Fetch the black bag! Calgary doctors now make house calls for home-bound seniors
It carves out time for people who need a slow medicine approach, says doctor
Many frail, home-bound seniors are getting access to doctors without leaving their living room for the first time in Calgary, as Edmonton doctors seek to expand their own, similar program.
The house calls are a throwback to another era — "slow medicine," as one doctor called it — and families says it makes a big difference.
"It's meant the world for me," said Durk de Jong, whose 86-year-old wife, Janny de Jong, has a doctor visit her at home regularly.
"That we don't have to go to the doctor's office for her is very important because she's in pain. If we have to go in, we use the wheelchair and we have to go in the car and she has to walk. If we didn't have this program, it would be disastrous for us now."
Janny de Jong was signed up for a pilot project in central west Calgary in 2018.
Dr. Carolyn Wong, who specializes in geriatric medicine, visits regularly, bringing her black bag and sitting on a chair in the living room to check Janny's vitals.
Wong is connected with the primary care network in that zone. She says that once the PCN started the pilot project, the group lobbied several years for the right to expand across the city.
This past fall, Alberta Health gave the go-ahead. Now, 10 doctors will be working part time, finding eligible patients with referrals through Home Care. The deal with Alberta Health lets them charge by the hour rather than by the visit to recoup their costs.
Wong says the goal is to improve the seniors' well-being, reduce the number of emergency room visits and allow them to safely stay in their homes, when possible.
"The typical full-time family doctor will have usually more than 1,000 patients on their roster," Wong said. "It's really difficult to carve out time for these people who need a slow medicine approach and a comprehensive approach.
"I can really see a lot of things that don't come out in an interview in a clinic. I can see: 'Oh, this is how you're managing your 20 pills? My goodness. How are you doing that every day?' Or I can see there's perhaps some tension and some caregiver burnout going on that's maybe more stifled in a clinic setting."
Edmonton program seeks to expand
The Edmonton program is similar but designed to serve more patients by using a consult model. Each senior keeps their regular family doctor. A specific doctor who specializes in care of the elderly comes in to do an assessment just when needed.
One of the doctors who started the program, Dr. Jasneet Parmar, said they created this new approach just before the pandemic.
Often we see them in a blue gown in a clinic or hospital and it dehumanizes them.- Dr. Jasneet Parmar
"The thank yous we get from family caregivers when we go into the homes and do these assessments and … link them up with all kinds of resources, almost every caregiver is in tears," Parmar said. "It's so difficult to access this kind of help.
"It also gives us an opportunity to see people in their homes. Often we see them in a blue gown in a clinic or hospital and it dehumanizes them. When you see them in their homes, this is what they're comfortable with. And it really reduces my desire to move them out of there."
The Edmonton doctors are now seeing 600 patients a year. They submitted a funding request to expand the program. Parmar says there's also a long-standing outreach team at the Good Samaritan Seniors' Clinic, but that, too, is at capacity.
They're hoping Alberta Health will increase funding, especially since the provincial government is now exploring how to keep more seniors in their homes longer.
Alberta Health declined an interview. In a statement, communications director Chris Bourdeau said: "These types of specialized alternative payment plans are available for other areas of the province if physicians choose them. We would welcome similar programs in other areas."
'Promised to take care of me'
As for Durk and Janny de Jong, they say Dr. Wong's visits have been critical to helping them spend these years together. Janny was in a nursing home alone for several months, but Durk says he didn't think staff were attentive enough to her pain.
He took her home on a weekend pass and refused to bring her back.
He's 90 years old, still going into the office every day at the insurance company he sold to his son. He checks in regularly, and when he gets home, he brings her water, takes her blood pressure and emails the result to Dr. Wong. Then he cleans up the place and makes supper.
"I can manage on my own in a house," said Janny. "It's fine. I can go to the bathroom but no stairs; I don't go outside. I don't go shopping or anything. I'm just, I'm a home bird. I feel very fortunate that I'm in that group who is being cared for at home."
She sat quietly as Durk bustled about.
"We've been married 65 years," she said. "When we were married, he promised to take care of me and he's been doing that."
The CBC team in Alberta is focusing this month on family caregivers — the husbands, wives, children and others who take on care of loved ones. Visit cbc.ca/familycare to read more.