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Revolution in Care for Elder Patients

Dr. Samir Sinha
Dr. Samir Sinha, Mount Sinai’s Director of Geriatrics, is a passionate advocate for elder patients

A bout of pneumonia combined with a bad fall could have been disastrous for a 100-year-old man living independently in his Toronto apartment.

The fall inevitably meant hospitalization and for older adults, a hospital stay often becomes the first step in a journey that takes them out of the home setting forever.  

But a revolutionary partnership changed the outcome for Mr. W., and laid the groundwork for a new vision of elder care in Canada. 

“We’ve created a hybrid model of home-based primary and specialty care for frail seniors,” said Dr. Mark Nowaczynski, Mr. W.’s family physician, and a new addition to Mount Sinai Hospital’s Ray D. Wolfe Department of Family Medicine.

Dr. Nowaczynski is the pioneer behind House Calls, a project reminiscent of a time when the doctor was at the patient’s doorstep, instead of in an office.  

Dr. Nowaczynski created House Calls in 2007 as a pilot project, and received full funding from the Ministry of Health and Long-Term Care in 2009. The program brings together an inter-professional team made up of a nurse practitioner, an occupational therapist, a social worker, a physician and a coordinator to provide care to some of our society’s most vulnerable people — marginalized, housebound seniors.

In November 2010, House Calls forged a unique partnership with Mount Sinai Hospital and Dr. Samir Sinha, Mount Sinai’s Director of Geriatrics. Dr. Sinha formed an integrated, inter-professional team to deal with every aspect of an older person’s care in hospital with the hope of returning that patient home, when possible.

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When Mr. W arrived at the hospital, already on antibiotics for pneumonia, Dr. Nowaczynski says his heart sank. In previous months, his House Calls team had worked tirelessly with Mr. W, helping him lead a largely independent life. The older man had made great strides; he went from a man bedbound to one who could take the elevator to visit the plaza below his apartment building.

But Dr. Sinha, continuing Dr. Nowaczynski’s philosophy of care, approached Mr. W in Hospital and asked him an important question.  

“If we can get you better, where do you want to go when you leave Mount Sinai?”

“I want to go home,” said Mr. W.

Two weeks later, he did just that.

Changing the Model of Care  
Mr. W. is an example of how the traditional model of care is changing in Canada.

Health care developed at a time when the population was younger, and generally healthier. Patients who visited the hospital usually had one issue, and it made sense for a person to be treated by one unit or one program organized around that particular illness.

Dr. Sinha makes a house call to examine Mr. W.
Photo courtesy of Dr. Mark Nowaczynski
Dr. Sinha makes a house call to examine Mr. W. 

Today, older people may suffer from multiple chronic conditions, hospitals are overwhelmed with an increase in the number of older adults and the situation isn’t going to improve.

Baby boomers started turning 65 this year and by 2030 Canada’s 65-plus population will double. The population for those 85 and older will quadruple.

Hospitals are not always the best option for a frail, older person. The elderly are particularly vulnerable in hospital, said Dr. Sinha. Older people can decline functionally and lose five to ten per cent of bone and muscle mass after only one week in bed.

Unique Partnership Fills Gap
Mount Sinai’s partnership with House Calls hopes to transform health care in Canada, said Dr. Sinha. Thanks to the partnership, he can now make sure a patient receives the best possible care, whether in the emergency department, on inpatient units or outpatient settings or even in the home for those who are too frail to come to the hospital.

“No other hospital in Canada has been able to develop such a true continuum of care,” said Dr. Sinha.

The House Calls program fills a gap, said Dr. Nowaczynski, and it makes a difference to people who otherwise may not have been able to access clinical care.

“I’ve come across patients who could only get to their family doctor’s office if they booked an ambulance and paid $300,” said Dr. Nowaczynski.

“One woman told me she sometimes had to decide between going to see the doctor or eating, and hearing things like that gives me a wave of nausea,” he added.

After two weeks of care at Mount Sinai, where he underwent aggressive therapy to help him walk again, Mr. W. was able to return home.

Dr. Sinha and Dr. Nowaczynski stopped by Mr. W.’s apartment several months later for an in-home consultation, and were greeted by a smiling man who was on his feet and ready to entertain. Mr. W. had laid out a delicious spread of pies, treats and coffee for the doctors. 

“We have to adapt our system to meet the needs of our highest users. By doing so, we can preserve independence, and allow people to keep living longer and living well,” said Dr. Sinha, referring to Mr. W.’s successful plan of care.

“More importantly, it allows patients like Mr. W. to remain in their own homes, which is where they want to be and where they can thrive.”

Mr. W. turned 101 on February 17, 2011. Dr. Nowaczynski said he continues to do well.