Ottawa Citizen Editorial: Burden of Care

Aging may be a natural part of life, and the senior years can be the happiest ones, but it's also true that these years typically mark the period when our medical needs are the greatest.

Accordingly, as the baby boomers, perhaps the largest demographic bulge in history, reach their retirement years and beyond, the demands on the health system will be huge. This is already happening, right here in our own community.

Dr. Jeff Turnbull, the new president of the Canadian Medical Association and chief of staff at The Ottawa Hospital, acknowledged recently that occupancy at his emergency department was 105 per cent. More than 400 surgeries were cancelled this year owing to lack of staff or other resources.

One major problem, as health officials have lamented for years, is that many patients are occupying scarce hospital beds when really they belong in long-term care facilities. Yes, these patients need medical or nursing assistance, but not necessarily the sophisticated treatment that ought to be reserved for acute-care patients who truly do belong in a hospital bed.

Turnbull pointed to the $183 billion spent on health care last year as proof that resources are in fact available -- in other words, the problem isn't simply money. The problem, instead, emerges from how the system is organized.

Hospitals should not be filled with ailing people who more properly belong in other kinds of facilities. Using hospitals as human warehouses is good neither for the hospitals (it obstructs their ability to care for people who do need acute care), nor is it good for those who have to endure the uncomfortable status of semi-permanent residence in hospital wards.

The ideal solution, argue many people, is to allow aging or chronically ill people to stay in their own homes for as long as possible, and deliver assistance and treatment to them there. However, home care puts a large burden on family and friends, who often are seniors themselves.

The Canadian Institute for Health Information says that one in six informal caregivers suffer from distress. Those helpers who care for people with diseases such as Alzheimer's or dementia are most likely to fall into this category. The victims of chronic disease are not just the sufferers themselves but those who love them.

The institute, in two new reports, shows that home care is indeed not without its problems. Clients can resist assistance, fight with caregivers and act in socially irresponsible ways. All these types of behaviours make it tempting simply to keep the patient in a hospital, even though the patient may not have any medical reason to be there.

Outcomes are not distributed democratically. A person's own family or social network, or lack thereof, can determine what happens to him or her. An unmarried patient is much more likely to receive institutional help than a married counterpart. This seems unfair -- because it means that the onus of care falls on the spouses of the ill.

Policy-makers and health administrators need to provide adequate space for the long-term ill, while recognizing that permitting patients to be cared for at home has its own risks for relatives and friends who, without sufficient respite or supports, sometimes put their own health in jeopardy.

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