Facing a health crisis
A health crisis may occur suddenly for a senior, or as an expected result of a chronic illness; either way, its effect on the patient and family can be catastrophic. If the ill person has been filling the role of caregiver to a spouse or family member, the illness may create the need for a quick response from private, community and government-funded services.
A health crisis can be addressed by a number of services:
- Family health care team
- Walk-in clinic
- EMS via 911
- Hospital emergency room
It's important to understand how Emergency departments are run, the alternatives, and some tips for preventing a health crisis.
Be Prepared
Be sure emergency information is collected, updated and accessible, including medications, pharmacy name, family doctor's name, medical history, valid health card (photo-ID health cards have expiry dates) and updated contact names and phone numbers. Families often post these lists on the refrigerator.
Attend medical appointments with your parents, meet their doctors and learn about their medical conditions. Become a partner in your parents' wellness; it will pay off when emergencies do arise.
Visiting Emergency
Medical professionals advise a visit to Emergency when any acute change occurs; in the case of the elderly, this might include trouble breathing, decline in cognition, a bad fall or perhaps excessive bleeding when taking blood-thinning medication such as aspirin.
Rather than driving your parent yourself, you may wish to call 911. The Emergency Medical Services will arrive quickly, assess and stabilize your parent, and advise whether an Emergency visit is required.
Making the Most of Your Visits
Emergency room staff strongly advise that patients bring an advocate, ideally a close friend or family member. That person should have a list of the patient's current medications and dosage, provide information as requested by the staff as to how their behaviour or condition compares to their normal state, and generally act as an advocate for the patient, who is usually confused, in pain and fearful. The advocate should also make notes about findings and recommendations.
When all patients enter Emergency, they are seen by a triage nurse who determines the urgency of their condition using a 5-level assessment tool known as the Canadian Emergency Department Triage and Acuity Scale. For example, Level 1 patients, in critical, unstable condition, such as cardiac arrest, must be seen immediately. Patients are therefore seen based on the acuity of their condition, not arrival time, nor the fact that they arrived by ambulance.
Geriatric Emergency Nurses:
A new innovation in many Emergency departments is the Geriatric Emergency Management, or GEM, nurse. This is a practitioner who will make a full geriatric assessment, including physical condition, cognitive level and home support. GEM nurses can diagnose, order tests and prescribe, working in consultation with the physician and emergency team. Their goal is to treat seniors, and to discharge them with a care plan that will ensure better long-term health and prevent future Emergency visits.
Alternatives for Emergency Care
Urgent Care Centres are clinics designed for low-acuity emergency patients, usually with a referral relationship to major hospitals. Check your Yellow Pages and/or your local hospital to learn if there is an urgent care centre in your area.
Telephone information lines such as Telehealth Ontario (1-866-797-0000) allows 24/7 telephone access to a registered nurse, who can help assess the seriousness of symptoms and suggest your options. MedicAlert bracelets, which contain medical history and contact information, and personal emergency response systems such as Lifeline allow 2-way communication to help guide your parents in assessing their problem and receiving help.
Admission to a Hospital
A health crisis will often result in admission to the hospital. Depending on the treatment, a patient may be eligible for a stay in a rehabilitation unit, either within, or affiliated with, the hospital.
Most hospitals have adopted a team approach to patient care. Hospital units contain a team of professionals including a social worker, dietician, speech/language therapist, physiotherapist, occupational therapist, psychogeriatrician, as well as doctors, nurses and specialists. Patient care is the result of the efforts and input of the team, and decisions regarding treatment, admission to rehab and discharge are made in accordance with insight from each member of the team.
Discharge
Once the patient has been deemed as an alternate level of care (ALC), they are no longer considered to require hospitalization, and are ready for discharge.
Alternative Level of Care
ALC is defined as when a physician (or designated other) has indicated that the patient occupying an acute care hospital bed is well enough to be cared for elsewhere and therefore they are awaiting admission to a long term care, designated assisted living (DAL) or personal care home (PCH). This indicator is designed to assess the processes that ensure the placement of patients in the most appropriate care setting. It identifies the proportion of patients who are occupying acute care beds due to the unavailability of services in another more appropriate setting. Maintaining a lower percent of ALC days requires aggressive management and placement of the most complex patients.
Physical medicine and rehabilitation
Physical medicine and rehabilitation is a branch of medicine, which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities, often caused by brain injury or stroke. A physician who has completed training in this field is referred to as a physiatrist or rehab medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients). Patients are referred to rehab programs from acute-care hospitals, remain a maximum of 90 days (usually 30-45 days) and return to an appropriate level of care in their homes and communities.
Palliative care is an approach to care for people who are living with a life-threatening illness, no matter how old they are. The focus of care is on achieving comfort and ensuring respect for the person nearing death and maximizing quality of life for the patient, family and loved ones.
Palliative care addresses different aspects of end-of-life care by:
- Managing pain and other symptoms
- Providing social, psychological, cultural, emotional, spiritual and practical support
- Supporting caregivers
- Providing support for bereavement
Comfortlife.ca lists retirement homes that support palliative care.
Palliative care may also be called hospice palliative care or end-of-life care. In some cases, these terms are used interchangeably or in combination. The field of palliative and end-of-life care includes providing care services directly to the patient, family and loved ones. It also includes the education and training of care providers, research, surveillance and advocacy. Individuals, families, communities, the private sector and governments all play important roles in the field of palliative and end-of-life care.
More information is available on palliative and end-of-life care in Canada, including information on service delivery and the involvement of the federal government at Health Canada's website, www.hc-sc.gc.ca
Hospital social worker / discharge planner
A key player in this process is the social worker, who often assumes the role of discharge planner. In this role, the social worker is responsible for discharging the patient back to the community with the appropriate level of care. This may entail counseling the patient on options for housing, care and other services, since returning to the former home and lifestyle may no longer be viable for the level of care now needed. The discharge planner works with social work counterparts in the community to set up services in the home, source housing such as respite or retirement residence stays, or admission to a long-term care home. In some cases, admission to palliative care is recommended.
Our senior care advisor hub is patterned around essential questions about knowing when to get care, where to find it, and when and how to seek more help. This is an ideal starting point, if you are caring for a senior loved one or you are senior with increasing questions or concerns. Links below point to professional, helpful content on this page, to other helpful resources and content on our website, or to relevant publicly funded resources (with notes on how to use those). 