A $1.3-million project co-led by Dr. Amy Salmon looks to help older, rural adults feel safe at home.
By 2030, one in four Canadians will be over 65. Ensuring health care systems are resourced to meet these anticipated care needs poses a hefty challenge. This is especially significant in rural areas where emergency room closures and a shortage of health care professionals are becoming more common.
When people can no longer live at home, they may be admitted to long-term care facilities. However, an older adult can wait for up to two years for a spot to open up, according to Island Health data. In some cases, a move to long-term care can negatively influence quality of life and make it difficult to access informal support networks. This is why new paradigms are needed to meet the needs of Canada’s ageing population, particularly in rural areas.
Together with a diverse group of professionals and communities, Advancing Health Director Dr. Amy Salmon is working on an innovative, long-term solution. Leveraging a unique partnership involving the Centre for Advancing Health Outcomes, Island Health, Gwa’sala-‘Nakwaxda’xw Nations, the Conconi Family Foundation, and a network of community-based non-profits, Dr. Salmon is using evidence-based research to improve health outcomes and reduce hospital admissions for older adults with complex needs on rural North Vancouver Island. This evaluation is led by Dr. Salmon, along with Ian Wood and Dr. Max Jajszczok of Island Health, and recently received $1.3 million in funding from Michael Smith Health Research BC.
Dr. Adam Easterbrook, Program Head for Knowledge Translation at Advancing Health, is working with Dr. Salmon on this project.
“Our team is always looking for opportunities to do work that’s embedded within health systems and services,” he said. “This project puts into practice findings from some our earlier work in senior care. It also allows us to build on existing partnerships like the one with Island Health, as well as develop new relationships with community-based organisations and Indigenous communities based on our shared goals.”
Advancing Health staff are building on their learnings from developmental evaluations of large-scale system transformation initiatives, such as BC’s youth mental health support program, Foundry and Providence Living’s Home for Us model to build supports that prioritises older adults’ safety and quality of life.
Plugging the gaps
Where and how we live and our connections to community are key determinants of health, particularly as we age. That’s why, says Dr. Salmon, focusing on supporting healthy aging at home is such an important aspect of care.
“More than 90 per cent of Canadian seniors want and expect to be living in their home as they age, and want support to assist them in meeting their health goals as they age at home,” said Dr. Salmon.
Presently, once older adults begin to have more complex needs without the assistance needed to stay at home, they’re transitioned to long-term care centres. But this transition is more than moving homes — it can often mean moving many hours away to other communities that are difficult for their loved ones to visit, making it a challenging solution for everyone.
To disrupt this status quo, Dr. Salmon’s new project is finding ways to support aging individuals at home. The team will focus on older adults in Port Hardy and the Gwa’sala-‘Nakwaxda’xw Nations (GNN) on northern Vancouver Island. The project will focus on adults who are over 60 who often stay in the hospital for long periods for non-medical reasons, sometimes referred to as “social admissions”, as well as older adults who may be at risk of admission to long term care due to lack of community- and home-based supports.
Social admission occurs when someone enters the hospital, often through the emergency room, for reasons other than an acute medical concern. For example, an older adult with dementia may have caregivers who are overwhelmed, or mobility issues (like not having an elevator or accessible shower), or challenges related to housing. In these cases, the hospital is seen as the safest option, and they may stay for a few days.
“In rural communities like Port Hardy, social determinants of health play a role in social admissions. For instance, power outages are common here. So, if an older adult has medical equipment that they need to use daily that needs to be plugged in, they might end up in the hospital as a social admission,” explained Dr. Salmon.
According to Canadian Institute for Health Information (CIHI) stats, the average cost is just shy of $3,000 per night for a bed in the hospital, placing pressure on important resources such as inpatient bed availability and emergency rooms. This project hopes to alleviate some of that pressure while ensuring that older adults receive the care they need.
Practical resources and community involvement
As part of their discovery process, the project team consulted with the community and learned that many older adults undergo social admission due to unmet practical needs, which can be solved by equipping them with the right tools. This inspired the team to add funding for practical assistance to their intervention program.
“With this opportunity and philanthropic funding, we can provide additional tailored support to help keep people at home,” said Dr. Salmon.
Assisted by $500,000 in funding from philanthropic partners, the project will provide funds for the purchase of resources which can help reduce social admissions and keep seniors safe at home. The administration of this funding will work in tandem with a new Friendly Visit Service, an innovative program introduced by members of Gwa’sala-‘Nakwaxda’xw Nations.
Friendly visitors’ work will be grounded in the cultural concept of the ‘bagwa̱nsap̓a’, as cultural strength and resilience of the First Nations on the North Island are rooted in cultural practices that instruct people on how people traditionally look out for the elders in their community.
Guided by local elders, the Friendly Visit Service will serve to make social and health care services more accessible for older adults, especially those who live in geographically remote locations.
“The aim of the friendly visit service,” said Dr. Salmon, “is to create safe and genuine connections to necessary services through non-medical friendly visitors, who will work to build relationships in a way that is comfortable to the older adult.
“It could be anything from visiting with them and sharing a conversation over a cup of coffee, to even helping them do household tasks, or driving them to their appointments. You can learn a lot about somebody, what’s working for them, and their unique needs and challenges, in a non-clinical way,” she added.
The team plans to hire two part-time Friendly Visitors who will be selected by the community partner organizations for their ability to form strong relationships.
Eliminating silos and fostering collaboration
Additionally, the project will identify solutions to improve coordination between services available on the North Island. Currently, there is no formal system in place to promote integrated care planning between Island Health, GNN, and community-based social service agencies. This can lead to siloed systems and older adults with complex health and social needs falling through the cracks. To address this, the project will establish a dedicated integrated care team, led by leaders from Island Health, GNN, and North Island Crisis Centre and Counselling Society, with roles supplemented by representatives from community agencies and service providers in the region.
The project has also received support from Providence Health Care, which will provide the team with referrals to their specialist geriatric services, including outreach to Port Hardy as needed. Together with this important resource, the integrated care approach aims to understand the needs and concerns of older adults in the communities and co-create plans that leverage existing community resources.
Dr. Salmon is enthusiastic about this unique opportunity to create change and learn. “I’m excited to learn from older adults and their families about what will help keep them safe and happy at home, and also look at how they build their resilience to live out their lives that support staying connected to the people and places that matter so much to them,” she said.
