Howard Ovens, chief of the department of emergency medicine at Mount Sinai Hospital, has seen many cases where nursing home residents arrive at emergency departments because the staff nurse didn’t have access to doctors or nurse practitioners who can provide an assessment. Emergency department visits can worsen health issues When he worked in Maryland, U.S., for example, there were state minimum requirements on how often medications need to be reviewed, he points out. He also thinks there should be more standards on the type of care residents receive. “There needs to be an obligation that…homes be able to get access to a primary care provider on a 24 hour basis,” he says.
Still, Samir Sinha, a geriatrician at Mount Sinai Hospital in Toronto, thinks that more standards for primary care access are necessary. “We’d like to get to that point, but we’re not there right now,” he says. O’Brien adds that AHS hasn’t yet evaluated the outcomes of the different models of primary care for LTC centres. “I’m not sure that one model actually works,” he says. But he says the variability is justified – having nurse practitioners available five days a week may work for an urban area, but may be too expensive for a small, rural LTC home. However, we have got a long way to go to make that happen.”ĭavid O’Brien, senior vice president of Primary and Community Care at Alberta Health Services, agrees that the models for care are “a bit eclectic,” with some patients being cared for by one provider and others by a team of providers, leading to different access levels. “It would probably be preferable that in-person assessments with an attending physician or nurse practitioner are available on a daily basis. “The arrangements are all over the map,” says Evelyn Williams, president of Ontario Long Term Care Physicians. In other cases, providers are busy seeing other patients so even when they’re called, they suggest the emergency department. Nursing staff can usually call a patient’s provider, but sometimes they avoid calling to not overburden the doctor.
In many other homes, doctors do drop-in visits once or more a week. Some homes have a primary care provider on site five days a week. In most provinces, access to primary care for nursing home residents is extremely variable. “The nurses are nervous, they’re overworked, and they’re concerned about their own liability, which is understandable,” says Sylvia. But she thinks if there was communication between Angela’s regular primary care provider and the emergency department doctors, many of the tests could have been avoided.Īnd she’s worried about another emergency department visit, since nurses at her mother’s home often send patients there if a family doctor isn’t available. Sylvia thinks that the hospital visit was justified – even if a doctor had been available that morning at the nursing home, they wouldn’t have known what was wrong without the X-ray. The doctors sent her home and told Sylvia to follow up with her mother’s family physician. The final test – an X-ray of the spine – revealed that Angela had compression fractures, meaning she must have had a fall in the night. “She was getting more and more agitated.” “She kept asking where she was and what was happening,” says Sylvia. “They tried to eliminate this, they checked that, and so on,” recalls Sylvia. Sylvia was worried about how her 92-year-old mom, who has dementia, would react to the trip – the lights, the new faces and the loud noises.Īngela was in the emergency department from 10 a.m. Her mother, Angela, woke up “extremely agitated and crying in pain,” so the nurses sent her to the emergency department.
This January, Sylvia got a call from a nurse in her mother’s long-term care centre.
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