and transportation.

On top of this, the facility has a partnership program with the Renfrew County paramedics who work alongside the personal support workers for two days a week, eight hours a day, visiting clients’ homes and fulfilling their medical needs. This prevents seniors from making frequent and sometimes unnecessary visits to the hospital.

It’s a perfect micro-model of home care for everybody that doesn’t sacrifice quality and they accomplished it faster than any government or policymaker.

If we want our health care system to be able to meet the needs of our growing and aging population, we need to move from the micro to the big picture. That means bringing care to the people who need it, not the other way around.

Better home care would certainly be a step in the right direction. 

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