Hospital-based Patient Care Navigators

“The British Columbia ministry of health has guidelines for patients 70 years or older admitted to hospital emergency,” says Linda Schwartz, a Clinical Nurse Specialist in Elder Care at Providence Health Care. “There needs to be an immediate screening of areas where people can be vulnerable: mobility, nutrition and hydration, bowel and bladder function.”

Providence Health Care, which includes 16 hospitals, clinics and residential facilities in British Columbia, serves “populations of emphasis.” Those groups include people with chronic illness—heart, lung and kidney disease, AIDS, mental illness and “urban health issues” (described as homelessness, addiction and malnutrition) and older British Columbians.

“Often older patients who come to hospital have multiple health issues,” says Schwartz. She calls them “geriatric giants”—ongoing conditions like heart disease, diabetes, incontinence. “And dementia is a big diagnosis among this group.

It’s wonderful to have a geriatric unit in a hospital, but we end up giving Cadillac service to 17 or 20 patients, and what happens to the rest?

“Emergency departments are one of the least friendly environments for older dementia patients. Things happen quickly and people must be triaged and moved along fast. For dementia patients, that’s not ideal,” says Schwartz. In fact, those conditions can exacerbate, and sometimes cause, hallucinations, hysteria and disorientation.

“What we’ve done, and in Ontario they are quite advanced in this as well, is introduce a nurse with specialized geriatric knowledge to the emergency department,” says Schwartz.

St. Paul’s Hospital has a geriatric consult team and both St. Paul’s and St. Joseph’s Hospital (two of Providence Health Care’s sites) have elder care clinics staffed by geriatricians and social workers, occupational and physical therapists, dieticians, and others.

“We have a lot of positions dedicated to providing geriatric expertise,” says Schwartz. It’s the geriatric nurse, the first point of contact, who acts as patient care navigator for people coming into emergency. “She alerts the consult team, and the team may consult the clinic for follow up if required.”

In Canada, that kind of consult team is unique to Providence Health Care, although the model is common in the U.S. and there are some in Europe as well.

“It’s wonderful to have a geriatric unit in a hospital, but we end up giving Cadillac service to 17 or 20 patients [the maximum the clinic accommodates], and what happens to the rest?” asks Schwartz.

“We really are trying to make sure older people who come here don’t fall through the cracks and I have to say it’s still challenging,” she adds. “I think we’re doing really, really good work, but there’s more to do.”

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Jasmine Miller

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