Home Care 3

I’m embarrassed at having said nothing here since January of this year as if either nothing has happened or I’ve just given up. Neither of those is correct.

The “Shared Care” activity that I was doing back in January succeeded financially – we got $200,000 – and has since gone nowhere. I got an email from a home care supervisor telling me to quit trying to organize a team to care for the homebound frail elderly because it would make her job more difficult. It then developed that the big funding really couldn’t be used for much of anything, and the homecare 24/7 team that looked feasible was sidelined in favour of goals like “reflect(ing) on how we can leverage our respective assets across organizations and communities” and “advancing/improving care of frail seniors across the continuum and geography of the Coast”. Operationally not-reasonable hot air in other words.

Physician after physician has told me one version or another of, “We are just slammed. Nobody here is willing to take on any more responsibility because we are stretched to the limit. Having to make house calls outside office hours is just out of the question.” Residential care waiting lists on the Sunshine Coast run to several months or more unless you are willing to be placed in Vancouver and the hospital general medical wards are 30% “ALC“ (alternate level of care): sad demented people wandering in the hallway waiting to go to nursing homes.

I had to shift my focus from accomplishing a “Home ViVE” type team to getting someone to take on my own elderly patients so they would not all suddenly fall onto the system with no primary care provider, no support at home, and nowhere to go but into the hospital to increase that 30%, when I retire.

The local Primary Care Network (PCN) is the BC Health Ministry’s answer to nobody being able to find a family physician, replicated many dozens (I couldn’t find in the online literature the exact number) of times across the province. How these locally-staffed and (in the case of the one here) full of not necessarily qualified people “networks” could or would produce even a handful of family physicians and/or nurse practitioners out of the air hasn’t been explained to me and seems ingenuous.

As part of this aspirational windowdressing there is a “Steering Committee” for each PCN and I was able to get this Committee to promise to hire a very capable nurse practitioner who lives on the coast and is good at dealing with homebound elderly people. It looks like this may happen and if/when it does she will gradually assume care of my patients and I’ll be able to retire almost completely from clinical practice. I’m 75 and have other fish to fry.

So my goal of getting some of the estimated 500 or so homebound frail elderly people on the Coast cared for to keep them out of the hospital – except for doing it myself – is at least temporarily diminished or put on hold. But there are two or three clinical people around who share my idea that offering these people an advance directive of effective treatment of crisis at home and avoiding hospital admission would be good for the patients and good for the system. This is an old-fashioned relationship-of-trust-based approach that appears to have gone out of style. Of course it makes no sense at all to pretend to offer the advance directive unless it’s backed by 24/7 availability of a care provider on the phone and a visit at home if needed.

A lot of things have happened and a lot of things haven’t but I’m not giving up, just regrouping. I’ll post again once my clinical retirement is confirmed.

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 40 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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