Dr. Mark Nowaczynski
On March 1, Maclean’s is hosting “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the St. Lawrence Centre for the Arts in Toronto. The event, in conjunction with the Canadian Medical Association, will be broadcast by CPAC. The conversation on health care reform continues in the coming months in Maclean’s and at town halls in Edmonton, Vancouver and Ottawa.
He was a frail old man living in Vancouver. Call him Mr. B. One night he developed excruciating back pain, and his doctor was summoned. Mr. B was a lucky man in that his doctor was John Sloan, a general practitioner whose practice consisted of treating the frail elderly in their homes. Sloan’s diagnosis was a compression fracture of the vertebrae due to osteoporosis. He prescribed pain medication, and recommended keeping him at home. “It hurts like hell for six weeks,” Sloan said, “and then it gets better.”
His family was skeptical. Aren’t hospitals where you go when you’re sick? But Sloan was a trusted doctor and diligent with his follow-up visits. One day, Mr. B had a setback, and the hired caregiver dialled 911. Three days later, Sloan received hospital reports, the first he knew his patient was admitted. Not good, he thought. He tried to convince the family to continue treatment at home, but they were awed by the medical resources deployed in aid of Mr. B. “He saw a psychiatrist. He saw a heart specialist. He saw a respiratory specialist. He saw an orthopaedic surgeon,” says Sloan. “The inevitable happened. He lost strength. He became confused.” He was put on antibiotics. He developed a C. difficile infection. Mr. B died in hospital.
Halfway across Canada, Mr. W was leading a largely independent life in his apartment in Toronto until last September. He was 100 years old, a retired Polish-born architect with a subversive sense of humour. He used a walker, but his intellect and imagination ranged beyond the walls of his apartment, abetted by the computer he’d learned to use seven years earlier. Last fall he grew weak. His son called Mr. W’s doctor, Mark Nowaczynski. Like Sloan, he’s a general practitioner specializing in treating frail elderly people in their homes. It was a Thursday. Nowaczynski diagnosed pneumonia, started him on antibiotics, arranged for additional home care by Monday. Give it time, he advised. Keep him out of hospital. By Friday night the antibiotics had yet to take full effect. The worried son dialled 911. Mr. W was admitted to hospital. An intravenous line went in his arm; a catheter in his bladder. He was confined to his bed, with the best of intentions. By Monday, Mr. W needed two people supporting him just to walk across the room.
The treatment—and mismanagement—of Canada’s older citizens represents one of the greatest challenges facing the national health care system. Not only does the greying boomer bulge represent a looming financial crisis, but existing models of care are inadequate, inefficient and frequently dead wrong, say many of those who navigate the system as patients and providers.
Today’s frailest patients often suffer from multiple chronic conditions, ingest a mix of drugs and frequently want for medical care until a crisis hits. Once they get to hospital they stay there, tied to machines, consuming high-tech resources to little effect, growing weaker until the dim hope of a nursing home bed is the best of two potential outcomes. A frail, elderly person suffers a five per cent functional decline for every day in hospital, says Nowaczynski. In 10 days, that’s a 50 per cent decline. “The hospitals are overwhelmed with these people,” he says.
On any given day, 7,550 acute-care hospital beds in Canada are filled with people who should be in long-term-care nursing homes or in rehabilitation. Annually, that’s 2.4 million hospital days, at $1,000 each—$2.4 billion a year—spent warehousing elderly people, often to their detriment, while denying space to critically ill patients. For these reasons, the Canadian Medical Association (CMA) wants long-term care included in a reformed universal medicare system. “Today we have 142 patient beds that are filled with people waiting to go into long-term care,” CMA president Dr. Jeff Turnbull said recently of a typical day at Ottawa Hospital, where he is chief of staff. The elderly would receive better care elsewhere at a fraction of the cost, if there was an elsewhere, he said. “Hospitals are not good places for people waiting for rehab or other circumstances,” he said. On that day, 38 admitted patients in Ottawa’s ER were waiting for beds.
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