Old art of living
I told you about Stéphane Lemire three and a half years ago, this “doctor who left the hospital” in 2012, he is a geriatrician and he thought he could better treat the old by visiting them at home.
Qu’il had better treat them.
He had a click when he was studying applied health management in England, where he learned that his grandmother Laurette, his second mother, was out of date. He did neither one nor two, jumped into the first plane to come to his bedside, and, returned to the hospital, he took a look at his file.
He hung on the calcium level, twice as high.
He had a medicine stopped, everything went back to normal. Two weeks later, Laurette “was back home, she was walking, she was washing her laundry by hand in the sink, she had even patented a clothesline to dry.”
The doctors had sentenced her.
Stéphane returned from England with the certainty that things had to be done differently.
“I was convinced, I still am, that we need to rethink the organization of care for the elderly,” he told me at our first meeting. The geriatrician must evaluate the person when she is in the best of her condition, and not at worst, when she is returned to the hospital. ”
He had a project in mind, social geriatrics, to identify problems early, when they are easier to adjust.
Before they degenerate.
But his idea has stalled, the former Minister of Health Gaétan Barrette was not very hot initiatives that came out of the “box”, Stéphane has had to make a strategic retreat and focus on the Foundation AGES qu he had founded, to consolidate his support.
And now, that’s it. The Caquist government found its idea good, enough to fund a pilot project in three regions, in Quebec City, Laval and the Bas-Saint-Laurent, where those who rub shoulders with the elderly will be trained to open the eye, question to identify problems earlier.
They are called sentinels, they can be the attendants, the meals on wheels, the people doing the housework, even the drug delivery person.
Social geriatric centers will be set up this fall and should be fully operational by the beginning of 2020. “The sentinels on the ground will be able to identify situations, they will be trained for that, and they will transmit what they have seen a navigator who will know which door to hit. It is he who will open the doors, who will link the services that exist. He will accompany them, not pitcher elsewhere, there is sometimes a surreférencite “explains me Stéphane.
And old people who are waiting on waiting lists.
No big structure, “there is enough”, no concrete, flexible teams linked to a CLSC, to which the medical staff will be attached.
Stéphane and Élie Belley-Pelletier, Executive Director of the AGES Foundation, have been working together for three years to develop this new system. They have first laid out the guidelines for everyone to work in the same direction, starting from the elderly person.
Not just based on what you think is good for her.
The nuance is great.
“What is very important is to respect the rights of the person, his decisional autonomy. People must be able to decide according to their values. When we place a person, it is sometimes because we want zero risk. But is that what the person wants? ”
You have to accept some risk, to a certain extent of course.
To trace this delicate line, Stéphane has just published a book , Vieillir, the beautiful case, with the author Jacques Beaulieu, where old age is not a simple gradient of gray. “The book is part of my approach to being a geriatrician, to change the face of aging, to make it less sad, less repulsive.”
“People accept everything on the back of normal aging. When they come to see us, they should have done it sooner. ”
Basically, the book explains how to differentiate between what is normal when you get older and what is not, so that people can sort things out and consult when they need to. “When a person gets older and has symptoms, they say,” She’s getting old, she’s lost, “as if it were normal, as if there was nothing to do.” Often, there is has something to do, because the person has something that heals, just like anyone else.
But we do not bother to look.
“I saw a person, it was four years that she lived with faecal incontinence, she was told that it was normal aging, he had bought diapers without asking questions. I fixed that with some exams and simple procedures. It’s sad that she had to live this. ”
Cases like that, he has plenty of them.
Like this man who was falling, for whom we began to consider a placement, until someone thinks to go to see him.
You know what was wrong?
Folds in the carpet, the man was sneaking in.
This is exactly what sentinels will do when they go to see people at home, open their antennas to see what might be wrong, a wound that heals badly, or even mild symptoms that could be investigated – and treated – faster.
They will report their observations to the navigator, who will take over, and who will see how to solve the problem before it escalates, before the situation worsens and costs more. “What’s happening is that those around the elderly are seeing things, but they do not really know what to do with that, where to go, what door to hit.”
It is one solution among others to unclog the network.
And, above all, so that our old people are better.
Local information matters to me and I want to participate in the future of my life.