Number one, we have to strengthen community care.
My area of expertise is in the realm of dementia. Many people with dementia get sick with minor illnesses—a bladder infection—that just brew and stew until they explode into a septic episode where they end up in hospital for a long stay, for months and months.
What you really need is a community care system that allows people—CCAC nurses, home care workers—to identify symptoms early, allows the patient to get to the family doctor quickly, or that has home visits.
Toronto has been experimenting with home visits. There are many seniors who cannot get to the out-patient clinics; they can get to the emergency department by an ambulance, and that's it. We need a system that gets them to family doctors, or that gets family doctors or nurse practitioners to them very quickly, that deals with the acute problems quickly, and that has immediate access to specialists in areas where they don't feel they can manage. Those specialists should have some ties to the hospital, and they should have the ability to have some elective admissions—this is language we don't like to use in acute care—maybe a one-week admission, to pre-empt or prevent a three-month admission.
We really need to look at systems in other countries, to see how we can get to patients quicker, how we can get help to them quicker, how we get to the specialists, and how we can do controlled, short admissions rather than long ones. That's what I see is missing in the system right now.