Seniors - Strategy Part 3 of 3
Recommendations and Solutions
“There is a tide in the affairs of men, which when taken at the flood, leads on to fortune; Omitted, all the voyage of their life is bound in shallows and in miseries.”
No one action will solve the problems that we face. What follows is a coherent program of linked areas of work, which if undertaken as a whole will shift the system. We begin with a short review and then look at each area in more detail in a follow up report.
· Establish a new healthcare delivery system that focuses initially on the needs of the very old and the terminally ill. It will offer the patient and the family a choice to in-hospital acute intervention. It will build on the hospice and palliative care sector and introduce the technology of Telehealth. It will have an organization separate from the existing health system, a radically different workplace culture and operational doctrine. It would operate Island-wide as a network like Interac and provide the model for a regional and later national system.. Founding partners could include Veterans Affairs Canada (specialize in chronic care of the elderly), War Amps (who understand the self-help health-model), the PEI Department of Health & Social Services, the PEI Hospice Movement, UPEI as the Research-Partner and perhaps Health Canada who could bring in the Aboriginal community. A prerequisite will be to end the anomaly where drugs, required to manage terminal illness, are free in hospital and yet are charged out to the patient if taken at home. This single practice forces the patient to choose hospital. Once built, like the cash platform for Interac, it could be expanded to provide better alternatives in a number of healthcare delivery areas such as:
o Post-operative in-home care thus becoming a foundation of an in-home care strategy..
o The foundation for a regional and then national “Rural and Remote Strategy” that would help all non-urban communities
o Creating a new workplace and a new area of specialty where the roles of doctors and nurses could be leveraged and integrated without the trauma of the current system
o Leverage the value of the small number of health professionals that will be available in the next 20 years
o Substantially reduce the costs of the system
o Provide the information and support so that citizens can take more control over managing their own health
· Mobilize the over 55’s back into the community. New research informs us that having purpose and a meaningful role in life is a very powerful factor in maintaining good health. Reducing claims on the health system will therefore require a deliberate research effort and a framework of incentives to welcome seniors into productive work. Not just traditional work in the hard side of the economy, but productive work in the community side of the economy. Today’s retirees will live twice as long as their great grandparents. Many who retire at 55 may face 30 years of life. With most of their economic needs met, the over 55 group has a chance to give back and become the force to rebuild community. Most of us need to feel needed and appreciated. Work gives us that sense of value. Our current approach to old age is to put the retired out to pasture and see them as a burden to be supported by the young. What if we instead set up a set of incentives to encourage seniors to play pivotal roles in their community? The following ideas are offered as illustrations of the types of incentives that could be explored: :
o A Community Builder Fund – set criteria for community organizations and then offer a “Stipend” tax-free to over 55 Community Workers. The level of the stipend need not be high but enough to provide a sense of value. The program would be funded from the savings in direct health care.
o Amend the pension rules to provide for earnings of retirees. The objective is to reduce the incentive to leave the productive part of the economy
o Amend the tax code to allow retires to write of expenses or time given to community groups etc
· Create a set of incentives that recognize the need for a different type of housing and living arrangements. Our social and physical environment plays a substantial role in how we behave and how we see ourselves. We need to enhance the physical environment for seniors with the objective of reinforcing autonomy, independence and interdependence. We need to support a physical world that is convenient and congenial for the elderly. So housing is a key factor in reducing the load on the system. Many of the features of a house suitable for a young family do not work for an elderly or even middle aged person. A widely dispersed suburban lot based on the automobile is also not a suitable place for seniors. Some of the areas that we could consider would be:
o Incentives for adjusting existing housing to the needs of seniors such as , ramps, rails, lever handles. The objective is to enable people to stay in their own home for as long as is possible if this is what they want.
o Incentives for creating ideal locations for seniors so that they can be close to family but not on top of family, such as granny Flat extension grants
o Incentives for increasing the density of downtown areas. Seniors need a compact downtown where they can walk to shops and see friends.
· Set up the equivalent of Family Resource Centres and “Best Start Workers” for seniors that do not have their own family available. The reality is that many elderly will not have their own family available. For many the only alternative is an institution with all the attendant expense and diminishing of health as control is lost. The objective of this area of work will be to fill that gap without being institutional The value of Family Resource Centres is that they do not create dependency but act as catalyst to help families help each other. The War Amps have a good understanding of this model of connecting people with similar problems and valuing strengths rather than focusing on weaknesses.
o Investigate an expansion of the role of the existing FRC’s to include the elderly. Such a concept also brings the young into contact with the old.
o Investigate the establishment of the elder equivalent of the Best Start Mother – the intent will be to have the “Daughter Without the Hang Ups” who can visit twice a week and help the senior through the system and through the adaptation that comes with aging
· Set up a research and development strategy that will focus on the wellness of seniors, the technology of remote healthcare and how the workplace affects health. Key areas of opportunity might include:
o What are the costs and the impact of offering a “Good Death” versus the “Hard Death”?
o Why are many seniors well – what is the impact of Role, Recognition, Community and Control in wellness and Mortality?
o The linkage between control, the immune system and health
o What are the key environmental and social aspects that we can alter that promote good health and promote poor health?
o What is it about the current workplace that sets up such steep health and mortality gradients?
o What is the relative impact of toxic workplaces on population health?
o What is an ideal workplace and how do we implement it?
o How can we use the principles of “Rotation” and “Integration” to build a breakthrough set of Telehealth technology?
o Deliberately aim on PEI to become the world’s technical leader in remote healthcare delivery
The Alternative Healthcare Delivery System
Good strategy finds the one action that gets most of the long list of what you want. Creating the new healthcare delivery system will do much of what we want to meet our objectives, so we will start here.
When you create the new, it is important to pick an area where the vested interest in the legacy system is either weak or absent.
We will pick death.
We do not take on the entire existing system as a body to be reformed, just as the banks did not take on their branch system. We will build an adjunct system instead that will attract business away from the mainstream. Like the banks, we will increase the value of the alternative and let the customer vote with their feet.
As we have seen, our current model is to try and cure death. A very small part of the current system is designed to make death what it is, the single most important human and spiritual event of a life.
So the big idea is to build up the palliative and hospice alternative and add to it the full weight of all the new information technology that will enable many more us to die at home and or be attended at a much higher level, be connected much more closely by our family.
The Pioneers already use the small existing Palliative Care and Hospice space. Our job will be to adjust the existing system so that we will attract the Innovators. What will we need to do this?
· Increase the available capacity of choice to those who are dying to have care but not aggressive intervention.
· Make drugs for pain management and terminal comfort available at no patient cost at home
· Add the TeleHospice aspects to not only connect the medical professionals but to connect the family who may often be far away
· Extend TeleHospice (Rotation) to post surgical care for all patients