Elderly and their caregivers need support to remain at home

At the Health Council of Canada, we’re developing a report on home and community care for seniors in Canada – a topic of national interest in the current media, most recently discussed in CBC’s Metro Morning.radio show.

We’re finding that the majority of care for seniors who are disabled, have multiple chronic conditions, or dementia is provided by family and friends. Not surprisingly, as the needs of the senior increase, so does caregiver distress. Although each province and territory offers publicly-funded home care services, eligibility, types of services, and hours of care vary across the country. 

We’re speaking to family caregivers to add real-life stories to our report. What we’re hearing is that home care services (primarily provided by personal/home support workers) are helpful, but often insufficient. In some cases even the maximum allotment (14 hrs/week in one province) is not enough to be able to run necessary errands and rush back before the time elapses.

In addition, night care can be exhausting if the care recipient wakes frequently. More opportunities for caregiver respite provide much needed breaks so that caregivers can carry out their responsibilities while maintaining their own health and wellbeing. Those who can afford to fill the gap, do so by purchasing additional services. Those who can’t may rely on occasional help from family and friends, but more often will become overburdened and distressed, both physically and mentally.

Shifting resources to home care can help seniors stay healthier in their homes for longer. Research shows how home care services can help alleviate pressures on the system by avoiding hospitalizations and delaying entrance into long-term care homes – a subject of interest to us, as are the specific practices and programs that are making a difference. Supporting caregivers and allowing for more opportunities for respite ensures that care recipients can maintain a desirable quality of life at home and their caregivers can remain healthy and avoid becoming hospitalized themselves.

I will be presenting on these and other issues at the Canadian Home Care Association Summit on October 24, 2011.

Look for our full report on home and community care for seniors in 2012!

Shilpi Majumder, Policy Lead, Health Council of Canada

Key Words: Home and Community Care, Primary Health Care

Patient Engagement Grows From Trust

Arlene Hache is the Executive Director of the Centre for Northern Families in Yellowknife, Northwest Territories. The Centre offers a broad range of services that support multi-stressed and marginalized families.  She is well known across the North as an advocate for social change and is a founding partner in the development of therapeutic programs and in-home family support services designed to support families recovering from trauma related to colonization and ongoing violence.  Arlene was awarded the Order of Canada for her work in the North in 2009.

As a habitual “no show” patient, I listened to doctors, nurses and health planners in community meetings try to grapple with the challenges I and others pose in terms of lost time and money when we fail to keep medical appointments.  They appeared to be frustrated and puzzled.  I was surprised, not realizing that my personal decisions had such systemic repercussions when they were simply based on how I felt that particular day.  All of us in the meetings were committed to improving the health system and its outreach to marginalized populations.  In response to the discussion, I reflected on the underpinnings of my own behaviour and recalled the numerous conversations I had had with women over the years about their experiences interacting with the health care system. 

For me, it really boiled down to the residual dregs of a long-time pattern of self-hate that revealed itself through sporadic attention to my health.  Other women, particularly those from small, northern communities who stayed at the emergency shelter exhibited similar responses.  Other factors that created barriers for First Nations and Inuit women included low-literacy levels, English as a second language, cultural differences and a lack of trust or comfort with mainstream service providers.  It was these needs that gave impetus to the establishment of a medical outreach clinic at the family resource centre in Yellowknife through a partnership with the local college, a medical clinic and the regional health authority.  The clinic was held one day a week and offered on a drop-in basis.  It was open to the community, but was situated in the same building as the emergency shelter for women who were homeless.  It was also used as the pilot site to introduce the doctor and nurse practitioner team in the North. 

The outcomes were interesting and the rewards were instantaneous.  The doctor and nurse practitioners fit into the chaotic nature of the family resource centre like a glove.  On the other hand, substitutes not so much.  We learned it takes a particular kind of personality to work successfully in a community-based setting.  People from the general public mingled with women from the emergency shelter in the kitchen as they drank coffee and ate bannock.  At first, both groups appeared to be tentative with each other, but as time passed a real familiarity and comfort level developed.  We learned community-based services create an opportunity to build inter-cultural understanding and acceptance.  The 24 to 30 women who stay in the shelter attended the clinic on a consistent basis.  One elder who didn’t speak English and had been limping for several years from an unattended injury was finally diagnosed and got hip surgery.  Women with mental health and addictions received immediate support with appropriate referrals so incarceration rates were reduced.  We learned that locating services where people are, in an environment that they trust, removes barriers.  It has been five years since the clinic opened.  It has been a tremendous experience.  About 45 people still come to the clinic each day.

Key Words: Access to Care in the North, Patient Engagement, Primary Health Care

It’s About Time

Eric Grief, M.D. is a family physician in Brampton and Thornhill, Ontario. He has written a book called Get Diagnosed Fast. His book can be accessed at www.publishamerica.com.

This bulletin by the Health Council of Canada highlights for us the factors contributing to whether or not patients feel ‘engaged’ in their medical care. What the survey results make apparent is how vital the time factor is in motivating Canadians to spend more energy safeguarding their health.

Time is brain when it comes to a brain attack (stroke) treatment and time is muscle in the algorithm for the treatment of a heart attack. So what does time represent in terms of the medical visit that millions of Canadians participate in annually? It turns out that time means engagement. People prefer that their medical doctor spends enough time with them—listening to their health concerns, organizing their symptoms and answering health-related questions and explaining treatment options. This time investment pays off dividends in the yield of ‘patient engagement.’

Unfortunately, medical doctors’ time is at a premium. This means that to ensure adequate time with every patient, some patients have to wait or else access medical care in a circuitous route: emergency departments, urgent access medical clinics, or clinic shopping that may involve out-of-pocket expenses.

Medical doctors and patients alike prefer to have health problems diagnosed and treated quickly. A fast and timely diagnosis leads to fewer backlogs, less suffering, and often results in improved patient adherence to treatment plans. Canadians can help their medical doctors at each visit by preparing in advance -  by rehearsing their concerns, negotiating their agenda their doctor, and asking questions. If they are not satisfied with the care, then Canadians need to follow up with the same medical doctor and explain their concerns forthrightly. Often, this latter strategy sends the message that people are not just a health complaint but rather they are humans with emotions who happen to have a health concern.

Medical colleges are aware that time is a factor in patient care. Ordering expensive tests does not replace one-on-one communication with patients... nor is it likely to replace doctors any time soon. Solving the time crunch requires continued vigilance from Canadians to communicate efficiently when visiting their doctor and from medical colleges to negotiate adequate payment schedules to reflect the time requirements that exist to deliver ‘timely’ care.

Patients engaged in their medical care ... it’s about time.

Key Words: Primary Health Care, Patient Engagement