Hope on the horizon for seniors

TheStar.com – comment – Hope on the horizon for seniors
May 02, 2008. Carol Goar

Paul Williams calls himself “a professional cynic” who is savouring a rare burst of hope.

Williams, a health policy professor at the University of Toronto, has spent the past 20 years trying to convince politicians, bureaucrats and medical authorities that most seniors don’t belong in nursing homes. Few listened. Even when he did get a sympathetic hearing, nothing changed.

Then eight months ago, to his surprise – and nearly everyone else’s – Health Minister George Smitherman announced a $700-million Aging at Home Strategy.

This spring, funds started flowing to Ontario’s 14 regional health units. They’ll soon be able to ramp up home care and offer seniors an array of services, from housekeeping to snow removal, to allow them to live independently for as long as possible.

What Williams finds particularly encouraging is that 20 per cent of the provincial money has been earmarked for innovative projects. Local providers are brainstorming, experimenting, listening to their clients.

“You really do have some choices,” he told a roomful of active pensioners this week. “For the first time in my career, I see the possibility of real change in Ontario.”

He is still cautious. He wonders if results-obsessed provincial officials will take into account intangibles such as dignity and quality of life. And he warns that without public support, Smitherman may have to back off or slow down.

“But we can try things we could never do before.”

He gave a poignant example. He once watched an elderly gentleman’s life spiral out of control because he could no longer buy cat food. No public program deals with that. The cat slowly died and the senior fell into a deep depression. He ended up in a nursing home.

“Should we provide pet care?” Williams asked. “No, not across-the-board. But it would have been a cheap solution in this case.”

Under the old rules, there was no room for cheap solutions, no matter how sensible or humane. Under the new system, there will be flexibility to offer seniors the help they need, rather than slotting them into one-size-fits-all programs.

The federal government has tested this approach on a limited basis. Twenty-seven years ago, aging veterans were pressing for more nursing home beds. Instead, Ottawa offered them a choice: more beds or more support in their homes.

The vast majority opted to stay in their homes, drawing on the services they needed. There were nurses to treat medical conditions, personal care workers to help with bathing and dressing, housekeepers to assist with cleaning and laundry and yard workers to cut the lawn and clear the snow. Each client was assessed individually. As his or her needs changed, the arrangements were modified.

“Which of the services do you think was used most?” Williams asked. To most listeners’ surprise, it was groundskeeping.

“Why not fix the eavestrough or shovel the sidewalk?” he asked. “It costs far less than long-term care.”

A nursing home bed in Ontario costs $130 a day. The government pays $80 and the resident pays $50 (or whatever they can afford).

For that same $80 public expenditure, community agencies could provide most seniors with all the services they need. They’d be healthier. And hospitals would be able to release them back into their homes, rather than waiting for a nursing home bed to become available (at a cost of $1,500 to $3,000 a day).

Funding has begun to shift and mindsets have started to change, Williams says, but there is still a long way to go. Doctors will have to make house calls. Teamwork will have to replace patchwork. And taxpayers will have to understand that unconventional solutions – from buying cat food to building wheelchair ramps – are often the best solutions.

Most seniors don’t want to end up in a nursing home, Williams said, to emphatic nods throughout the room.

But many expect they will. This time, the nods were grudging.

Williams used to offer such audiences moral support. Now he can offer them hope.

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