'My absolute dream job': Unique program brings physicians to housebound seniors

Last week, as Toronto faced its first major snowstorm, photojournalists spent some time with doctors as they saw patients and gave them booster shots of the COVID-19 vaccine.

Photojournalists cover doctors giving at-home patients COVID-19 booster vaccines

An animation gif shows physicians Eugenie Phan and Christa Sinclair Mills, and occupational therapist Leslie Coulter, visiting patients of House Calls in Toronto on Jan. 21. (Evan Mitsui/CBC, Cole Burston/AFP/Getty Images)

Patients of family physician Eugenie Phan don't go to her office. Instead, she visits them — in their homes. Phan works at House Calls, one of Canada's largest home-based primary care programs with 536 patients last year.

It's a collaborative model of care for seniors started by the program's clinical director, Mark Nowaczynski, about 14 years ago in Toronto. 

Today, the team of nine primary care providers include seven physicians and two nurse practitioners, as well as nine others who provide services such as physiotherapy, occupational therapy and social work. 

Last week, as the city faced its first major snowstorm, photojournalists Evan Mitsui and Cole Burston spent some time with Phan and her colleagues Dr. Christa Sinclair Mills and occupational therapist Leslie Coulter as they saw patients and gave them booster shots of the COVID-19 vaccine.

'Through good and bad times'

Phan recently made the jump to be full-time with House Calls. Until last month, she had been working at a family medicine clinic, working part-time there and half the time doing home visits.

"I just found with the pandemic there was a huge need for care at home," Phan said in a phone interview this week. "We all know, there were not enough long-term care beds. Hospitals are overcrowded — patients not wanting to go into hospital ... And there's a lot more demand." 

On a Jan. 21 visit, pictured below, Phan examines and gives her patient Sara Zimmerman a fourth shot of the COVID-19 vaccine. 

(Evan Mitsui/CBC)

Zimmerman has been her patient for many years, for almost as long as Phan has been with House Calls, which she joined part-time in 2014. 

(Evan Mitsui/CBC)

"I've been taking care of her for many, many years ... And I've seen her through good and bad times," said Phan, who also provided medical care to Zimmerman's late husband. 

During the visit, Zimmerman smiles in the foyer of her home. 

(Evan Mitsui/CBC)

'Precious' cargo

In another part of Toronto on Jan. 21, Dr. Sinclair Mills of House Calls is seen outside an apartment building, as she preps to provide checkups and administer COVID-19 vaccines.

She said she keeps the PPE in the trunk of her vehicle, but the vaccines ride in the front with her.

"They're a bit fragile and a bit precious," said Sinclair Mills, who has worked for House Calls since summer 2012. "So they get buckled into the passenger seat." 

(Cole Burston/AFP/Getty Images)

She visits with Geraldine Anderson, a colleague's patient, to administer a booster shot in her Toronto apartment.

"For her to get out and stand in line or even book an appointment for a vaccine is obviously challenging and poses risks to her," Sinclair Mills said.

(Cole Burston/AFP/Getty Images)

A dose of the vaccine rests on a container of candy in Anderson's living room.

(Cole Burston/AFP/Getty Images)

After making her rounds, Sinclair Mills said the woman, pictured in bed and out of the frame below, has been her patient for about a year. She had a fall, ended up in hospital and returned home. But her function declined "quite significantly" so she was referred to House Calls. "That is a very common story."

(Cole Burston/AFP/Getty Images)

Out there on the road, Sinclair Mills said the work can be lonely. There's no quick hallway chat with a colleague and there are logistical challenges with the weather, parking and patients, who can't get to the door right away. But she and her colleagues have found ways to stay in touch with instant messaging apps and regular in-person meetings. 

A decade now with House Calls, Sinclair Mills said, "I genuinely love it, and I feel extremely fortunate to have found this gem. This is my absolute dream job. I never imagined it was possible."

(Cole Burston/AFP/Getty Images)

By car, on bike — even snowshoes

In the summertime, Phan gets around by bike and during the winter, she drives — though she was on foot on Jan. 21. When Toronto got about 50 centimetres of snow at the beginning of that week, her car was stuck in the snow and she couldn't see patients. But Dr. Nowaczynski, who had just purchased a pair of snowshoes, used them that day to go see patients, she said.

"Our motto of our team is, "We will make it happen,'" Phan said.

(Evan Mitsui/CBC)

Phan waits to be let into an apartment to administer a third dose to a colleague's patient.

(Evan Mitsui/CBC)

At the beginning of the pandemic, Phan said House Calls tried to do visits over the phone, but it didn't work because many patients are hearing impaired and confused.

"They live at home alone," like this woman who Phan inoculates with a booster against COVID-19.

(Evan Mitsui/CBC)

In an emailed message, Phan said seeing patients at home shows her a side of them she wouldn't see in the clinic.

"The home is a visual extension of themselves as we get a glimpse into their life through their hobbies, their furniture ... their memories and mementos, their pets, cleanliness, etc.

"When I visit my patients to check in, I am not just addressing their medical issues, but I'm also checking in on their overall well-being and this takes time."

(Evan Mitsui/CBC)

She knows she can see way more patients in a clinic than during house calls, but she said, "I am definitely happier." She hopes "our work will help to eventually change the 'standard of care.'"

(Evan Mitsui/CBC)

Phan prepares to give a third dose of the COVID-19 vaccine to Edward Khan at his apartment.

(Evan Mitsui/CBC)