Examining the community’s response to ALC - Dr. Peter Zalan

What was the local response to the growing ALC crisis?

In October 2008, nine physicians volunteered to form a task force to advocate on behalf of our patients. Because we understood early on that we needed total community involvement if we were to have any success, the Sudbury ALC Community Steering Group was established.

The Minister of Health asked that we develop a made-in-Sudbury solution. We took a three-pronged approach: increasing capacity; improving efficiency; and developing programs to prevent our fragile elderly from becoming ALC patients.

Here are some of the results of our plan:

We made the case to the Northeast Local Health Integration Network (LHIN) that we would need to keep the Memorial site open to care for ALC patients. Funding was authorized until April 2011.

We advocated on behalf of St. Joseph’s Health Centre to secure sufficient funding to build St. Gabriel’s Villa. St Gabriel’s is under construction and will open in January 2011. We lobbied the City of Greater Sudbury and North East LHIN to open 24 additional long-term care beds at Pioneer Manor. The beds should open in early 2011.

A new emergency department outreach program was launched earlier this year. This is a co-operative effort between the hospital and three of our long-term care homes where Emergency Department nurses make “house calls” to residents in their own home.

The hospital introduced geriatric emergency management in September. Any high risk patient over 75 who comes to the emergency department is assessed by a nurse specialized in identifying geriatric needs to ensure a safe and timely discharge back to the community.

During hospitalization with an acute illness, frail and elderly patients lose muscle mass and strength. Such patients may become incapable of returning to independent living. Rehabilitation can mean the difference between going back home from hospital and becoming an ALC patient.

I saw rehabilitation’s value within my own family. My aunt broke her hip when she was 92. After her surgery, she was transferred to a rehabilitation hospital. After two months, she was able to go home, where she lived independently with home care services until the age of 98.

My aunt lives in Toronto. In 2008, Sudbury had no dedicated rehabilitation to help the elderly. In the spring of 2009, Sudbury took its first step towards addressing this gap with the recruitment of our first geriatrician – a specialist dedicated to care of the elderly.

We have had successes: the opening of a Functional Enhancement Unit and a Geriatric Rehabilitation Unit at St. Joseph’s Complex Continuing Care Centre and the recent opening of a Geriatric Day Hospital at the Sudbury Regional Hospital. These new units are dedicated to rebuilding strength and function in our fragile elderly.

But we also face challenges. We have a shortage of personal support workers and health professionals. We need more geriatric specialists. Sudbury is short of physicians to care for the elderly. Compared to 10 other countries, Canada — specifically Ontario — has the worst record on timely access to family physicians. We identified the need for additional affordable supportive housing. By the government’s own studies, affordable housing is the most cost-effective method for managing a significant number of ALC patients. We continue to advocate actively because we will need more capacity.

In my next column, I will explore Ontario’s finances and the consequences for our health care system.

Dr. Peter Zalan is the president of Sudbury Regional Hospital’s medical staff.