Population health | Factors leading to vulnerability Participants commented on the multitude of social issues that increase the risk of a community-dwelling adult becoming a “socially admitted” patient, such as poverty, homelessness, social isolation, lack of primary care, and substance use disorders. The inability to advocate for oneself was also a common observation. | “And I find, like, for the most part, for us, like, a lot of it comes down to, like, finances is, like, one of the biggest contributing factors for a lot of them. Because we see, especially lately in today’s society, like, people don’t have the finances to find adequate housing. Like, a lot of people come in, they’re, like, homeless or where they’re living, like, the conditions are poor. So, like, we had a patient not that long ago who he had literally was living in a shop that he once owned because he couldn’t afford his apartment anymore …. During COVID, it closed because he couldn’t keep up with the, like, financial pressures and everything with COVID. There’s no bathroom in the place. There was no running water. And he was, like, using the garage next door to use the bathroom. So, like, we see a lot of patients that, like, homelessness is huge. And then a lot of our patient[s] are vulnerable as well in the sense of, like, their educational levels because they don’t understand. And I find, too, like, sometimes they’re taking… Like, they’re going outside for smokes, whatever. They’re going socializing, and they’re, like, being taken advantage of by other patients in the hospital. Like even if it’s as little as, like, “Can I have a smoke?” or “Can I have $5?” Like, I find our patients literally, like, fall under this category of, like, they just don’t know better so they get taken advantage of by other people.” — HC803 “One of the challenges with community supports is that, as we all know, there’s lack of sufficient community support for the aging population in our community. The second part is, is that sometimes there are physical issues. So, sometimes these patients are living alone in a home that is multilevel, and they don’t have a washroom on the main floor, for example, and they need to ambulate with a walker. And, so, there are physical barriers that may impair their ability to even exist in the community even with added community supports. So, those are things that have to be taken into consideration that we often as health care providers don’t think about.” — HC156 “… sometimes it’s the home situation has gone for so long not being looked into or sort of being overlooked. We sometimes get couples or who are living alone, managing. Sort of managing the best that they can at home. But if they don’t have a lot of social support or don’t have a lot of family checking in on them often.” — HC638 “And I think the absence of having … of that subset of people, having an advocate for them, both in the community and when they interact with the acute care system, makes them particularly vulnerable.” — HC300 |
| System changes for addressing “social admissions” Participants shared their visions for improvement to the current system to provide appropriate care to those accessing acute care with social needs. | “The acute care system is becoming the community system. We’re becoming nursing homes … this [inter]mediate pathway between community and long-term care. Because long term care is failing at admitting people in a timely fashion.” — HC506 “I would like to see more geriatrics in the hospital. I think we need to [be] more prevention-based rather than reaction-based … which is what we are.” — HC236 “In an ideal world, if someone presented to the emergency department where their presentation was considered to be a social admission or a ‘can’t go home’ situation, that there would be a multidisciplinary team that would look at that patient’s situation from a holistic perspective. So, taking into account their medical history and their presentation, making sure that, you know, they’ve had a full workup, making sure that we understand the social factors and the kinds of resources that they’ve accessed, and what could be accessed.” — HC300 “How do you put the patient back at the centre of the table? …. Even if you look at how our services are delivered, they’re organized from a provider lens, not from a patient-need lens.” — HC605 “So, there’s some longstanding [type] disease or the sequela of something [type] that happened 20 years ago. We would never be involved in their care if they were in the community because there’s no need.” — HC549 |