FAILED CURE: 6TH IN A SERIES
Are 'ghettos' a cure for senior care?
July 5, 2008
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Joseph Hall
HEALTH REPORTER
Every aging person who needs home care in Ontario will be able to receive it provided they are willing to do one thing.
Move out of their homes.
That's the prescription one of Ontario's top hospital administrators gives for the chronic shortage of home care services that lingers almost six years after Roy Romanow's report on the future of health care pegged it as a national priority.
"When you look at home care, you have got to say what kind of home are we providing service to?" says Dr. Robert Bell, president of Toronto's University Health Network.
"Is it a bunch of different apartments or homes scattered across the city of Toronto, or are we actually going to try to provide a supportive housing approach that actually brings together people who need similar resources so we can provide them in an effective, efficient way?"
With no spaces available in chronic care or rehab facilities, patients needing these services can do one of two things: Plug up hospital beds or receive help at home, Bell says.
But in Ontario, where Community Care Access Centres have been set up to dole home care services out, there is still far less supply than demand, despite Romanow's recommendations, Bell says.
"Because of that, we've got people sitting in more expensive acute care facilities across Toronto, across Ontario, no question," he says.
But Bell says the province's three-year, $700 million Aging at Home Strategy – announced last August – could solve the problem, provided the homes where that aging takes place are clustered together in home care enclaves.
The strategy, said former health minister George Smitherman, is aimed at bringing preventive medicine to those who would otherwise slip to institutional care.
"We're going to reach out with many more preventative, proactive strategies to try and prevent the transfer to the hospital in the first place," Smitherman says.
But, he says these strategies will not only include medical visits, but transportation to clinics, phone calls to shut-ins, ethnically sensitive services and even home-based palliative care.
"Ontario has put a lot of the Romanow home care money into a very sophisticated end-of-life strategy," he says, referring to a piece of the dedicated funding Ottawa offered to implement the commission's 47 recommendations.
But Smitherman, now minister of energy, says Ontario's efforts in home care are simply seeing the province barely keep up.
"We have to remember that there are a higher percentage of old people than five or six years ago when Romanow was doing his work," he said in an interview last month.
"We're going to see the number of seniors double. It's kind of like working up hill. You've got to sprint, just to keep pace."
To keep pace, and to practise effective preventive medicine in a home setting, seniors in need of such services have to be congregated, Bell says.
"You can't find all 40 apartments across Leaside," he says.
"But if those apartments were all in one complex, be it a townhouse, be it an apartment building, wouldn't that be an effective way to do it?"
Bell says the provincial strategy of home care is only manageable through geographical congregation.
"We need to be able to send SWAT teams of advanced practice nurses from the hospitals into supportive housing before the patient needs to be cared for in the emergency department," Bell says.
"But we can't do that across the city in 50 different neighbourhoods, we've got to have some consolidation to make it effective."
Bell stresses he's not advocating the creation of nursing home warehouses or districts. He envisions, rather, the kind of "retirement community" settings that many seniors voluntarily settle in anyway.
"These people don't need nursing homes," he says. "They need to know that if they have a problem at nighttime they have someone who they can call."
But what of those people who would not want to leave their family home, with its memories of children and familiar neighbours?
Bell is blunt in his answer.
"I think as a society we've got to say `You've got a choice,'" he says.
"If you're able because you've saved up enough money, because you've got a lot of kids who are going to provide the supportive housing services for you, then knock yourself out. Live in your own home, choose the environment you're going to live in...
"But we can't do it all across the city; we have to aggregate it together. So please, sell your house, move into supportive housing."
Any requirement that forces the elderly to sell their homes to access government home care does not sit well with Susan Eng, vice-president of advocacy with Canada's Association for the 50 Plus.
"It creates a seniors ghetto," says Eng. "And I think that is really sacrificing the health and well-being and actual needs on the back of efficiency."
Donald Juzwishin, chief executive of the Health Council of Canada, sees merits in both views, stressing case managers should be used to assess the type of home care needed on a patient-by-patient basis.
"We just have to be careful here not to lump together or just assume that everybody can age at home with home care; that would be wrong," says Juzwishin, whose federally funded group was set up to monitor and advise governments on Canada's health care system.
"Just as it's wrong to assume that everyone has to go into congregate housing to get cared for."
Toronto Star