COVID-19: An ER doctor explains why the federal budget blew a shot at avoiding a postpandemic crisis in seniors care

"The only thing I could offer my patient, after telling her she had cancer, was the kindness of strangers."

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      By Tahara Bhate

      Long before this pandemic, we knew we had a crisis in elder care. As a nation of pilot projects, the last decade has been spent tinkering with peripheral issues: “hospital at home” models, geriatric emergency nurses, and ER-based mobility assessments have proliferated across Canada.

      They were brilliant healthcare innovations that were, nevertheless, handicapped by their scope.

      Then COVID-19 hit, and 15,000 seniors died.

      Like many physicians, I waited eagerly for the most recent federal budget, hoping the government would seize the momentum and announce a moonshot, a generational reform of how we care for our elderly. Now the lack of a comprehensive strategy for seniors care has laid the groundwork for the next healthcare crisis, one that healthcare workers will not have the reserve to manage.

      A while ago, I met a feisty octogenarian with multiple medical issues. Living alone, she had been unable to see a doctor about niggling pain. Unfortunately, scans in the ER revealed an advanced cancer causing a blood clot.

      Because she wasn’t sick enough to require admission, she needed to be started on a daily injectable medication for her clot. The medication and injection supplies were not covered by provincial pharmacare, and there was no government funded service that would provide a daily nurse visit at home to administer them.

      After an hour of phone calls, a local pharmacy owner volunteered to administer the medication himself, as well as cover all costs until she could be assessed for coverage under the palliative program. In a supposed universal healthcare system, the only thing I could offer my patient, after telling her she had cancer, was the kindness of strangers.

      Elderly patients are often isolated and malnourished

      Elderly patients make up a large proportion of my clinical practice, and their stories are often heartbreaking. They are admitted to hospital with the diagnosis “failure to thrive”, a euphuism for the fact that they are isolated, malnourished, and living in unsafe environments.

      Sometimes we are more blunt and write “caregiver burnout” as the reason for admission. They are then held in acute-care beds, four to a room with limited social or physical therapy, sometimes for months.

      Eventually, they are transferred to underfunded and underresourced long-term-care (LTC) facilities that are often little more than warehouses. My octogenarian’s story stood out to me amongst all the others because it is such a perfect microcosm of the ways our society, and now the federal budget, has failed and will continue to fail seniors.

      Volunteers running errands is not a substitute for home care

      This is a once-in-a-generation budget, as reflected in both the size of its deficit and the ambition of its central tenet, a national childcare plan. COVID-19 has cut a wide swath across our society, and the diversity of sectors earmarked for support in this budget is understandable.

      What is not understandable is the paltry $90 million allocated over three years to support a new “aging in place” initiative that appears to re-create the structure of the failed Canada summer student grant program by earmarking funds to support the administration of “volunteer based” community supports.

      A volunteer helping a senior run daily errands may be well intentioned but it is unsustainable as policy and not a substitute for home care. In addition, there is no mention of any support for caregivers.

      I applaud Finance Minister Chrystia Freeland’s efforts to counter the “she-cession” by prioritizing childcare, but that is only half the battle for the women of the “sandwich generation”.

      Finally, on the issue of long-term care, $3 billion has been pledged to help provinces implement and maintain national standards currently under development. Without mentioning the discrepancies between nonprofit and for-profit care, neither the dollar amount nor the scope of the commitment go far enough.  

      Like so many crises this year, the spectre of military deployment to LTC has been pushed aside by the panic of the third wave, even as we swore never again. For healthcare workers, though, we will watch our elderly patients suffer long after the news coverage stops, with all the moral distress that entails.

      Just as with childcare, we need a national seniors-care program that explicitly recognizes home care as equal in importance to residential care. As an emergency physician, I can manage a broken hip. But I can’t change the fact that if you had had some help at home, you might not have fallen in the first place.

      That’s up to our government.

      Tahara Bhate is an emergency physician with Vancouver Coastal Health and a clinical lecturer in the department of emergency medicine at UBC.