Good afternoon.
On behalf of Canada's 250,000 registered nurses, thank you for the opportunity to speak to the important issue of chronic disease related to aging. CNA will be sending you a brief on this subject containing key recommendations and supporting evidence, but today I will focus on a few main points.
Canada needs a national strategy on healthy aging that includes chronic disease prevention and management, a strategy anchored in team-based care and enhanced access to primary care and community-based supports, particularly for older Canadians, who are more susceptible to chronic diseases and their related complications.
Chronic diseases are the major cause of death in Canada, and their treatment represents a $90 billion annual cost to our economy, accounting for 67% of all direct health care costs. Given that many of these diseases can be prevented or lessened, investments in this area will save health dollars, improve quality of life, and save lives. CNA therefore urges the federal government to lead a healthy aging strategy that emphasizes chronic disease prevention and management.
A comprehensive pan-Canadian healthy aging strategy should be multi-faceted and include measures to foster health promotion and early detection of disease, keep people in their homes longer, support formal and informal caregivers, address the determinants of health, and facilitate better access to health services, including appropriate end-of-life care.
Multiple chronic diseases, not age, are the main driver of health system use by seniors. Multiple chronic conditions require expensive treatments, complex care management, and represent a considerable burden for individuals and their families. For example, health professionals regularly deal with the compounded effects of obesity, type-2 diabetes, and high blood pressure. What's especially alarming is that this is a cluster of conditions that is increasingly common among younger and younger Canadians. We need to act now to reverse this alarming trend.
An example of success can be found in the Complex Chronic Disease Clinic in Calgary, Alberta, where an interprofessional team has reduced hospital admissions through an integrated approach to care. Registered nurses, nurse practitioners, physicians, and pharmacists are collaborating to address medical, social, lifestyle, and other factors that affect health outcomes. This comprehensive chronic disease management model reduced the total number of hospital admissions by 24% and the total length of hospital stay by 51%.
Of course, the ultimate goal is to reach patients and families and give them the supports and tools they need before multiple chronic conditions develop. Health screening, early detection, and access to the right interventions early on can help patients to better manage initial risk factors and conditions, increasing their chances of preventing and reducing the severity of the occurrence.
As we age, the likelihood of developing chronic conditions increases. For too many of our seniors, however, interventions come too late. For example, when hypertension is undetected or not well managed an individual is at greater risk of establishing a stroke and/or advanced cardiac disease. When a health crisis hits, it often triggers the all-too-common chain of events involving ambulance transfer to an emergency room, hospital admission, prolonged hospital stay, and rehabilitation. This situation illustrates the serious consequences of insufficient community and home care services in Canada. All too often, home care services are time-limited and focused on post-hospital recovery versus ongoing chronic disease management. This gap in service is likely familiar to many in this room.
Thus, CNA's second recommendation is that the federal government support primary care reform with a particular focus on home- and community-based services, emphasizing interprofessional collaborative teams. There is a desperate need to bolster community-based health services such as primary care, ambulatory care, and home care to improve the health of our nation.
Far too many Canadians visit our emergency departments or are hospitalized for health conditions that could and should be managed in the community. There are excellent examples of primary care models that should be more widely implemented. These include community health centres, family health teams, and nurse-practitioner-led interprofessional clinics. These models fully harness the expertise of health professionals so that Canadians have access to the right care at the right time and in the right place, thus helping to reduce barriers to accessing needed services.
Primary care initiatives that ensure earlier and more consistent access to care lead to straightforward, low-cost, easier-to-manage interventions. As registered nurses, we know this territory well. A simple example is community-based or mobile foot care clinics that provide timely support for lifestyle and behaviour changes that result in early detection of serious foot diseases that may lead to the need for amputation for people with diabetes. A foot clinic may not be the most glamourous example, but it represents a tangible, community-oriented service that demonstrates the benefit of addressing minor complications early, before they snowball into personal catastrophes.
We know that prevention diverts health care costs away from far costlier acute care interventions down the road. Optimizing the health and wellness of Canadians requires that care be brought closer to home, to the very heart of our communities.
We need to think and act differently to expand the implementation of new approaches such as mobile health clinics, after-hours services, home visits, and community outreach programs that are publicly funded and not for profit.
In one such approach, teams of mobile emergency nurses responded to non-urgent calls from long-term-care homes. A recent study in Toronto demonstrated that these teams were effective and able to provide the necessary care for 78% of the residents they visited, who would have otherwise been sent to emergency rooms for treatment. The cost of these mobile visits is 21% less than the cost of having those same needs addressed in the emergency room.
Let me once again stress that now is the time for a national strategy on healthy aging. CNA's vision for this strategy is one that enhances timely access to primary care, harnesses the effectiveness of interprofessional collaborative teams, brings care closer to homes and communities, and provides the appropriate range of community-based supports necessary to adequately prevent and manage chronic disease.
Chronic disease is indeed an alarming and growing concern, in every part of our country and around the world. As discussions on the next federal, provincial, and territorial health accord ramp up, we must take the opportunity to confront this pan-Canadian epidemic in a more strategic way. Indeed, registered nurses and other health care providers play an integral role in preventing and managing chronic disease throughout the entire continuum of care. Greater benefits to the health of individuals and enhanced health system sustainability can be realized by a healthy aging strategy that emphasizes chronic disease prevention and management and is enabled by primary care reform.
Thank you, again, for the opportunity to speak with you today.