Senior (and younger) volunteers from several central Ottawa communities have been working over the past five years to develop age-friendly communities. Emerging from the collective learning and a broad base of activities is a focus on the determinants of health and the evolving crisis in health care. As the baby boom generation approaches the age of frailty, there is a critical need for community-government collaboration and innovation.

The volunteer teams and community partnerships have been addressing:

• seniors’ safety
• primary care
• home care and support services
• technology to support seniors’ independence and improve interaction with the health care system
• support for aging at home or alternate living arrangements

The work has been coordinated until now by Senior Watch Old Ottawa South (SWOOS), a committee of OSCA, the Old Ottawa South Community Association. The project has benefitted from the collaboration and active involvement of volunteers and advisers from neighboring communities, supportive research and community organizations, and has been encouraged by politicians and governments.

1.    A New Phase – the Seniors Health Innovations Hub (SHIH)

It is now time to expand and formalize this initiative.  The SHIH will implement innovations recommended by experts and supported by rigorous evaluation, in order to:

• assist seniors to maintain health and independence;
• reduce the burden on public systems through efficiency gains and mitigating the increase in institutional care costs; and
• enhance the contributions of seniors to the social and economic life of the community through inclusive local initiatives

To formalize the SHIH, we will form:

• an organizing committee to develop a provisional board of directors for incorporation as a not-for-profit social enterprise, and
• an advisory and support network of individuals and organizations who are willing to lend their skill and expertise  

2.    The Big Picture

Population aging is challenging our communities and our country. Health care and social support systems are facing cost escalations and growing labour shortages that are reaching crisis proportions.  Many seniors do not have reliable and available primary care, and their numbers are growing rapidly.^[1] In Ottawa, Ontario Health had identified 7700 seniors in central Ottawa with either no primary care provider, or with a tenuous connection^[2].  According to primary care expert Dr. Kamila Premji, that number will escalate as older physicians retire, and younger ones choose other options than full-time family practice:

Conclusions and Relevance Primary care is foundational to high-performing health systems, but the sector faces capacity challenges as both patients and physicians age and fewer physicians choose to practice comprehensiveness. Nearly 15% (1.7 million) of Ontarians with a comprehensive FP may lose their physician to retirement by 2025. To serve a growing and increasingly complex patient population, innovative solutions that extend beyond simply growing the FP workforce are needed.^[3].

Emerging evidence also portends serious challenges in availability and adequacy of home care and home support services. Already, almost three-quarters of total hours of care received at home, are provided by family/friend caregivers^[4] and growing dependence on them could precipitate calamitous personal and family consequences as they become stressed and overburdened. 

Commercial housing options for independent and assisted living are priced for the affluent, whereas public and nonprofit facilities have long wait lists. 

New technology products bring some promise for reducing costs and improving quality of life, but these need to be carefully assessed by seniors to ensure their safety, usefulness and affordability.

Public health resources are in effect being rationed by shortages of providers and long wait times, and “two-tier” access is beginning to emerge. Because most systemic shortcomings disproportionately affect disadvantaged groups, governments are focusing public resources to mitigate those unfair impacts. However, the crisis is spreading throughout the population and what was a universal health care system is retracting, with the emergence of enterprises which allow the more affluent to pay for priority access to health care.

3.    The Purpose of the SHIH

Community piloting of innovations will inform the community and governments about the strengths and weaknesses of product and service innovations which have been recommended by experts.

Public resources will be complemented by community contributions and collaborative evaluation.

Community innovation and collective learning can adopt a format that classic experimentation is not capable of.  Operational efficiencies and service improvements can be made in real time and assessed through continuing monitoring, using what the social science literature refers to as Theory of Change. Some acceleration of normal scientific inquiry is justified if the baby boom cohort is going to benefit while they are still in the “pre-frail” age range.  We have five to ten years for prevention, service improvement, lifestyle and technological innovation to have effects on this population. The time to start is now.

4.    Programs of the SHIH

We envisage the development of the SHIH in one or more locations accessible to seniors in central Ottawa communities.  It will deliver direct service and also be responsible for organizing innovations and encouraging new service developments.  The SHIH can operate in spaces provided by the communities, as well as provide services virtually.

The plan is for the SHIH to host nurse practitioners, nurses and community support services. Administrative coordination and allied health team services will be contracted with existing service agencies, and research/evaluation support from local universities.  It will provide:

Primary Care by:

• seeking funding for a Nurse Practitioner Led Clinic.  The clinic will partner with service organizations to provide seniors without a regular doctor or nurse practitioner, with primary care, backed by a virtual team of allied health professionals.  The services will be provided primarily by nurse practitioners with physician consultation available where needed.

Homecare and Support Services by:

• facilitating and evaluating the feasibility and potential for home care patients to self-manage their care with aid of funding provided directly to them.
• providing a catalyst for existing service organizationsto enhance quality of life and find service delivery efficiencies. This may include the organizing of home care around a community nursing clinic, if partners can be found.
• Assess and evaluate the experience of family/friend caregivers; propose and evaluate new supports
• Assess and integrate, if appropriate, the results of a current experiment in volunteer assistance for palliative care patients in the community (Carleton School of Social Work and Centretown Community Health Centre)

Resource Information

• Through an online guide and specialized clinics, provide health related information to the community and encourage optimum utilization of services, social engagement, lifestyle education and safety resources, emphasizing inclusiveness and access. 

Technology Resources

• Assist with the testing and evaluation of new technology products to support seniors
• Take part in the development of a new “wellness app” that encourages self-managed health

Housing

• Support alternative housing/living developments that respond to seniors’ preferences and needs. This could include adaptation of current homes, non-profit housing, communal living, and potentially be financially supported by a community land trust or by partnering with private owners.

Other Explorations

• Encourage and evaluate a broader range of practice for local pharmacists – i.e., for routine prescriptions, medication reviews, chronic disease management, immunization and for extended monitoring of patients
• Assess needs and encourage advancements in community safety (e.g., initiatives by the Ottawa Council on Aging).

5. Our Progress to Date

Primary care

We have co-sponsored with the Centretown Community Health Centre and Perley Health, an Expression of Interest to Ontario Health East, for a nurse practitioner-led clinic to provide primary care to some of the more than 7700 seniors in central Ottawa who do not have a regular primary care provider. The proposal has been endorsed by the Ottawa Health Team. The clinic would hire two nurse practitioners and an RN to begin, but is scalable to six nurse practitioners.

• To support this initiative, we have received a grant from the Community Foundation of Ottawa to engage two nurse practitioners and an epidemiologist to design the business case feasibility analysis and evaluation framework.
• We are also in active discussion with the U of Ottawa School of Nursing to plan nurse practicums in geriatric primary care and explore potential research/innovation partnerships connected to the SHIH.

Information, Navigation of Community Supports and Community Feedback

We have developed an online resource Guide for Aging in Our Community.

We have received a grant from New Horizons for Seniors to develop a printed brochure to publicize our online guide. It includes a community feedback form to permit self-identification of people needing primary care, to recruit volunteers for testing of new seniors’ technology and to explore ways of supporting family and friend care providers

Technology to Support Aging in Place

We have been active in testing several new technology products and are represented on the Advisory Committee of the National Research Council Aging in Place Challenge, and.

We have received financial support from NRC-IRAP and from a commercial technology start-up to test a seniors’ wellness, health and medical record app. This project includes active participation of research experts from U of Ottawa Medical School, Bruyère Research Institute, Carleton U schools of Engineering, Sociology and Social Work.

Housing

There is a memorandum of understanding (MOU) involving a commercial developer and the City of Ottawa, to develop one floor of a new apartment tower as communal living. We have assisted the incorporation of a new housing organization, Abbeyfield Riverside, and have offered to transfer our role in the MOU to them. They are also exploring other options for an Abbeyfield Home, such as donation of property.

6. Evaluation

The evaluation of the SHIH will combine qualitative research and developmental evaluation of innovative approaches with a community lens to identify and quantify:

• All financial costs: to governments at all levels; to service organizations; to individuals and their families; to businesses and other institutions;
• All human resource costs: to service providers; informal caregivers; community organizations and volunteers;
• All financial benefits: to clients, care providers and caregivers, to local businesses, to care recipients and their dependents or estates, to the community in the forms of economic growth and accrued property value; to governments at all levels in the form of tax revenues and savings in institutional and other related costs;
• Self-reported satisfaction, experiences and insights, of service recipients, families and caregivers, service providers and community organization leadership;
• Patterns of resource usage, progression of aging-related needs, and community and health system responses;
• Efficiencies in human resource utilization and service coordination; and
• Recommendations for other communities and governments.

7. Implementation

As stated above, we are looking for individuals to help incorporate the SHIH.

• We welcome motivated, visionary individuals to help organize a provisional board of directors with broad community representation, for incorporation as a not-for-profit.
• We will also form an advisory and support group of experienced individuals who are willing to lend their expertise to the development and the implementation of the SHIH.

8. Contact Information

Individuals or organization representatives interested in helping with this ambitious initiative are encouraged to contact the SHIH organizing group (currently hosted by SWOOS) using this link: https://tinyurl.com/TheSHIH and includes founding members: Anna Cuylits, Terry Hunsley, Carolyn Inch, Patricia Eakins, Maura Guiliana and Peter Heyck.

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[1] National Institute on Aging, 2020, National Seniors’ Strategy

[2] https://www.ontariohealthprofiles.ca/ontarioHealthTeam.php

[3] Premji, Kamila et al, 2023, Trends in patient attachment to an aging primary care workforce: a population-based serial cross-sectional study in Ontario, Canada, https://www.medrxiv.org/content/10.1101/2023.01.19.23284729v2

[4] MacDonald, Wolfson and Hirdes, 2019 The Future Co$t of Long Term Care in Canada, National Institute on Aging