Carewest Sarcee's C3 Program

As Canada's population ages, health care providers continue the push to develop innovative solutions that help seniors stay independent and in their homes as long as possible. At Carewest Sarcee, the Comprehensive Community Care (C3) Program is doing just that. C3 is aimed at seniors living in southwest Calgary who qualify for continuing care but want to stay at home. Started in June 2001, the program has grown rapidly and quickly has become an integral part of the Calgary Health Region's services.

A 1999 Calgary Health Region Utilization Improvement Project served as the impetus for C3. While the project focused on improving efficiencies across the system, it also looked specifically at the burgeoning needs of Calgary's growing elderly population. The goal: to find more effective ways to provide better care for the frail elderly.

"We know that most seniors want to live in their own homes for as long as possible," says Jennie Hollings, C3's program leader. "We also know that many people end up in hospitals or care facilities simply because they and their families lack the support they need to stay at home." The C3 program provides 24-hour support to the frail elderly, beginning with in-home support for things like bathing and dressing and supplemented by medical, social and recreation support at a Day Centre.

While the C3 program is not a new concept, it is new to Calgary. The program is based on an American model that was developed in the mid-'70s, and similar programs have been in place in Edmonton since the mid-'90s. Hollings says, like any idea, C3 has grown and adapted to meet the specific needs of the people it serves. "The clients are the ones who really direct the program, and that's as it should be," she says. "This is their health and independence we're talking about so they have to be proactive. We can provide information but they have to buy into it."

Hollings says home caregivers play a pivotal part in the C3 program. They go into a client's home as often as needed. "Many clients need help getting up in the morning and preparing for bed," she adds. "But caregivers can be there any time, meaning they're attuned to clients' habits and routines. It also means they're more likely to notice little signs that could indicate problems." The caregivers provide important continuity, and act as a liaison between clients, physicians and other health care professionals.

Home caregiver support is supplemented with two to three visits a week to a Day Centre housed at Carewest Sarcee. Shuttle buses carry clients from their homes to the Day Centre where seniors can tap into a comprehensive health care team made up of physicians, nurses, home support workers, a pharmacist, occupational therapist, physical therapist, recreation therapist, social worker, and dietician. Working with this team, seniors have access to recreation and social opportunities as well as coordinated medical care. It's a synchronized approach designed to intervene before a health issue becomes a full-fledged crisis.

The centre includes a variety of facilities such as laundry, bathing, exercise, physiotherapy, a dining room, kitchen, and common area. Two on-site physicians monitor clients and perform any necessary procedures. And while medical care is a key part of the program, Hollings says the social side is also important. Many elderly people are lonely, cut off from daily interaction with others. The C3 program provides ample opportunities for seniors to connect with others and engage in familiar activities like baking, crafts, art classes, bingo, playing cards, board games, sing-a-longs and bus trips. Exercising groups, walking, and individual physiotherapy help seniors maintain function and mobility so they can remain independent at home.

Seniors may also stay overnight, providing valuable respite to spouses and caregivers, or may be admitted for short-term treatment when they're too ill to be at home. The C3 program offers round the clock response seven days a week so when the Day Centre is closed, on-call nurses and physicians are available to respond to emergencies.

Hollings says a big challenge is making the program as simple and seamless as possible. Clients are referred to the C3 program through a single point of entry, the Community Care Access phone number. People may call the C3 program at Carewest Sarcee at 403- 686-8140 if they want more information on how to make a referral. The only stipulation is clients must live within a 45-minute drive of Carewest Sarcee.

Clients begin with a short trial period to determine if the C3 program meets their needs. For most people, the next step is to meet with a caseworker and develop an individualized care plan. Nothing is done in isolation, ensuring clients receive quality care as their health situation changes. Hollings adds that very occasionally someone will decide not to continue with C3 after the trial period. If this happens, the team makes sure the person is referred to another more appropriate part of the health care system. However the majority of seniors respond well to C3's caring, friendly environment.

Jon Stevulak can't say enough good things about C3. He joined the program because he requires ongoing medical monitoring. Added benefits are the opportunity to socialize with other people and much-needed respite for his wife. But the 77-year-old also enjoys other aspects of the comprehensive program. "The main thing I need is exercise and they give me lots of exercises to do." Agnes Nottel is another satisfied client. "I enjoy everything about the program," she says as she relaxes with a newspaper in the sunlight. "It's great here. Everybody is so friendly. It's like a big family."

The program accepts 100 clients who pay a monthly fee of $200, plus the Blue Cross portion of medications. No one is denied access for financial reasons, and if cost is a factor, a social worker works with clients to find a solution.

As the program nears its second complete year of operation, Hollings says preliminary evaluations indicate the C3 model is working well in the southwest Calgary neighbourhood. "There's no doubt the model proved itself after the first year," she says. "Initial statistics show we're doing a much better job keeping the frail elderly in their homes and out of hospital or continuing care settings." Hollings says evaluations of 64 C3 clients found that in the year prior to joining the program, these people were admitted to the hospital 114 times. During their first year in the program, hospital visits dropped to 21. These same 64 people had 236 emergency room visits the year before joining the program. During the first year of the program, the number dropped to 41. She adds a partnership between the Calgary Health Region and the University of Calgary ensures that ongoing monitoring and evaluation will remain an integral part of the program.

Hollings says the best result is the strong relationships the Calgary Health Region is forging with seniors and their families in the southwest quadrant of the city. C3 has been so successful that the Calgary Health Region hopes to eventually expand the program to other parts of the city. "To most of us, staying in our homes symbolizes our independence. And independence is at the heart of the C3 program."