A synthesis of the Canadian Health Care system & Seniors Care: A review of MHST 601 course

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The Masters of Health Studies (MHST) course 601 – Foundations of Health Systems in Canada offers an introductory focus of exploring the Canadian healthcare system and factors that influence the same. This was completed by curating and synthesizing articles related to weekly topics. Over the thirteen-week course different social media platforms, discussion forums and blog posts were utilized for student interaction of weekly topics. Throughout the course topics were often expanded upon to within the interest of choice. Over the thirteen-week course, I explored senior care within the Canadian health care system. This blog will synthesize seniors care as explored over the course. Prior to exploring the healthcare system, the task was given to explore our current professional identity and/or begin building a professional identity to aid in discussion opportunities through out the course.

Throughout MHST 601 course, the use of social media for professional presence was explored by myself and fellow classmates. With this we considering how our posts can be used positively among the professional world. While I am not professionally obligated to have a professional identity, the global pandemic has been a major event that has benefited from the use of social media to disseminate information. Our online interactions can also cause consequences for our personal and professional lives, no matter which type of account is utilized. Social media can have common consequences to the general public such as cyberbullying and self image mutilation (Naions, 2019). When it comes to professional consequences it is possible for them to exceed farther to disciplinary action from employers and regulatory bodies.

As a registered nurse my regulatory body is the College of Nurses of Ontario. The College of Nurses of Ontario is the regulatory board for all registered nurses, registered practical nurses and nurse Practitioners within Ontario. This license is renewed annually, this process includes updating the college “about your employment status and areas of practice and education, and paying an annual fee” (College of Nurses of Ontario, 2017). The college also establishes entry to practice requirements, practice standards, disciplinary as needed relating to practice standards, and assisting legislative needs for the province (College of Nurses of Ontario, 2017). One of the requirements as a nurse in Ontario is to hold professional liability protection; I hold this through the Registered Nurses Association of Ontario (RNAO). This is association represents registered nurses, nurse practitioners and nursing students in Ontario with a focus on advocating “for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve” (Registered Nurses Association, n.d.). After establishing how my regulatory body influenced my professional actions and how it fit within the health system, we moved on to exploring the health care system as a whole while breaking it down into sections.

The forefront of exploring the healthcare system is exploring how we define health. Since 1948 the World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Official Records of WHO, no. 2, p. 100). Although this definition is still one of the leading definitions of health, it doesn’t reflect the advances that the medical field and society have made. As the definition hints at, health has many domains to it. “At every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour” (Simcoe Muskoka Health Unit, n.d.). If we take into account the determinants of health and Leonardi’s (2018) definition of “health as the capability to cope with and to manage one’s own malaise and well-being conditions”; we see how these overlap each other. One’s ability to cope or manage a medical condition could be influenced by income, ability to work, and social support network.

As we know health is multifactorial, through fore it requires a complex budgeting framework to met the needs of the population. The Canadian Healthcare system funding begins with the Health Care Act originally adopted in 1984 and provides guidance for each province to be able to receive federal funding but does not regulate how these services are delivered provincial (Closing the Gap, 2018). For the province of Ontario, the healthcare funding starts with tax payers’ dollars (Closing the Gap, 2018). As expected with the little funding allocated to health care, it is a balancing act that some times results in patient’s being in bed that don’t match the care needed resulting in a designation of Alternative Level of Care. This designation is essentially bed bloggers for acute care hospitals and accounts for 14% of Ontario hospital beds; at times this could be seniors awaiting home and community care services and/or supportive living environments (Closing the Gap, 2018). As Vanderveen (2019) stated “Ontario health systems in Ontario are designed to focus on acute care; however, older adults need chronic disease management”; this means that our traditional model of care is not suited towards senior friendly care (Ryan et al, 2017).

In order to make a difference for our seniors we need to work collaboratively amongst organizations to stop the disjointed or siloed services that are within the Ontario model of care currently (Vanderveen, 2019). A comprehensive geriatric assessment (CGA) can be the first step in aiding in improving senior outcomes within our health care system, specifically in the emergency department as “when frail older adults receive a CGA proactively and in a timely manner, it might reduce the chance that they will need an emergency room visit or hospital admission. Long-term care residential placement might also be postponed” (Vanderveen, 2019). As stated in Vanderveen (2019) report by Monteserin et al, “a CGA is “a multi-dimensional interdisciplinary diagnostic process to determine the medical, psychological and functional abilities of frail elderly people in order to develop and coordinate integrated plans for treatment and long-term follow up”.

By looking at the geriatric giants, the bigger picture of how the patient presents is accounted; in the traditional model a ED doctor may treat a wound on a senior patient and discharge home, with a CGA it is possible to identify the cause of wound, risk of falls and assist in a safe discharge plan by connecting the patient with appropriate resources (Ryan et al, 2017).

Figure 1: Geriatric Giants

As we can see seniors care is unique and requires specialized care. This starts with health promotion. Health promotion is important as it enables an individual to make healthier life choices by providing information that allows an individual to have control over their health. Taking the next step is applying health promotion initiatives across a multi level of influences to address the determinants of health. In order to bring about change through health promotion, one may look at “health behavior models and theories help to explain why individuals and communities behave the way they do” (Simpson, 2015). The Health Belief Model (HBM) is one of the oldest models but is still widely recognized (Glanz & Bishop, 2010). “The HBM theorizes that people's beliefs about whether they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action” (Glanz & Bishop, 2010). As Glanz and Bishop (2010) stated “The HBM has been applied most often for health concerns that are prevention-related and asymptomatic”.

When it comes to the patient population over 65 years of age, they become more vulnerable to adverse outcomes while being hospitalized. “Special considerations should be taken for the care of elders in the hospital, especially those with advanced age, baseline cognitive impairment, functional limitations, or frailty (Sanon, 2020). By implementing the HBM at all levels within the organization, for example, Orillia Soldiers Memorial Hospital (OSMH) is shifting model of care for medical and rehabilitation to integrated model will improve the health outcomes for patients on this unit.

Figure 2: Applying the HBM from institutional level to interpersonal level.

Figure 3: Applying the HBM from interpersonal to intrapersonal level.

As can be seen from the figures above, by starting at the institutional level and working down the levels to intrapersonal level, health outcomes for the senior population can be influenced to result in the better outcomes.

We are seeing increased admissions for medical reasons in this population but also for social reasons such as failure to cope, caregiver burn out or responsive behaviours. Li and Huynh (2020) stated that “as public spaces close and visitor restrictions are imposed by different institutions, seniors who live at home alone or in residential facilities are cut off abruptly from society, with no contingency plan in place”. This abrupt cut off can lead to responsive behaviours in some seniors, especially those with dementia. This population doesn’t adapt as well to sudden changes and often non pharmaceutical strategies to help with behaviours include: “distraction, stimulation and social interaction”; although this is a challenge it can lead to depression, or acute events that may lead to hospitalization (Li & Huynh, 2020; Canevelli, 2020; Suzuki, 2020). Unfortunately, this cycle needs to be address in order to advance the health care of seniors.

By exploring ways to support individuals in their home longer and with the correct supports, we could help this crippling health care system be more efficient at providing person centered care. If we utilized the National Seniors Strategy model, specifically the pillar for care closer to home, this would allow person-centered care to occur by care providers who have the knowledge and skills to care for them (Sinha, Nolan, McDonald, Nicin & Wong, 2020). By supporting these individuals in their home, we can be more cost efficient and respect their wishes. As Sinha et al (2020) states this population have “an increased need for improved care coordination, primary care, and social support, as well as in-home episodic care needs associated with chronic disease during the waiting period for placement in a LTC home”. Addressing the patient as a whole allows all needs to be met and has many benefits of Improved quality of life, prevent decline, encourage independence, reduces risk of illness, reduces stress as in own familiar environment and can expedite healing (Bayshore, 2017). With the advancements in technology development health care is going to be reshaped (Canadian Medical Association, 2018). I feel the use of these advancements such as virtual care that we are seeing being implemented during the global pandemic is the perfect time to move forward and think outside the box for seniors’ care in the future.

In conclusion, this course overall has allowed myself to explore seniors care within the Canadian health care system. The knowledge acquired has allowed myself to become aware of challenges faced by this population as well as ways to overcome these challenges. By exploring this topic, I had the opportunity to collaborate with fellow professionals of a variety of disciples across the provinces of Canada. This collaboration has grown my knowledge of the Canadian health care system in which I can implement in my current practice.

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References

Bayshore. (2017, February 17). Benefits of Aging at Home [web log]. https://www.bayshore.ca/2017/02/17/benefits-of-aging-at-home/#:~:text=Aging%20at%20home %2C%20or%20%E2%80%9Caging%20in%20place%E2%809D%20as,health%20resulting%20in%20the% 20loss%20of%20complete%20independence.

Canadian Medical Association. (2018, August 15). The future of technology in health and health care: a primer. https://www.cma.ca/sites/default/files/pdf/health-advocacy/activity/2018-08-15-future-technology-health-care-e.pdf.

Canevelli, M., Valletta, M., Blasi, M. T., Remoli, G., Sarti, G., Nuti, F., … Bruno, G. (2020). Facing Dementia During the COVID ‐19 Outbreak. Journal of the American Geriatrics Society, 68(8), 1673–1676. https://doi.org/10.1111/jgs.16644

Closing the Gap Healthcare. (2018, May 30). Healthcare in Ontario: How does it Work and How is it Funded? https://www.closingthegap.ca/healthcare-in-ontario-how-does-it-work-and-how-is-it-funded/.

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Li, H. O., & Huynh, D. (2020). Long-term social distancing during COVID-19: A social isolation crisis among seniors?. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 192(21), E588. https://doi.org/10.1503/cmaj.75428

Naions, D. (2019, December 19). What Is Social Media? Lifewire: https://www.lifewire.com/what-is-social-media-explaining-the-big-trend-3486616

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Registered Nurses’ Association of Ontario. (n.d.). About RNAO. Retrieved from https://rnao.ca/about

Ryan, D. P., Splinter Flynn, D., & Wilding, L. (2017). An Overview of Geriatric Emergency Management Nursing Practices in Ontario. Perspectives: The Journal of the Gerontological Nursing Association, 39(4), 6–13.

Sanon M. (2020) Hazards of Hospitalization. In: Chun A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_33

Simcoe Muskoka Health Unit. (n.d.). Determinants of Health. Determinants Of Health. https://www.simcoemuskokahealthstats.org/topics/determinants-of-health.

Simpson, V. (2015, Mar). Models and Theories to Support Health Behaviour Intervention and Program Planning. Retrieved from https://extension.purdue.edu/extmedia/HHS/HHS-792-W.pdf

Sinha, S., Nolan, M., McDonald, L., Nicin, M., & Wong, I. (2020, November). Bringing Long-Term Care Home. https://static1.squarespace.com/static/5c2fa7b03917eed9b5a436d8/t/5fb57afdbb4dec698ea3b7d2/1605729021992/BringLTCHome_V2.11.17(4)pdf.pdf .

Suzuki, M., Hotta, M., Nagase, A., Yamamoto, Y., Hirakawa, N., Satake, Y., Nagata, Y., Suehiro, T., Kanemoto, H., Yoshiyama, K., Mori, E., Hashimoto, M., & Ikeda, M. (2020). The behavioral pattern of patients with frontotemporal dementia during the COVID-19 pandemic. International psychogeriatrics, 32(10), 1231–1234. https://doi.org/10.1017/S104161022000109X

Vanderveen, C. (2019). Comprehensive Geriatric Assessments: A Rural Ontario Area Case Study. Canadian Social Work, 20(2), 64–77.