In rural communities there is a large barrier to care for most elderly populations living at home who have a chronic disease or multiple chronic diseases. The challenges with living in a rural community can include no public transportation or ride system, retention of resources in key healthcare positions such as community care and social work and a lack of infrastructure such as assisted living. ALC rates in particular have been identified by Ontario’s Northwest Local Health Integration Network as an area that remains high in the region. ALC is an acronym used to describe Alternate Level of Care and is a “designation given when a person has been medically cleared for discharge but remains in hospital due to lack of appropriate alternatives” (Kuluski, Im, & McGeown, 2017). “ALC is a care quality issue that places people at risk of functional decline, delirium, falls and infections and generates significant costs via emergency room backlogs and delayed surgeries” (Kuluski, Im, & McGeown, 2017). The solution currently is not working and seems to revolve heavily around returning the patient’s home often in situations that are less than ideal. A lot of these patients are able to return home with assistance but often that assistance that is lacking or is there until resource shortages occur and the patient is once again left to fend for themselves.
There are currently a lot of strategies in place for this population with a main focus of “staying in the home” it’s what patients want after all and prevents unnecessary system strain and better quality of care (Smith-Carrier, et al., 2017). The problem is these programs revolve around strategies and resources that rural and geographically challenged communities simply don’t have. In some cases a person could go home if they had a consistent way to see their doctor for check-ups yet with no reliable transportation system and the inability to walk to an appointment these appointments become useless. There is however one promising strategy on the forefront in Northern Ontario which is a community paramedicine program. “With not all patients requiring transportation, paramedics are increasingly providing basic assessment, treatment and referral to appropriate health and community services. This is evident with seniors and medically vulnerable residents in rural communities, where health workforce shortages result in paramedic services filling essential primary health care service gaps.” (Martin, O'Meara, & Farmer, 2016). The results of this program have from the patients’ perspective provided improved health monitoring and primary care access close to home, security and support for vulnerable residents, and improved education and empowerment for better health management (Martin, O'Meara, & Farmer, 2016). The success is measured both through patient and health system perspective yet this program has not been adapted across all of rural Ontario and that needs to change. Wrapping care around the patient has always been important and focusing on the adaption of a care program such as the paramedicine program may make one small segment of our vulnerable populations a little less vulnerable.
References
Kuluski, K., Im, J., & McGeown, M. (2017). "It's a waiting game" a qualitative study of the experience of carers on patients who requrie an alternate level of care. BMC Health Services Research, 1-15.
Martin, A., O'Meara, P., & Farmer, J. (2016, September 24). Consumer perspectives of a community paramedicine program in rural Ontario. The Australian Journal of Rural Health, pp. 278-283.
Smith-Carrier, T., Sinha, S. K., Nowaczynski, M., Akhtar, S., Seddon, G., & Pham, T.-N. (2017). It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. Health and Social Care In the COmmunity, pp. 723-733.