Providence Health Care provides residential care for approximately 650 frail elders across five sites in Vancouver. The primary medical care is provided by members of the Division of Residential Care, Department of Family and Community Medicine. The Division of Residential Care is comprised of a small number of “neighborhood physicians “ who are associated with one or more site, and care collectively for the majority of residents within. There remains opportunity for individual physicians to join the division and care for patients from their own practices; however this is becoming less common. In addition to organizing resident medical care, the division aims to increase the education and research capacity within residential care at Providence.
Elders living in residential care have become increasing complex over the years. Those with high cognition are generally able to be supported at home with additional help. The majority of residents in our facilities suffer from cognitive impairment, generally dementia. There is also a population of residents that are physically disabled to the extent that they cannot be safely supported in the community, often from strokes or similarly disabling conditions. All of our residents are frail, meaning that they have limited physiologic reserves and can become acutely unwell without much provocation.
Growing numbers of residents come to our facilities very near the end of their lives, for care and comfort in their final days. A significant number of these residents die within 3 months of entering residential care.
Providence Health Care has begun a journey, entitled “Residential Care for Me
( RCforMe )”, which is a project aimed to create environments that offer the opportunity for residents to flourish and feel truly happy to reside in our facilities. Such issues as returning control to the resident over the way activities of daily living are supported by staff, meals offered, care is provided are a few examples of how we hope to realize this change.
Providence Health care is undertaking a residential care redevelopment project that will incorporate many of the ideas that are arising in the RC4Me initiative. This redevelopment includes the construction of a new facility within the next few years, and reconditioning or redeveloping other facilities in turn.
The model of medical care of PHC is based on a “palliative approach” to resident care. This uses a symptom – management approach to treatment, focusing on quality of life, over ever – increasing treatments in an effort to extend life at the expense of quality and comfort. Many medications that might have been useful at an earlier stage of life for disease prevention are no longer required as residents enter the final period of their lives. Other treatments may be modified to guidelines that are more appropriate to the level of frailty a patient is demonstrating.
We strive to provide as much medical care as possible within our homes, utilizing acute care services only when necessary. Our physicians have committed to regular attendances at our sites, for proactive care and health maintenance. We attempt to recognize conditions that might be reversible, and treat them as necessary. Should it become apparent that a resident is nearing death, we offer treatment aimed at ensuring a comfortable end of life. We have available a palliative care team for assistance in this regards, if needed.
Our program and division are working towards further advances in medical practice in residential care, as the complexity and acuity of our residents grows greater. We hope to achieve a model whereby a physician is available on – site each weekday, for monitoring of their own residents, and assist in the assessment of any other resident in need of urgent medical care. In doing so, we hope to reduce the need to transfer residents to acute care sites for conditions treatable within our facilities.
We currently have physician learners present in our facilities on an intermittent basis. We hope to increase the presence of learners to include all facilities, to enhance opportunities for education and care of elders, both now and in future. Similarly for research; we have a small number of research projects underway in our division, and hope to increase the involvement of our members in greater research participation in future.
We invite physicians with interest in residential care medical practice to enquire about joining us at Providence Health Care. Please contact Dr Ken Tekano, at the address below, for information.
Dr. Ken Tekano Division Head, Residential Care
Location: Vancouver, BC,
Melanie Catacutan Administrative Secretary
Location: 1190 Hornby Street, 2nd Floor, Vancouver, BC, V6Z 2K5