Are house calls a remedy for rising health care costs?

By Susan Lunn | CBC –

Are house calls a remedy for rising health care costs?

Premiers this week struck a committee to look at innovative ways to save

Health care dollars, as they ponder the possibility of getting less money from

Ottawa in the not to distant future.

As politicians worry about how to pay for Medicare, more and more people are dealing with the health care and other issues associated with old age, putting extra burden on hospitals and health-care budgets.

One Toronto hospital is looking at an old idea to help keep costs down while improving quality of life for elderly patients: house calls.

Read Susan Lunn's story and listen to The House after the jump...

As Dr. Mark Nowaczynski rides up in the elevator, in a subsidized apartment building in Toronto, he checks the file on his newest patient.

"Was it (apartment) 901?" he asks Stacey Pustowka.

Pustowka is a social worker who is part of Nowaczynski's team called House Calls, a program that cares for frail, elderly seniors, in their homes.

Nowaczynski got the idea from his early days as a family doctor in Toronto.

"I would see an elderly woman struggle with her walker, get out of the chair in the waiting room, slowly walk to the waiting room, and I would be looking at her chart and think, 'She lives two blocks away. I could easily go to her'."

That's exactly what Nowaczynski does today; the only difference is he works with a team of social workers, such as Pustowka, and other health care workers, including occupational therapists.

Today, Nowaczynski and Pustowka is visiting 82-year-old Rosa for the first time.

The two don't even have to knock on the apartment door, Rosa's daughter, Rose, is waiting for them.

Rosa sits on the sofa in her small one-bedroom apartment, her tiny living room suddenly crowded with visitors.

"My biggest thing is that she still recognizes who I am, that to me is the biggest plus," Rose says, wiping away a few tears.

Dr. Nowaczynski begins his assessment, asking Rosa to walk a short distance unassisted. He takes her blood pressure and listens to her heart.

What he finds isn't good.

"Her heart rate is about 100, which is high. And it's irregular. And she's breathing about double the normal speed, so she's in heart failure."

But Dr. Nowaczynski isn't the only one evaluating Rosa today.

Pustowka asks Rose other questions, such as how often does her mother get out of the apartment to socialize, can she bathe herself, and does she cook?

Nowaczynski and Pustowka only heard about Rose and Rosa because they ended up at Mount Sinai hospital a week ago.

Rosa fell and was taken by ambulance to the emergency department.

There she was assessed by a special kind of nurse who is trained in Geriatric Emergency Management.

Nana Asomaning remembers what the emergency room physicians first found.

"She didn't have any acute presentation seen by the medicine team or the cardiology team, they weren't really finding anything, they weren't that concerned about her," she recalls.

But Asomaning is trained to look for more: social issues or cognitive problems that may put an elderly patient at risk of further decline.

And she found Rosa met those criteria.

"She was a fall risk. She hadn't taken medications in two years. Her daughter had taken her keys from her because she was afraid her mother would wander, and wouldn't be able to care for herself."

So after a night in the hospital, Asomaning referred Rosa's case to House Calls.

This is part of a new focus at Mount Sinai that aims to make the hospital more senior-friendly.

Every morning, a team of health care specialists comprised of doctors, nurses, social workers, occupational therapists and pharmacists review the medical files of a number of senior patients at Mount Sinai.

Beyond discussing the health issues, the team focuses on social supports, the patient's mobility, mental health and, most importantly, what has to happen to see the patient return home safely.

This all-encompassing way of caring for the elderly is the brain child of Dr. Samir Sinha.

The entire focus is to make sure these seniors don't decline in hospital to the point where they can't go home. Sinha calls it the hazards of hospitalization.

"One-third of patients actually lose an additional aspect of their basic functioning by the time they are discharged from hospital. So if you already had problems with walking, or problems with bathing yourself, or toileting yourself, and you lost that additional functional ability in hospital, that might mean the loss of an ability that allows you to remain independent at home," he explains.

Sinha has placed a new emphasis on mobility. There are fewer catheters, so patients must get out of bed to go to the bathroom. Patients also eat their meals in a chair, not in bed.

"We've actually been able to show within the last year, that we've been able to reduce our overall length of stay for those 65 and older. We're returning an increasing portion back to their homes to where they came from," he says.

The physician in chief at Mount Sinai can see the benefits too.

While the program is still in its early stages, Dr. Tom Stewart says he would be surprised if it didn't save money - and, therefore, be an idea other hospitals will be forced to consider.

"Either we reduce the amount of services we offer, or we find new money, which isn't going to happen, but we have to change," he says.

Both programs save money.

Dr. Nowaczynski and his team look after about 250 frail seniors every year. The average age is 87. Most, if not all, would qualify for a nursing home, which costs about $50,000 a year. Through House Calls the tab is more like $2,000 to $5,000.

"I did a rough guestimate that for every dollar the ministry of health invests in our program; we are saving the system between $5 and $10. If we were able to do this on a larger scale, it would have a huge impact on reducing hospital costs, and long-term care costs," Dr. Nowaczynski says.

And there are signs things are changing.

It just got easier for physicians to do home visits in Ontario. Earlier this month, the provincial government announced a new fund to pay physicians who do home visits at least half of the time.

Premiers this week struck a committee to look at innovative ways to save health care dollars, as they ponder the possibility of getting less from Ottawa in the not to distant future.

But as politicians worry about how to pay for Medicare, Rose has more personal fears about what will happen.

"I'm concerned. I'm on minimum wage. They give you as much hours as they can, which isn't a lot. If you don't have two or three jobs? What happens when I get old?"