Warning signs about the aging wave

On Sept. 23 in Clarenville, Kathy Dunderdale pledged $3.4-million dollars to set up an organization to make the health care system more efficient. She also declared that within 120 days, a re-elected PC government wouldlay out a plan to cut wait times in hospital ERsand for some orthopedic services.

Why the need for another four months? The Conservatives have been in office for 2,800-plus days. Before that, the Liberals were in office for more than 5,200 days.

Warning signs about the aging wave, and its impact on health care, have been widely advertised. There has been much talk, but not nearly as much action.

Dr. Roger Butler sees the future of medicine in his practice in the old General Hospital on Forest Road in St. John's, where 70 per cent of his patients are seniors.

He knows this is just the start of the wave.

It's a cruel fact: the elderly frail consume the majority of health care resources. Many seniors have complicated medical problems, and if they're admitted to hospital, their stays are often long, and costly.

Dr. Butler says the 15 per cent of seniors who are frail [most of them 85 and over] consume 55 per cent of acute care costs.

His real worry? Estimates that the number of frail elderly will increase three-fold in the next 20 years.

"And that's a conservative estimate," Dr. Butler tells me.

Ask the seniors who come to Dr. Butler's office what they're most of afraid of, and they tell him it's the acute care hospital. The places the rest of us clamour to get into to have our bones X-rayed, our hearts and knees and hips repaired, to get an MRI.

"They know the hospital is a dangerous place," Dr. Butler says.

Dangerous in a hospital? Afraid? I wanted to know more.

'God knows what will happen'

He told me seniors typically go to the hospital only when they need to, and that means entering through the emergency department. It's often an eight- to 10-hour wait on a stretcher.

If they're admitted, there's concern about being sent home too quickly. If they need to go to a nursing home, and there's no bed, it means a longer hospital stay.

"God knows what will happen to me," they confide in him.

As most of us bundled up against a bracing easterly wind on March 30, 30 health care and support professionalsdoctors, nurses and social workersmet in an all-day session at the Holiday Inn in St. John's, to try and get a handle on the future that Dr. Butler lives on a daily basis in his clinic.

The Summit on Seniors' Care was initiated by the Newfoundland and Labrador Medical Association, and their conclusions were arresting: in just 14 years, one-quarter of our population will be 65 and older.

Their stark conclusion: "these changes will place increased strain on personal care homes, long-term care and acute care beds, on diagnostic services capacity, and on medical treatment and management."

So, we think waits are long for hospital admission, treatment and surgery now? What will it be like in another decade?

Seniors' strategy

Politicians in the province have taken steps to help seniors stay longer in their homes, including the heating cost rebate, a non-taxable benefit for low-income seniors, and the provision of homecare services. The prescription drug program means seniors in need can be prescribed the drugs they need without having to take money from their food or heat budget.

But what about the inevitable need for help as the body becomes weaker, when, even with family and community support, the needs multiply?

All three parties have pledged to address the coming deluge in some way or other.

The NDP has made the linkbetween long wait times in emergency rooms and the need for special services for seniors, and would institute a publicly-paid and universal home care and long-term care program.

The PC platformpromises a "Close to Home" strategy for long-term and community care that suggests help for people in their homes, and will focus on "increasing the focus on quality of life in all aspects of care."

TheLiberals promise a pilot projectto develop a geriatric focus to health care, with a desire to returnseniors to their homes with "appropriate supports."

Sparse details

All the platforms sound hopeful, but the details are sparse. There is much talk of planning, but everyone knows the clock is ticking. And time won't wait.

Dr. Roger Butler doesn't want to wait. A few days before the election officially got underway, he and Dr. Patrick O'Shea, on behalf of the Medical Association, presented a 10-point plan out of the Seniors' Summit in March.

Their key recommendation is for a pilot Acute Geriatric Care Centre. The centre would be set up in the hospital and work closely with the ER as the first point of contact for severely ill seniors. That's where they would be assessed, and a treatment plan worked out. A team would help navigate them through the various levels of care they require, including whether they need to be assigned to acute beds in hospitals, a rehabilitation centre, or a long-term care bed.

And perhaps the most comforting part for the patient who's been discharged from hospital, there would be follow-up for up to six weeks by a team of professionals, including a doctor, nurses, social worker, a physiotherapist and an occupational therapist.

'Geriatric medicine is not sexy, it's low-tech, it's grinding medicine.' Dr. Roger Butler

Dr. O'Shea connected the dots that day when he talked about "bed blockage", and its relationship to increased wait times. He said "the majority of patients in those beds are seniors," who could be discharged from hospital, if only they could get into a long-term care bed, or had the support to get back to their homes.

"This bottleneck in the system keeps patients waiting on stretchers in the ER and in hallways, and results in significant delays for those waiting to be admitted for surgery and other procedures," he said.

Can this province adopt a strategy that provides seniors better care and frees up beds and facilities to others who need them? Dr. Butler is hopeful.

He figures he's got another 10 years in practice before retirement, and his push will be to work toward a better system. He says there are some good things happening.

For one thing, doctors in Memorial University's family practice residency are getting intense training in caring for the frail elderly. Other professions are also directing a bigger part of their training toward care and treatment of the elderly.

"We have to make this a valuable facet of medicine," he says.

"Geriatric medicine is not sexy, it's low-tech, it's grinding medicine."

And he has one more thought. "It's very rewarding."