Health Committee on Oct. 24th, 2011

[Dr. Yves Joanette]

The deployment of this Canadian longitudinal study is, as you can imagine, a long-term thing. It will take about 20 to 40 years. We're at the point now, after three years, of the first re-evaluation of the cohorts, nearly 50,000 people. This is a unique platform Canada has for all the researchers in Canada, which will also attract research from outside of Canada and make Canada recognized as a leader in this area. I think this kind of research will allow us to determine the trajectory and to be able to answer more specifically what these determinants, such as nutrition and so on, are.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Joanette.

Thank you, Dr. Carrie.

We'll now go to Mr. Daniel.

[Joe Daniel, Conservative, Don Valley East, ON]

Thank you, witnesses. Certainly your reports were very interesting to me.

One of the things you've implied is that seniors are treated slightly differently in terms of response times for their treatment. Has anybody actually looked into the cost of all those delays to actually see what the benefit could be if treatment were done more quickly? In other words, what is the cost of a senior getting worse because treatment has been delayed, and what are the costs of all the other things, like keeping them in hospitals and so on?

[Susan Eng]

We haven't done the research ourselves. We rely on institutes like CIHI to help us with that kind of research. But certainly it bears doing research to see what the cost is. In individual emotional terms, it's quite obvious. There are both the perceived mistreatment and the real mistreatment. When there is a fear of mistreatment, that probably far exceeds the actual impact. So the neglect and the psychological trauma of feeling that your medical or physical needs are not being met exacerbate the problem.

We do get the concerns. We personally don't have the research showing what the impact of those is. We only have the anecdotes that cause us to point this issue out to the various policy-makers and administrators to make sure they are, first of all, judging whether or not they themselves are making differential choices based on a person's age and whether or not they are communicating their choices well so as to allay the person's fears. That has been our focus, rather than specific research as to whether or not treatment would actually have a negative clinical impact, but I think it stands to reason that it could. I'm not aware of research that has actually looked at that, but perhaps Dr. Joanette might know of some.

[Dr. Yves Joanette]

There was a very specific study done, the SIPA project, the integrated health system approach to older people, which showed that with this integration of community-based and hospital-based approaches, and with navigator nurses who would help the person and their family, the cost was not necessarily less, but with the same money the impact was much better. So I think that's the kind of impact we could have.

[Joe Daniel, Conservative, Don Valley East, ON]

Changing the subject a little bit, when we talk about caregivers and caregiver support, are there proper training courses here that will actually train people to properly handle seniors as they age? I think there are a lot of caregiver-type programs that are around, but I'm not sure they actually address the issue.

[Susan Eng]

No, in fact we were partnering with the Yee Hong home to provide some caregiver support seminars. You don't really know what you don't know until you have to confront it. Do you know how to help somebody with a broken hip? Can you change a bed with somebody in it? Do you know how to handle dosing of medications? Most people go through their lives never knowing that or needing to know that, and suddenly they are obliged to take on the care of someone who is, by definition, more frail, and any mistake could be fatal.

What we're calling for, which we don't see a lot of or a systematized delivery of, is caregiver support in the form of training and education and constant support. That, to my knowledge, doesn't truly exist in a formalized way. We are also calling for navigators to help caregivers navigate the health care system. Again, it's a system they didn't need to access for themselves right away. These are ways in which the formal health care system can help us help them by simply providing information and support in training.

[Joe Daniel, Conservative, Don Valley East, ON]

Are there any other comments?

[Dr. Yves Joanette]

The area of Alzheimer's disease is a good example, because there are a number of websites, in French.

There is the website www.aidant.ca.

which is a site CIHR supported. It was Francine Ducharme who disseminated this and Dr. Ken Rockwood in Halifax, in English. There is the Canadian Dementia Knowledge Translation Network. This is a website to exchange and offer support to all Canadians in the area of Alzheimer's. So maybe we should take these examples and expand on them.

[Joe Daniel, Conservative, Don Valley East, ON]

Madam Eng, when we take a look at the diversity of Canada, we see that we have people from almost every country in the world. Are you finding that there are different sets of diseases that are prevalent in different groups?

[Dr. Yves Joanette]

There are certainly some genetic predispositions that are associated with some ethnic groups, and these have to be taken into account above and over the linguistic and cultural aspects.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we'll go to Mr. MacAulay.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Thank you.

There has been some discussion about responsibility and jurisdiction. Of course it is a provincial jurisdiction, but I am one who feels that whoever signs the cheque should have some say. Sometimes that would help a lot.

Ms. Clark, do you feel there are a lot of people in institutions who would not need to be there if there were proper preventative programs in place?

[Patricia Clark]

Yes, that's my gut feeling. Many people are there because of lifestyle issues. If they had the opportunity to change those lifestyle issues earlier in life, they wouldn't be where they are today. But that is not an easy thing to do. It's looking at behaviour change.

[Lawrence MacAulay, Liberal, Cardigan, PE]

I agree with you. It's hard to measure success and prevention, because how do you do it? If it didn't happen, you don't have it on the slate and then you can't go to governments and get the money.

Monsieur Joanette, as you indicated, the public deciders need to know. Somehow you're suggesting that there might be enough money around. I never saw anything yet that had enough money. But if it does, great.

A number of years ago I helped put a study together, and one of the most interesting things I got involved with was a doctor in Vancouver in a hospital. They closed a number of beds and they took the funds that they saved and put a program in place in a community where there were a lot of older seniors. In fact, they saved so much money that they could close a number of other beds. That's why I asked the question on prevention.

This doctor was also explaining to me about the drug problem, about his mother who lived in another province. When he was home, he would take her off the medication. All doctors are not perfect. We always believe them, but the fact is that sometimes they over-medicate.

A national home care program is something we need to have. I know it's provincial jurisdiction, but somebody has to be in charge. If there were a program put in place, you would have doctors, lawyers, engineers who would give their time. That's what happened in Victoria, British Columbia. It has to be put together. It would have to be a pilot project. I wanted to hear that here, because you're the people who would be feeding the information to the public deciders. I hope that some programs can be put in place not to cure diseases, but to prevent things like a broken hip. If you fall, somebody should be in who's properly trained, a doctor, who would help them get on their feet. That takes dollars out of government costs. It also gives the quality of life that the senior wants to have. It might not be what you think they should have, and we went through that with my parents. They wanted to be in their home.

You can go on and talk about home repair programs and rails above bathrooms. There are people who are short of money and these people cannot do it. Anyhow, there are many other things I could tell you, but I think you know where I'm going.

[Dr. Yves Joanette]

First of all, l hope you didn't hear me saying there was too much money for research. I'd need more knowledge if we want to take these evidence-based decisions. But you're right. You're referring to an integrated health systems approach from community to the hospital. We have the proof, the SIPA program of Dr. Béland. Dr. Bergman was one of the first in this field. This program was based on capitation—having the money following the person, not the building, and trying to see that the money is based on knowledge and individual choice, using nurse navigators. We need research to prove that.

[The Chair, Conservative, Joy Smith]

Ms. Eng.

[Susan Eng]

I want to comment on how the health care system can provide that transfer and that connection with the community. We talk about an acute event: a broken hip, a stroke, or a seizure. There is a project happening in Toronto--and I'm sure it's happening elsewhere also--called “virtual ward”. That consists of taking the acute ward, or monitoring the ward after an acute incident, and taking it home.

What do they do? They still discharge you after two or three days, but they follow you home with a case manager. Usually a nurse practitioner will monitor you on a daily basis, check you in, maybe order more tests if necessary, do everything they might do for you while you were in the hospital but in your home. This allows you to stabilize in your own home and look for options for rehabilitation and long-term care in your own home and the opportunity there is to prevent readmission. The value of preventing each readmission was estimated to be $10,000. So there's your opportunity right there to provide a win-win situation.

[The Chair, Conservative, Joy Smith]

I want to say a special thank you to all our guests. This was a very beneficial and insightful presentation today. This committee has a special interest in taking a very close look at aging and its effects on certain diseases that are so prevalent. So we want to thank you very much. And I thank the committee members for their very good questions.

The committee is dismissed.