Primary Care Reform in Residential Care
The Centre partnered with the Providence Health Care Elder Care Program, the Department of Family Practice, and Haro Park Centre to prepare a project proposal for primary care reform in residential care. We are pleased to have received funding from the VCHA to implement an innovative reform project that we anticipate will address a number of the challenges facing residential care today.
The ongoing demographic shift in BC means that in less than 30 years, one in four people will be over the age of 65 years (BC Ministry of Health statistics). An aging population has an economic impact as health care expenditures rise with age. The average annual expenditure in BC associated with caring for an 85-89 year old is approximately $18,000 and this rises to $36,000 for a 90+ year old. As these age groups reflect the demographic profile of residents, primary care reform in a residential care setting is a strategic priority for the Vancouver Coastal Health Authority.
Residential care across British Columbia is facing unique and significant challenges with the shift towards complex care. The following are some of the challenges faced by the system:
- A 16% increase in resident acuity in a one year period (2002 and 2003) (Changing resident acuity in long-term care and the impact on physicians and staff, Centre for Aging and Health, June 2004);
- An increasing family physician manpower shortage within residential care;
- A scarce pool of new physicians willing to provide care to the elderly;
- A shrinking pool of skilled nurses;
- Stagnant staffing levels in residential care amidst increasing resident acuity;
- A fee-for-service system that favours in-office visits and does not include important fee items for therapeutic activities in a residential care setting (e.g. care conferences and medication reviews);
- Justifiable increasing demands by residents and families for improving the medical care and quality of life for frail elders;
- Overcrowded acute care services (ER and inpatient) that do not cater to the specialized needs of the elderly and often discharge elderly patients into a residential care setting before they meet the criteria for admission.
In light of the above challenges, the principles of primary care reform (i.e. nurse practitioner, electronic medical records, population-based funding, physician networking, etc.) have to be introduced into residential care in ways that are economically realistic and sustainable. The goal of the project is to develop a family practice network that redefines the provision of care, ensuring that it is resident-focused, accessible and provides adequate medical coverage for residents who have challenges with mobility, are cognitively impaired, and who experience multiple chronic diseases with co-morbidities or are medically unstable.
The family practice network proposed will improve the experience of the interdisciplinary care team working at these sites and will improve the relationships among physician, team, elder and family. Improving the quality of physician work life is an important success factor to the sustainability of the network and therefore an important component of this project. In summary, the six facilities from Providence Health Care and Haro Park Centre are committed to implementing an innovative and sustainable physician model of care that not only improves access to care for residents, but will also retain the interest of experienced physicians and entice new physicians.
For more information contact
Nick Groves, Project Leader