Speaking out for better elder care

The Report: November 2007 vol.28 num.5

by LAURA BUSHEIKIN

ike most health science professionals, HSA member Vikki Tellier can talk at length about ways to improve our health care system. And she has impressive credentials for such a conversation: five years as an occupational therapist, in addition to 21 years as a physiotherapist at Nanaimo Regional General Hospital, combined with active membership in a professional union.

And like most health care professionals, Tellier would prefer to share her ideas with people in positions to do something with the information.

So when she got a call asking her to participate in the provincial governments Conversation on Health earlier this year, she didnt hesitate.

Tellier was one of three HSA members from her workplace who participated in a health professionals focus group held in Nanaimo as part of the Conversation on Health. The three of them were very well prepared ... thanks to their union, Tellier said.

-The union had a list of three topics that were important to advocate for. Each of the three participants chose a topic related to our field of work: innovations in health care; recruitment, retention and staff shortages; and elder care. These are huge issues for our field of practice," she said.

Some fortuitous HSA networking provided Tellier and her colleagues with key information about the focus groups structure. This allowed them to effectively strategize to get their topics on the agenda. -A few days after I got the call, I went to Vancouver for steward training. There was a physiotherapist there who had participated in the Conversation on Health in Kelowna the previous week," she said, and the information she gathered about the process was invaluable. The three HSA representatives arrived at the Nanaimo session with not only a list of key topics, but an action plan to make sure these topics were raised in an effective fashion.

-After everyone introduced themselves, we had 15 minutes where we put points onto sticky notes and the sticky notes on the wall. Then the sticky note topics were put into sub-groups and we were divided to discuss the topics that were most highly weighted."

She and her two colleagues worked as a team by separating and each focusing on one of the subgroup discussions. They each took on reporting roles for their subgroups, further ensuring a strong voice for HSA and for their facility.

Telliers topic was elder care ... a natural choice, given her workplace focus.

-The average age of our regions population is among the highest in Canada. Elders are living longer with more complex problems. How do we keep them as healthy as possible? What kind of services do they need in an acute care hospital and in the community so they can function independently for as long as possible? How do we avoid having them plug up a huge number of acute care beds when they can no longer live independently?"

She has answers to these questions:

-We need to better coordinate services between acute care and community services. In the hospital, we need to be able to assess and treat patients in a timely fashion and get them out as quickly as possible. The hospital is not a good place for the elderly. They fade and languish if they spend too much time there. Immobility and hospital ‘bugs are bad for their health.

-We need an outpatient assessment and treatment program for people out in the community. We need a day program where they would come in and be fully assessed by the whole team ... the physiotherapist, the occupational therapist, the dietitian, and the pharmacist. Wed look at their medical needs and review their lab work and their medications. We could catch them before they get sick and arrive in the ER. In conjunction with that you can have some conditioning programs to increase their physical functioning so they can remain mobile, because as soon as someone loses their mobility they lose their independence," she said.

Tellier also advocated for a streamlined system for patients to transition from one level of care to the next as their needs change, since physical and mental decline in the elderly is often part of the aging process.

Over time, everyone who lives a long life will eventually need some form of assistance. Patients and families need a simple pathway to guide them through the end of life years. Currently, many services are available but it can be like negotiating a maze wearing a blindfold when attempting to find access to services. Too many patients dont seek or identify services until they are in a crisis or have a fall that results in a broken bone. These patients often spend months in acute care beds.

Some simple reforms of policies around access to care beds would also make a big difference for many patients, Tellier said. For example, if an ailing elder is entirely cared for by family members, she may not be eligible for facility care as she declines. Patients are obliged to maximize use of home support to be eligible for facility care. So families may be penalized for not using home support, even though they are greatly easing the burden on the health care system. Then they end up with an elder at home for whom they can no longer provide adequate care. A burned out family results in a patient in the emergency room.

Such inconsistencies are a source of daily frustration for Tellier, who works mainly with elders with multiple diagnoses. The opportunity to participate in the Conversation on Health provided at least some relief for that frustration, even though Tellier has some skepticism about the process itself.

-One part of me says its just lip service and the government probably has its own agenda anyway. But another part of me says if I dont make my voice heard I have no right to complain. One positive thing was that many of the higher level administrators for our region were present and listening to what we were saying.

-It is always worthwhile to get your voice heard. If people dont ever hear about ideas and issues how can you expect them to act? Planting a seed is never a bad thing. I have a garden and I plant a lot of seeds every year. If even one grows thats better than nothing.

-Some day I might be in need of these services and maybe, if I keep butting my head against the wall, they will be there. I am an eternal optimist," she said.