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The sunshiners: frail old people living at home

Dr. John Sloan

Dr. John Sloan, a GP who has spent many years doing house calls with frail seniors and through this work encouraged Vancouver Coastal Health to develop the Home ViVE program of multidisciplinary care for home bound seniors.

One of my directors sent me a link to Dr. John Sloan’s blog, Sunshiners. Her 85-year-old father, a huge fan of Dr. Sloan, had sent it to her.

Who is Dr. Sloan? Some of you who have worked with him in Vancouver might know that he was the early pioneer of the Home ViVE program (link opens only from VCH computers) in Vancouver. As a GP he spent many years doing house calls with frail seniors and through this work encouraged Vancouver Coastal Health to develop the Home ViVE program of multidisciplinary care for home bound seniors. This program targets frail seniors who would otherwise be in residential care, and allows them to have access to the medical and home supports needed to live at home.

We’re lucky he has rejoined the Home ViVE team on a part-time basis since we expanded the program in September of this year.

His website—coined The Sunshiners: Frail Old People Living at Home—has a great video of him presenting at a conference. It’s 42 minutes long but I encourage you to watch it, even if it requires a couple of sittings. I was very taken with what I learned. Dr. Sloan clearly has a love and a special view of what frail seniors want in their later years, and I find his views worth considering. He is entertaining.

Not to give away the entire plot, but I will point out the highlights.

  • He speaks passionately about the mismatch between our hospital system and what frail seniors need.
  • He makes the argument that for frail seniors, a “crisis” is really a crisis of function—such as mom can no longer make it down to meals—where the family can no longer cope. For these types of “crises”, the rescue that a hospital delivers scientifically appears to have no impact on improving the outcome.
  • He says that many seniors (not all perhaps) don’t want a “rescue” in any case. They just want to be kept comfortable and functioning. Extension of their life does not have the same importance as comfort and quality of life.

I am curious if those of you who work with frail seniors agree with Dr. Sloan’s views or not. I am also curious about what staff and physicians in our hospitals think about Dr. Sloan’s presumption that many frail seniors do not and would rather not benefit from the wonders of our hospital system.

Take a look if you can find the time, and let me know what you think.

About the author

Mary Ackenhusen

As President and Chief Executive Officer of Vancouver Coastal Health (VCH), Mary Ackenhusen leads the largest academic and tertiary health authority in British Columbia.

A member of the VCH Senior Executive Team since 2007, Mary has distinguished her collaborative leadership style by fostering a patient-centred approach to care, innovation and the redesign of services to enhance quality and efficiency. She has served as the Chief Operating Officer – Coastal, as well as the Chief Operating Officer – Vancouver, leading the largest community of care within VCH. In 2013, she served as acting Chief Financial Officer and Vice President of Systems Development and Performance.

Prior to joining VCH, Mary served on the Fraser Health Authority’s leadership team for almost a decade. She led Fraser Health’s facility planning and real estate, systems analysis and performance improvement, and new business development. In 1990, she became Director of Quality and Operations at INSEAD, an international business school based in Fontainebleau, France.

Mary is a graduate of the Harvard Business School’s Master of Business Administration program and the West Virginia University’s Industrial Engineering masters and undergraduate programs. In 2013, she was named one of Canada’s Most Powerful Women by the Women’s Executive Network.

Connect with Mary

Permanent link to this article: http://upfordiscussion.vchblogs.ca/2011/11/the-sunshiners-frail-old-people-living-at-home/


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  1. Laura Frith RN OHN(c)

    Our department at the Richmond Hospital provides telephone follow up of the over-70 patient population. We are identified as Geriatric Transition Nurses. We telephone clients within 24-48 hours post discharge from the Emergency Department. Our role is to follow up on their acute visit to see how they are managing at home as well as provide support and resources for the client and their family. We try to help this population navigate the community support systems as well as health care services.

    Our goal is to keep our client population safe and well supported in the community with appropriate resources for as long as possible. We are a small team in the acute/community system (only 3 staff) but feel that Dr Sloan knows his topic. We hope for continued support with in the context of keeping this client population in the home environment and providing family and services that can support that.

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    1. Mary Ackenhusen

      There is so much that we can learn from each other, and on this subject in particular, Richmond has done some amazing things. I know that there is a small delegation visiting the Richmond team tomorrow to find out more about your successes. Thanks!

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  2. Jackie

    As a nurse and as a caregiver of a friend who is considered frail elderly I am pleased to have the voice of Dr. Sloan be heard by others. He makes some very valid points about the frail elderly, the health care system and the incongruency of the two.

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  3. Mary Ackenhusen

    I read Dr. Sloan’s book, The Bitter Pill, over the holidays and found it very thought provoking…. my 83-year-old mom was visiting and picked it up and stayed up all night reading it—”Yes,” she said, “I want a doctor like Dr. Sloan – where can I find one?” (unfortunately she is from the States so I don’t know!).

    I’ve now shared it with a number of the Vancouver leaders who are also intrigued with what his experiences and ideas might mean for the way we manage frail seniors.

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