
                         THE GREYING OF HEALTH CARE

                              By ANNE MULLENS
                               Vancouver Sun

     VICTORIA - Margaret Slater sits comfortably on the couch in her
     small apartment. Peering into her 78-year-old eyes is nurse
     Margaret Nicholson.

     ``The swelling is definitely better. Not only that, but the redness
     is really fading. Can you see my face?'' Nicholson asks.

     A few steps away in Slater's bedroom, a home-care worker folds
     Slater's laundry. The doorbell rings with the arrival of a hot
     lunch from Meals on Wheels.

     This homey, comfortable scene - part of an experiment by the city
     of Victoria - could represent health care of the future.

     As little as three years ago Slater would have been been in
     hospital, occuping an acute care bed for weeks or months, most
     likely awaiting permanent placement in a nursing home.

     Instead, despite becoming virtually blind two weeks earlier when
     her retinas suddenly detached, Slater is healing at home.

     With almost one of every five of its 280,000 citizens over age 65,
     Victoria's population represents what Canada's will look like in 30
     years.

     By 2021, Statistics Canada predicts 20 per cent of Canada's
     citizens will be age 65 or older - an estimated six million people.

     And just as Victoria has felt compelled to find new ways to cope
     with the elderly in its health care system, experts say the rest of
     Canada must soon follow suit or risk being swamped by the health
     needs of the aging baby boom population.

     Almost 50 cents of every dollar spent on health care goes to
     someone over 65, with the most expensive time being the last 30
     days of one's life.

     ``Not only does independent living give the elderly a better
     quality of life, but it costs the system less,'' says Dr. Gloria
     Gutman, president of the Canadian Association on Gerontology and
     director of the Simon Fraser University Gerontology Research
     Centre.

     ``If we continue to deliver health care that places a heavy
     emphasis on cure and institutionalization, the costs will be
     unbearable,' says Blossom Wigdor, chairman of the National Advisory
     Council on Aging and a professor of psychology at the University of
     Toronto.

     ``We must begin to make the transition towards integrated,
     community-based services.''

     Enter the Victoria Health Project, which runs 12 programs designed
     to keep the elderly out of hospital and living independently in the
     community.

     ``We are a senior's test lab,'' says Rod Deacon, communications
     director for the project, which was created in March of 1988 by the
     provincial government, the regional community health department and
     the local hospital society.

     At that time, seniors consumed 60 per cent of the Victoria's health
     care dollars. At least 20 per cent of all acute beds in the
     region's hospitals were being occupied by elderly who didn't need
     acute care but were awaiting placement in long-term care
     institutions.

     ``At the rate we were going we would have soon needed to build a
     large number of beds to accommodate the demand,'' says Lindsay
     Critchley, manager of the Quick Response Team program, which comes
     under the Victoria Health Project's umbrella and sees 1,600 clients
     like Slater each year.

     Other health project programs include ``Wellness Centres'' to keep
     the healthy elderly from becoming sick; home palliative care
     programs to let the elderly die at home; caregiver support to
     bolster the spouse or aged offspring looking after the elderly at
     home; adult day care programs; homemaker support; seniors' support
     groups; and an outreach program for the elderly with mental
     illnesses.

     All 12 programs operate on a total annual grant of $3.5 million
     from the government.

     In just three years the programs appear to have made a substantial
     difference to the number of seniors coming into care, Deacon says.
     Despite having seniors flock to the region to retire at a rate of
     about 1,200 a year, the number of elderly occupying acute care
     hospital beds has dropped 60 per cent.

     The waiting list for nursing homes has dropped by 48 per cent. The
     region does not expect to require more health care beds for 20
     years.

     ``The program really has no detractors,'' Deacon says. ``It is
     popular with seniors, it is popular with health care providers. The
     whole thing just makes sense.''

     Slater is typical of the kind of patient in a sudden medical crisis
     that is ``scooped up'' by the Quick Reponse Team in the hospital
     emergency or in a hospital bed and taken home.

     A few days after her retinas detached she had an operation to mend
     the right eye. She spent four days recuperating in hospital before
     the QRT liason nurse felt she could safely heal at home, with a
     little help.

     The ``help'' consisted of a live-in homecare nurse who spent 24
     hours a day with Slater for the first four days, dropping her hours
     at the apartment down to six, then four, then two as Slater's
     health improved.

     An occupational therapist came by twice to make Slater's apartment
     safe and functional for her newly acquired blindness, such as
     removing throw rugs over which she might trip.

     A worker from the Canadian National Institute for the Blind placed
     red nail polish blobs on the dials of two stove elements, allowing
     her to feel when she had placed the elements on ``medium'' to heat
     a bowl of soup.

     ``Being in the hospital was grim. I didn't like it. I much prefer
     being at home,'' says Slater, who pays $6.38 a day for the
     services, a variable scale based on her income.

     Initial results show 31 per cent of QRT's clients need no further
     care once they have passed their immediate medical crisis. Another
     third have continued community support such as a homeworker who
     comes in periodically to do household chores.

     Less than 10 per cent of patients so far have had to return to the
     hospital, Critchley says.

     But while the project seems to be working for Victoria, can it be
     transfered to other cities which may have a lower density of
     seniors or cover a larger urban area? Is this the way that aging
     baby boomers will be treated in the future?

     ``It would take an initial influx of money to change the systems
     around, but there is no reason why this couldn't work in Montreal,
     Toronto, Kingston or any Canadian city,'' Wigdor says.

     ``Indeed, it doesn't take a genius to see that this is the way we
     have to go.''
