Adult day programs are growing in popularity across the country as governments recognize the advantages to supporting the frail elderly to age in place. One model for such delivery is the Comprehensive Home Options of Integrated Care for the Elderly (CHOICE) program in Edmonton, Alberta.
Developed in 1996 by Alberta Health Services in partnership with CapitalCare and the Good Samaritan Society, and modeled after the Program for All-Inclusive Care for the Elderly (PACE), the CHOICE program provides the support adults 60 and over need to continue living in their own homes when their health needs increase.
Typically, clients of the program are high users of the health system because of complex health conditions which may include: mobility/balance challenges, chronic pain, urinary incontinence, hearing loss, visual impairment, weight loss or malnutrition, depression, dementia and mental health issues. They may also be in need of medication management or care due to caregiver burden/burnout.
Take Ernie Golka for example. He was 78 when he entered the CapitalCare CHOICE program. He had experienced a heart attack, several surgeries and was exhausted from the frequent trips to the hospital to be treated for his multiple medical conditions. His family was equally exhausted. They were trying to juggle all his medical appointments with their own hectic lives.
“For both dad and for us, CHOICE has been a godsend,” says Ellen Golka-Moxham, Ernie’s daughter. “We don’t know how we would have managed without it and we seriously doubt if dad would be doing as well as he is today without it.”
The CHOICE program operates like a day clinic. Clients come to the centres a few times a week to receive a variety of services from a multidisciplinary team including physicians, nurses, pharmacists, dieticians, occupational and physiotherapists and social workers. The regularity of their visits helps staff develop a rapport with clients and get to know them on a personal level. In-home care and after-hours emergency access are also provided.
“CHOICE is effective at preserving the health of frail seniors, keeping them out of hospital and delaying their admission to long-term care because the interdisciplinary team gets to know the clients and can quickly detect any change in their condition," says Trish McGrath, manager for CapitalCare’s CHOICE programs.
In addition, clients benefit from regular social contact with other clients and from the centre’s recreational programming.
Lillian Clyne enjoys knitting and painting ceramics. The 82-year-old has a number of health problems, including congestive heart failure, chronic leg ulcers and arthritis. But since enrolling in the CHOICE program, she has not been readmitted to hospital or had to visit the emergency department.
Nearly 20 years after its development, outcomes are showing the approach has been successful in reducing the elderly’s use of in-patient and emergency department services, preventing their health from deteriorating and delaying the need for institutionalization.
Three major outcomes include a significant decrease in acute care utilization: 1. Decline in the number of patients visiting ER, from 64.6% to 40.5% and, 2. Decline in the number of patients hospitalized, from 64.7% to 29.8%) in the year following CHOICE admission, and 3. Reduction in the number of falls (from 66.0% to 29.8% in the year following CHOICE admission) [publication pending- Samuel et al. 2013].
Edmonton’s CHOICE program was recently adopted by Health Sciences North (HSN) in Sudbury, Ontario. On September 16, HSN opened the Short Term Assessment and Treatment (STAT) Clinic for frail seniors 65 years and older who can live safely in the community, but who are without a primary care provider (family doctor) and at risk for placement in a nursing home.
The CHOICE program is also one of five integrated home care programs in Canada being studied, by a doctoral candidate at Carleton University in Ottawa, to identify promising practices that target the vulnerable elderly. These include: the Home Health Services Program in the Fraser Health Authority in British Columbia; the Aging in Place Program in Ottawa, Ontario; the SMILE program in Kingston, Ontario; and the Carefirst Program in Toronto, Ontario.