Monday, March 28, 2011

Best practices in senior health

In a surprising reversal, what do you think they have decided?

Specialists making house calls.
We know that Canada is terribly short of geriatricians. It is the lowest paid of the specialities, and no wonder elder seniors, with increasingly complex comorbidities, and multiple chronic care issues, are served by GPs without an understanding of palliative care, integrating families into the FHT, and a surprising attitude of navel gazing.

The statistics are cited here: (I hope this Globe reporter is accurate!)
- 65 and over is Canada’s fastest-growing age group, expected to hit 23 per cent of the population by 2031.
- The number of people in their eighties is increasing even faster, with each costing the system an average of $18,000 a year.
(Considering that a Herception cancer treatment costs $40,000, I wonder what they are so worried about? Many of us are paying our own way, or leading healthy lives.)
- Among its 68,000 doctors, Canada has fewer than 300 who specialize in geriatrics.
-  The number of annual deaths is projected to increase from about 250,000 to 430,000 by 2031.

(Death isn't expensive, it's the dying that requires home support, PSW, palliative specialists.)

Mount Sinai Hospital in Toronto will open an Acute Care for Elders unit next month. And as part of its new geriatric program, it has specialists and family physicians doing house calls to keep seniors home longer, thus avoiding unnecessary hospitalizations.

The two low-cost, low-tech approaches from geriatricians Samir Sinha of Mount Sinai and University Health Network and Dr. Dias take place continents apart. Solutions come in simpler forms: workers trained to prevent problems and to red flag others.

I have been writing about this forever: better trained, regulated PSWs who understand more about the aging process, who treat residents as individuals, avoid giving all the same treatment. They must understand the health issues facing individuals, with expertise in physical, mental, emotional, social comorbidities.

Better training in palliative care.

"Nurse-led outreach teams seen as new kind of ‘house call’ in LTC."
Not all aging at home have transportation to Primary Care staff. It is costly for pros to make house calls, but it prevents unnecessary visits to ERs, and hospitalization.

In some for-profit institutions care is lacking. Some LTC are run by giant US-based corporations, others part of a chain whose mandate is led by shareholders: the bottom line.

Are we in denial about the growing issue of elder care?

No, we're not. But we do need to be realistic, and not fearmonger.
More of us are eating better, exercising, remaining active, socializing, volunteering, and working hard to keep healthy.

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