House Calls 8: More on Home Support

Bearing in mind the story of Mrs. Forsyth which seems to keep repeating itself, I have been meeting for about a year now with the generous and hard-working administrative people at Vancouver Coastal Health (VCH), our local health authority. In the beginning, I was suggesting that home support workers be allowed to call the doctor (or their supervisors be required to at least try to call a doctor) in a crisis, extra home support be made available promptly for an old person in a crisis, and that as far as possible old people get help from the same familiar support workers over long periods of time.

We have decided lately to focus on preventing the “Mrs. Forsyth” admission by making an effort to contact the doctor. At least that way there is a chance to avert a hospital admission if the doctor is one of the still-pretty-rare ones available and willing to make an urgent housecall. Our latest meeting was between a VCH administrator involved in home support, a representative from one of their contract home support agencies, and myself. The meeting was productive, but I was quite surprised at how difficult it appears to be to enact this apparently simple procedural rule.  There is no clear way for VCH to include such a directive in their client files, and problems with the agency’s systems as well.

Long story short, we will meet again at the end of March and see if there has been any progress. But we have discussed a pilot project involving our home care program which could test the feasibility of direct home support-MD communication.

I don’t think I need to repeat what I’ve already said  about the potential win-win that occurs when we do better and more desired hands-on home care of old people, resulting in happier clients and also cost-saving.  But there are times when from my naïve perspective I start to wonder about a corporate process that seems to do everything in its power to speed hospital discharges but then doesn’t understand that keeping people who don’t need to be there from going to the hospital in the first place is a lot easier and much cheaper.

Reading that over, I don’t want to be misunderstood as bashing administration. There aren’t many doctors who miss a chance to insist that administrators are to blame for everything wrong with our system, but I’m not one of those.  If we don’t talk frankly, admit our biases, and believe in one another’s wanting only the best for our patients and clients, we will miss a much more important opportunity to make progress.

Thanks, VCH, for listening.

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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