by the Seniors Health Innovations Hub (SHIH) (Central Ottawa) seniorshealthinnovationshub@gmail.com Presenter: Terrance Hunsley Co-Lead

The older adult population in central Ottawa has a serious problem. Some 7700 of its citizens over 65 do not have a primary care provider. We have a solution to propose – a solution that is both innovative and cost-effective.

Our objective is to support independent ageing at home and in the community. The Seniors Health Innovations Hub (the SHIH) is a seniors-led organization in central Ottawa that anchors a health-centred collaboration among volunteers, experts, community organizations, public institutions, and service agencies. We use our own experience to contribute to research and understanding of issues around the subject of ageing. As a catalyst within the existing system we explore innovations in home care and community support services, caregiver supports, housing alternatives and adaptation, supportive technology, social inclusion, lifestyle and safety.

Today, we are focussed on one overriding issue: the critical need for primary care for seniors. In particular, those older adults identified by Ontario Health as lacking reliable primary care in central Ottawa.

Last June, in partnership with Centretown Community Health Centre and Perley Health, the SHIH responded to Ontario Health’s call for “Expressions of Interest” for innovations in primary care.

We made a modest, affordable proposal: the creation of a clinic employing nurse practitioners to provide team-based primary care for seniors in our diverse population who need these services.

This kind of clinic has a lot going for it on many levels. First, it is costeffective. While fully qualified and licensed to provide primary care, nurse practitioners take less money and less time to train than physicians. Next, it is executable. A large number of nursing professionals in the country offers a robust “supply pipeline.” There is minimal, if any, trade-off in service — nurse practitioners enjoy, along with access to consulting physician services when needed, levels of trust and cooperation with their patients comparable to physicians.

Why is primary care so important?

It’s simple. Good primary care helps prevent human suffering by detecting and treating health issues early, promoting healthy lifestyles, and providing ongoing support. Studies have shown how primary care catches problems before they escalate, leading to better health outcomes. Conversely, lack of access to primary care results in more acute cases requiring specialized care, strained ambulance, paramedic and emergency room services, and longer hospital stays, with institutional care becoming more frequent and prolonged.

Why is primary care for seniors so critical?

While an effective healthcare system should provide all Ontarians with high-quality, quickly accessible primary care, there are compelling reasons to ensure that every older adult has a reliable, familiar and accessible primary care provider:

1) Although seniors overwhelmingly desire to remain living independently in their homes and communities, they also tend to acquire multiple chronic conditions and disabilities and face advancing frailty. They are often heavily dependent on the health care system. The absence of responsive primary care results in serious health problems and health system interventions that are needlessly costly and serious. Accessible and responsive primary care is a critical factor for quality of life. It reduces excessive care burdens and anxiety for family and friends. Stress, burnout, depression and financial sacrifice among family/friend caregivers are already far too high. The most recent Health Quality Ontario report indicates that 44% of family/friend caregivers are in distress. They suffer from depression or anxiety, sometimes both. Many are unable to continue their role. That 44% figure represents an increase of 21% in the past two years! Moreover, with a large baby boom cohort and a smaller, globally-mobile younger generation, more and more caregivers are also vulnerable seniors!

2) Finding better ways to address the growing geriatric caseload would decrease pressure on the overall system as well as on physicians who primarily have not been trained in geriatrics and have tended to prefer other specialties.

How can the Ontario government address this need?

Ontario Health called in the spring of 2023 for expressions of interest in proposing innovative approaches to expand team-based primary care, emphasizing health equity and cost-effectiveness. This initiative promised only $30m in new spending at a time when the Ontario College of Family Physicians (OCFP) warns that the count of 2.3 million Ontarians without primary care in September 2022 will increase to 4.4 million by 2026 – two years from now. If we apply the same growth rate to central Ottawa the number of seniors without regular primary care will be about 15,000. This could be an underestimate, since retiring physicians are likely to have had a more-than-proportionate number of seniors on their rosters.

Which brings us back to our proposal. Our approach offers a quick and scalable solution integrating nurse practitioners into a virtual team with professional support from a community health centre and geriatric healthcare institution.

The Financial Accountability Office informs us that the Health Ministry already has some $4.4 billion of unallocated funds budgeted over the 2022/3 to 2025/6 period and intends to use the recent (larger) increase in federal health transfers for other priorities. There appears to us to be substantial fiscal room for a robust response to the issue we are bringing forward.

There is no doubt that we have a serious problem in central Ottawa. But we think we have a solution, and one which can be scaled across Ontario to enhance healthy ageing in a cost-effective way. We hope that the provincial government will fund our modest proposal.