Between 2008 and 2013, the number of Canadians receiving some form of home care grew by 55 per cent, to 1.4 million. And as our population continues to age, more and more Canadians expect that care at home will be a viable option. Since the beginning of many coordinated home care programs in the late 1980s home care clients have changed. They are sicker, frailer, more acute, and more complex. The challenge is that in spite of the growth in numbers and increasing complexity and acuity, home care programs are having to do more with less. Demand for home care is increasing, but funding has not kept pace. Although home care programs are seeing more clients who are sicker, the volume of service per client is shrinking in order to keep up with this growing demand. If home care is to be sustainable in this environment, we need new and innovative options to adequately address care needs in the community.
Home care programs offer sophisticated care and effectively manage complex conditions and multiple chronic conditions. However, there are times where a more acute event, a decrease in health status, or a need for more intensive observation or intervention is required. Interventions that are not required, nor are they best provided, in an acute care hospital or busy emergency department. Yet because we do not currently have an integrated health care system, if someone currently requires more urgent intervention for a condition that is not life threatening, there is little option other than going to an emergency department.
A promising alternative to the current situation is a transitional or halfway hospital. A transitional hospital could serve a population in a geographic area in an integrated manner when they are already a part of a home care program. A home care client may have fluctuating levels of health and need an urgent intervention, but not necessarily from an acute care hospital. For example, a frail elderly person who suffers from a short-term illness like a virus that creates a state of dehydration or electrolyte imbalance that cannot be fully managed at home and requires a short term intervention. There are a myriad of other health concerns that are urgent – but not emergencies -, that lead home care clients to seek hospital care because there are no intermediary options.
This kind of solution exists in many parts of Sweden. A transitional short stay (24-72 hours) unit designated just for home care clients—for clients known to their team and connected to their team – a truly integrated system. Such an option could be offered in Canada. There would of course be parameters around the type of concerns that could be seen and how many over-night stays could be accommodated. In a transitional, or half way hospital, the services provided would be much less intensive than the hospital would provide, but more intensive than home care can provide. Most often the individual might require frequent intervention for a few days such as IV antibiotics, comprehensive wound care, or monitoring of a frail elderly person for a few days. Home care provides regular but episodic care whereas in a transitional hospital care would be more regular and could support integrated care; at least for home care clients. Monitoring and decision making by a health care professional such as physicians or nurses or more frequent observation by a regulated professional would be possible. This level of care would be less expensive than occupying space in an emergency department or in an acute care hospital and being seen by member of the health care team would be expedited because the client is already known to the team. This would be the case in an integrated system.
In Canada, this level of care is only available in acute care hospitals. In many cases clients with complex chronic conditions recognize a problem they are experiencing that requires intervention. It is time for some creative problem solving and decision making if we hope to create a sustainable health care system into the future. . It is time to stop doing things the same old way in home care programs—after 30 odd years it is time for a change.
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Thanks Kimberly. Sounds sensible. Do you know any region in Canada poised to try this? If tried, I suggest that it be evaluated, since what works in Sweden might not work (or might work even better) here.
Thanks for your comment, Andreas. I am not sure what region might be poised to try this or similar approaches. I agree it absolutely needs to be evaluated. There are some sub-acute models that could likely be modified to create an approach such as this (thinking of some of the options we have in Alberta). I just think we desperately need another option to meet some acute, but easily managed health concerns of clients with complex, chronic and likely multiple co-morbidities in home care beyond the emergencies department.