Last week, I participated in an information event for fellow seniors on transportation choices. A full house of 150 people registered for the seven panel speakers and keynote speaker at a large seniors’ residence that also provided the lunch. One of the speakers was a representative of the local health integration network (LHIN) for eastern Ontario (known as the Champlain district). She spoke to this new agency’s mandate, and more specifically about “Aging at Home.” This refers to the emphasis on providing services closer to where seniors live to allow them to live at home longer, rather than face the higher costs of the delivery of health services in hospitals and long-term care facilities.
Another speaker was from the Council on Aging and its new participation in a national and international campaign to get cities to sign on to a program of “age-friendly” communities. This also is geared to making the senior years more active by removing barriers those with declining abilities, which for our event means making it easier for people who don’t drive to get around. Is there enough quality in the alternatives to driving for this shift to occur humanely?
The title of my blog, ‘hearth health,’ has another meaning to what I intended in this context. What I intended was to look at ‘hearth’ as the place each of us feels most connected to, a more symbolic meaning than the physical space in front of a fireplace (or ‘heart earth’ the two words that, overlapped, make up ‘hearth’). It is part of living locally, of making shorter, if not fewer trips, and of people surrounded by things and people that have more meaning to the individual.
But these references to health care offer another meaning of ‘hearth health,’ in the sense that rather than focus on the health of one’s hearth, one is talking about health care that is delivered closer to the hearth’s of the recipients, if not right in it.
My mother-in-law died a year ago at the age of 100. She never learned to drive, even though she was widowed 38 years before her death and continued to live in the far suburbs of New York City. She started needing some housekeeping help at about 94, after she fell getting off a tour bus, and never received physiotherapy for her back, so she developed a stoop and lost much of her ability to bend over or to reach high places. Her stamina was also affected.
At 96, after falling on two consecutive days and having an ambulance dispatched both times to take her to the local hospital, we were contacted by the hospital and given the direction to quickly find her a nursing home, implying that she perhaps should have already been living in one, and being clear that they had little choice but to keep her in the hospital until she could be placed, without ever setting foot in her apartment again. It was a change she accepted, but not very graciously some days, as she did not like the confining environment of a nursing home.
This is as much a financial motivation as a service one; seniors should be provided just as much support as they need and no more, and it should be provided economically. From the seniors’ point of view, independence is very important, along with being close to friends and family. And unless you are a social butterfly, your closest friends will be neighbours. Relocation late in life is very disruptive.
Our Ottawa Seniors Transportation Committee is very interested in the cost of travel for seniors to get health care, which the participants in our event all rated as their most important category of trips. It has been a long time since doctors made housecalls, but in later life, trips to doctors’ offices can be very problematic (our committee has been looking at the high cost of parking for these appointments).
The LHIN supports local agencies trying to provide this transportation to those who don’t have cars or don’t drive, plus other trips that make it possible for seniors to continue living in the family home or at least in a smaller place independently. They cannot provide operating budgets, but have recently bought vans for these agencies, reducing the costs to local agencies to drivers, other operating costs, and the booking support.
The increasing use of information technology (IT) for tele-work and tele-shopping and tele-banking are already helping, not to mention the growing use of the Internet for linking to past friends as well as current ones and finding new ones. But ‘tele-health’ is still in its infancy. Can seniors buy accessories for their home to allow their vitals to be transmitted while talking on a video line like Skype? Or could government see to the creation of places equipped for this, perhaps with a nurse present, allow for seniors to ‘see’ primary physicians and specialists remotely, without having to visit an office in a far-away hospital, medico-dental centre, or health campus, all within a block or two of walking.
There is also the need to get the message of location-efficiency to this older cohort, the one that, in their youth, were the first to embrace wholeheartedly the automobile as a good and essential appliance for life. Rural areas have stronger support networks, but they also have greater distances to cover to reach essential services. And the suburbs, although closer to services, are poorly serviced by transit or taxi service, and these neighbourhoods lack a full spectrum of housing types, so as one ages, one rarely can find locally the smaller residential options that remain close to friends and the familiar merchants and professionals.
At our follow-up meeting yesterday, I approached the LHIN representative and suggested this new meaning for ‘hearth health’ as a way to describe what was needed in their approach to the quickly growing seniors demographic. I was suggesting that health care provided closer to seniors was really ‘hearth health.’ I was also serving my own agenda, advancing the importance of ‘hearth’ to all health issues.