In early August 2011, the Canadian Medical Association released a report on the state of Canada’s health care system. The report was the result of cross-Canada consultations.

Sadly but not surprisingly, the report said that our health system is fundamentally fractured and failing — especially for vulnerable groups such as children, the elderly, aboriginal peoples and those with mental illness.

For elderly patients, one of the reason the system fails them is because it was not designed for long term care or care provided in the home. It is designed for short term hospital stays, which is reinforced by funding models. The result is that when an elderly patient falls ill, the focus is on getting them back to the point where they can free up a hospital bed rather than restoring their health and helping them get ‘on their feet’.

Today, there is no other place to get care for a medical “emergency” for the elderly and this is a shame. It is costly, inconvenient and the elderly are given a bad rap as bed blockers. My recommendation: get ‘em up and outa there to their own facility which will support them. And then send them home with community supports to enable ongoing rehabilitation.

In an ideal world, we would have more health care professionals such as physiotherapists and nurse practitioners (who follow-up the doctor’s orders), occupational therapists, visiting pharmacists, geriatric care managers to provide care once an elderly patient is discharged from the hospital. Currently discharge planners are obligated to get patients on the road as quickly as possible – at the very least out of hospital beds. (Yes, old folks can land in ALC beds but this is completely unnecessary if post-care in the community was better and available). And let me be clear: this is not patient care orchestrated and delivered by families.

A convalescent care facility would have a slower pace and caregivers would have a better understanding of the elderly and their shortfalls (poor hearing and eyesight, poor balance, perhaps some denial of their predicament). Any of you caring for an elderly person can add to the list.

Another advantage of this approach is that there is less cost because all the care is in one place, reducing the need to move patients from one facility to another. It is also easier on the patient and ensures that all of the recommended treatment is followed.

Until there is a caring facility in place the elderly will be forced back to the hospital doors, needing more medical care “plugging up” the emergency system again. The hospital system of care as designed to-day is not for the chronically ill. Inroads have been made (GEM) but essentially the elderly should not be in a hospital at all. And we know this.

I am often consulted when an elderly person is in denial. Families need help in getting their loved one to understand what is wrong and what treatments are required. The patient needs education about their disease and they must be provided with realistic information about recovery.

Denial starts when clear information isn’t provided in the hospital by a doctor. Too often the elderly patient doesn’t have a clue who the doctor is and consequently family is left explaining the situation, and the elderly person is in denial. This is not a family responsibility. The elderly patient should not have to schedule yet another appointment with their primary care physician to receive this information. A bedside visit prior to discharge would be so helpful to their recovery and future planning.

If your family member is in the hospital, try and arrange for a bedside visit where the doctor makes it clear what future treatment will be and what the patient should expect in terms of recovery. If at all possible, it is important that another family member be present during the meeting and that way they can help to make sure that your elder understands what the doctor is saying.