Agents of change | The geriatrician released from the hospital

They are agents of change in their field. But we know little or nothing about them. The print presents it to you during the holiday season.

Geriatrician Stéphane Lemire is rarely bored by the hospital.

Except perhaps the complex, “intellectually challenging” cases to deal with. And even.

But what he “doesn’t miss at all,” he insists, is the feeling of seeing patients “too late.”

Too late ?

Too late as in the case of M^moi Poitras*, 85, who arrives by ambulance after falling into his messy apartment and will spend the first 24 hours – if not more – lying on a stretcher in the emergency room.

“We’ll put her in a diaper, she won’t be mobilized all this time and her abilities will drastically decrease,” summarizes the geriatrician.

Consequence: m^moi Poitras will never return to live at home.

The 46-year-old specialist doctor left the hospital environment almost 10 years ago to create the AGES foundation with which he is developing a model of “social geriatrics” aimed at preventing this type of scene which is too common in the four corners of the world. Province.

Think of the “social pediatrics” of D^r Gilles Julien, but for the elderly.

“We keep seniors healthy at home with resources that already exist in the community,” he sums up. Nothing magical or even new, insists the doctor who doesn’t have a wooden tongue.

“The novelty is to do it. »

Grandma is in the hospital

Two elders inspired this remarkable doctor: his grandmother Laurette and his neighbor when she was studying Applied Health Management in England, Ms.^moi Gordon.

It was his grandmother who made him want to become a geriatrician. They have always been very close. She made him do his homework when he was little.

After graduating from medical school, while studying applied health management in London, his 95-year-old grandmother was hospitalized. We inform him that there is nothing more to be done. She decides to take the plane to accompany her in her last moments.

Laurette was delirious. However, looking at her balance sheets, she finds a double the calcium rate. She quits a drug.

Result: His calcium level drops to normal.

“There’s something wrong with our system if you’re at risk of dying from something reversible from medication,” she says in a moving interview.

Two weeks later, Laurette was released from the hospital, fit enough to enjoy life, her family.

m^moi Gordon, his 93-year-old neighbor in London, suffers from a fairly serious cognitive disease. She wanders a lot. Yet she manages to live at home, because she receives three visits a day: delivery of meals, supervision for taking medications, etc.

One day, when his neighbor had an acute respiratory problem, Dr.^r Lemire calls the ambulance. After evaluating the patient and administering the inhalers, the paramedic concludes that there is no need to transport her to the hospital. She the latter makes sure, thanks to her system in place, that a nurse comes to see her at home the next morning.

“The click is done, start the D^r Curiosity. Even if you’re out of shape, you can stay home with the right support. »

Ten years later, one of the AGES foundation’s projects is to train paramedics in the approach to social geriatrics, inspired by what was seen in London to avoid systematically transporting the elderly to hospital. emergency.

Sentinels and Navigators

But let’s go back to Mr.^moi Poitras, that the D^r Lemire allegedly saw “too late” in the hospital. In his model of social geriatrics, the employee of a community organization who comes to clean up Mrs.^moi Poitras is trained as a “sentinel” every week.

In this programme, the guide knows how to distinguish normal aging from accelerated ageing. He would have noticed during his last visit some bruises on Mrs.^moi Poitras, consequences of a small fall, and sounded the alarm.

The sentinel would have access to a “pivot” – a position created in the same organization for the social geriatrics project – who would take over, make further observations and help the older person obtain community services.

We could have cleaned out his apartment, provided him with a walker, paved the way for the refrigerator. The doctor could have adjusted her meds as needed.

All this outside the hospital.

It is more effective to make the most of interventions in the community, argues the D^r Lemire, that “to go to the health network, re-enter a waiting list and have to wait for the evaluation of a health professional to have access to this or that service”.

Clearing out a house is not a confidential act and reduces the risk of falling.

However, community organizations are too often unable to “unblock something with the health network” when it becomes necessary, explains the geriatrician who started his first pilot project in 2014 in Lower Town Quebec. The medical specialist was a volunteer driver there for a few months to understand the needs in the field.

It is here that he imagines a navigator function in charge of finding this path to the appropriate services.

The premise: there is a shortage of personnel in the healthcare network – therefore we do not add nurses or other professionals, because in any case we will not find any; there’s no money, so it doesn’t have to be expensive, and “we don’t want bricks; we want services”.

Currently, the AGES foundation has about ten pilot projects in as many regions of Quebec, thus reaching more than 15,000 seniors.

Half of the projects are funded by the Ministry of Health and Social Services (MSSS); the other through philanthropy.

In one of the pilot projects, out of 1,000 elderly people who had direct interventions, only 5 needed a family doctor to get a diagnosis or resolve diagnostic or therapeutic impasses.

Additionally, organizations that have assistants trained in social geriatrics have better staff retention, she points out.

At 25-30 million a year, we can take action across Quebec, extrapolate, and at the same time reach 170,000 at-risk seniors.

“If we can implement the AGES foundation plan within five years, I will never lose the hospital again. »

Self ?

“Politics” – that is, the Coalition avenir Québec which has returned to power – is in favor of extending social geriatrics to the whole province, he says. But “the machine” has not yet delivered the program promised by the CAQ in the 2018 election.

“Maybe we don’t in shape not in the usual financing model of the MSSS, which generally passes through the CISSS and CIUSSS”, he specifies.

And there is the vision of the management of social geriatrics which sometimes clashes with that of the healthcare network. “Management in 2022 shouldn’t be from top to bottom. It’s more support, learning management methods, continuous improvement, ”describes the D^r Curiosity.

Lost opportunity

The pandemic should have been a “big one Wake Up ” , he believes. The geriatrician regrets that we have “locked the elderly in their homes” and that we do not seem to have learned anything from it.

During the pandemic, housekeepers who played the role of “sentinels” were no longer allowed to go to senior citizens’ homes. The “navigators” then get on the phone to reach them.

“We realized very quickly that confined seniors were rapidly losing their autonomy,” he says. We hastened to organize training courses and video clips to limit deconditioning and the consequences of confinement. »

“Without wanting to criticize” the government, it published its official recommendations on the matter… a year later, he specifies. “Fieldwork quickly shows us the problems,” he says.

A flexibility that contrasts with that of the bureaucratic apparatus.

Hence a certain feeling of impatience. “In fact, I’m starting to get fire in my ass,” says the doctor.

Every day that passes without the program (government, to roll out the model to all of Quebec) being unblocked, funded, “it’s an elderly person we risk evacuating who’s going to go to the emergency room or CHSLD,” she pleads. .

“It has to stop. »

1.M^moi Poitras is a fictitious name to represent many cases that the D^r Lemire observed over the years.