Ontario Health Care System: What about our Seniors?

As a resident of Canada, I am grateful to have access to health care when I need it, but what if it isn’t funded to benefit everyone? Have you ever wondered how our Canadian or Ontario Health care system is funded? What about our vulnerable senior population that doesn’t fit into a typical health care setting?

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). Only 38.7% of tax dollars is allocated to health care and is distributed by the Ministry of Health and Long-Term Care into eight subsections (Closing the Gap, 2018). These eight subsections are: “Ontario Health Insurance Program, Population and Public Health, Provincial Programs and Stewardship, Local Health Integration Networks, Ministry Administration, Health Policy and Research, eHealth and Information Management and Information Systems” (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 stated by Closing the Gap (2018) “We have an aging population and a large number of seniors that are going to be entering our healthcare system soon, so it’s important to find ways to make our healthcare system sustainable.”; this is why my personal opinion is advocating for stronger geriatric services in all Ontario hospitals and communities is important.

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). One way to advocate for this is though the implementation of geriatric emergency management nurse in all Ontario hospitals. According to Ryan et al (2017) Geriatric Emergency Management (GEM) provides “specialized geriatric nursing care in ED [emergency department] and helping build overall capacity to care for older adults in the ED is a valuable innovation in ED services”. Over the last decade in Ontario the Seniors Strategy “with the help of the Regional Geriatric Programs” a network of GEM nurses was developed (Ryan et al, 2017). The GEM nursing network “currently comprises approximately 130 nurses in 60 Eds” and are currently seeing less than 1/3 of older adults in ED (Ryan et al, 2017). Although the implementation of a GEM nurse role is complex it benefits both staff and the patients (Flynn et al, 2008; Ryan et al, 2017). The GEM nurse role is complex and comprised of two components; first is a comprehensive geriatric assessment (CGA) and secondly capacity planning (Ryan et al, 2017).

A CGA can be the first step in aiding in improving senior outcomes within our health care system, specifically the ED 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”. GEM nurse’s are looking for geriatric giants as seen in the figure below by Ryan et al (2017).

By looking at the geriatric giants, the GEM nurse is looking for the bigger picture as the patient presents; in the traditional model a ED doctor may treat a wound on a senior patient and discharge home, with a CGA the GEM nurse can 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).

The second component of a GEM nurse role refers to capacity planning which could include “teaching, mentoring and coaching, providing assistance for senior friendly care initiatives” (Ryan et al, 2017). The GEM nurse has the opportunity to increase staff geriatric knowledge as it can be difficulty to differentiate between geriatric syndromes from normal aging process (Fox et al, 2016). Some important geriatric pearls that can aid in staff include:

1) “Not everyone that is confused has dementia” (Flynn et al, 2008)

2) “What you see may not be their baseline” (Flynn et al, 2008)

3) “The stated problem may not be the real problem or the only problem” (Flynn et al, 2008)

By allowing the GEM nurse to be apart of the capacity planning they are fostering an interprofessional approach to the senior patient, overall increasing patient outcomes.

Working in a rural hospital in Ontario, I do not have access to a GEM nurse within my facility. I have had the opportunity to work along side a multi-disciplinary team addressing responsive behaviours within dementia patients. This was a temporary opportunity but was the first time I had the opportunity to network with community partners to assist in care planning for our patients. From this I have learnt how important it is to advocate for our senior patient population. I am an advocate for senior friendly initiatives with my facility and hope that one day we will have the opportunity to have a GEM nurse join our team. For now I will continue to educate my fellow colleagues on the importance of being aware and watching for geriatric giants among our patients to encourage better outcomes.

References

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/.

Flynn DS, Jennings J, Moghabghab R, & Wilding LJY. (2008). Geriatric emergency management nursing in Ontario. NENA Outlook, 31(1), 17–20

Fox, M. T., Butler, J. I., Persaud, M., Tregunno, D., Sidani, S., & McCague, H. (2016). A multi‐method study of the geriatric learning needs of acute care hospital nurses in Ontario, Canada. Research in Nursing & Health, 39(1), 66–76. https://doi.org/10.1002/nur.21699

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.

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