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Canada — Because this is the rainy day : a discussion paper on home care and informal caregiving for seniors with chronic health conditions

June 3, 2011 Comments off

Because this is the rainy day : a discussion paper on home care and informal caregiving for seniors with chronic health conditions (PDF)
Source: Change Foundation

Can we provide good care at home for seniors with chronic health conditions? If so, at what cost? And to whom? To explore these questions, The Change Foundation commissioned leading home-care expert Dr. John Hirdes, (Professor, University of Waterloo and Scientific Director, Homewood Research Institute), to examine data on Ontario seniors with chronic conditions to help us understand how they use home-care services, what their health-care needs are as they move from hospital to home and/or community care, and what the implications are for their caregivers.

Dr. Hirdes and his research team delved into rich, detailed data about home-care use in Ontario from 2004 to 2008. The picture that emerges illustrates the need for action to address three objectives:

  • to better align home-care services to seniors’ needs;
  • to realign resources from acute to community care; and
  • use home care more strategically to provide seniors and their informal caregivers with care and support tailored to their needs as well as to help solve health system problems.

One of these problems is the growing number of Alternate Level of Care (ALC) patients—a term for people who are in hospital beds but could be cared for more appropriately in other settings. Although there are a number of possible destinations from ALC—retirement homes, assisted living/supportive housing, rehabilitation facility—this work focuses on seniors in ALC beds who are waiting to be discharged home with services tailored to their needs or who are waiting for a long-term care placement.

An examination of the data also suggests that we must be careful not to simply transfer problems from hospital to home. For home care to be the solution for seniors with chronic health conditions, their caregivers—family and friends—need to receive adequate support. Without it, they may be unable to cope, their own health could deteriorate, and as a result, their loved one could end up back in hospital. An examination of one subset of seniors in Ontario—those with congestive heart failure—points to the importance of chronic disease management, especially when multiple medications are in order. The role of primary care in coordinating care needs for this population is particularly critical and speaks to the need for a more integrated system. This commentary will share worrisome new data about the failure to follow best practices in treating seniors with congestive heart failure. The data (discussed later in this commentary) is yet another example of the disconnect that exists between primary care and the rest of the health-care system. This systemic failure to communicate and connect sends many seniors on a troubling trajectory back to hospital. This failure can be averted if we act on what we know now.

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