A Different Kind of Medical Care

A Toronto Grace Health Centre Program helps people age at home safely and surrounded with care.

By Jane Ayer

Crawling through the snow in her sister’s backyard, 77-year-old Donna White started to panic. With two artificial knees preventing her from standing up without something to hold on to, the “what ifs” started to play loudly in her head. What if I can’t find something to help me stand up? What if I can’t find a way out of the backyard? What if no one can hear me call for help?

Her sister and brother-in-law, whose house she was looking after, were away for the month, and their neighbours were nowhere in sight on that chilly March afternoon. They likely hadn’t seen her fall while she was filling the bird feeders. Inching her way towards the house’s back door, hands and knees soaked with melted snow, shivering from the cold, White made herself a promise: she would get what she calls “an alert button” as soon as she could.

“I knew it could have been really bad. And I’ve had quite a few falls—I probably average at least two ‘good’ falls a year,” she says, explaining she made a call soon after that changed her life.

Aging in Place

The Salvation Army Toronto Grace Health Centre’s Remote Care Monitoring (RCM) program, which White had heard about from a friend in her seniors’ residence, is the prepandemic brainchild of hospital CEO Jake Tran. Designed to help an older population living with frailty or at risk patients stay in their homes while still being cared for by hospital staff, the program also helps free up ever-in-demand acute care beds. The onset of COVID-19 accelerated Tran’s idea into a full-fledged pilot project in the summer of 2020.

“We were asked to open up 20 beds for chronic ventilators,” says Tran. “But where would we put those 20 patients? We knew we had the remote care monitoring system in place, so we decided to take it to the next level. That was the beginning. It allows us to then not rely on institutional responses but use the clients’ home. We call it aging in place.”

Funded by public and private donors, this aging-in-place system provides both medical and nonmedical monitoring by a team from Toronto Grace, 24 hours a day, seven days a week, which includes checking reports and alerts that come in from clients’ devices.

Levels of Care

Eighty to 90 percent of the program’s patients need only the most basic of its services, like White, who simply wanted a medical alert device to help her feel safe going about her day. That’s where the Odyssey device comes in, which clients can wear as a pendant, a watch, or even attached to a belt clip, where it can detect falls or unusual movements and notify the Toronto Grace staff. The pendant permits geo-fencing for patients prone to wandering, with alerts sent to family members or the RCM team. And direct, two-way calling allows clients to call for help as soon as they need it with the simple push of a button.

Devices and technology that provide a deeper, more extensive level of care are also available. In a manner of speaking, these devices act as in-home care monitors. Depending on the client’s needs, the technology can do everything from check blood pressure, oxygen levels and body temperature to dispense medication—complete with facial recognition ensuring the medication is dispensed to the right person, an audio announcement when it’s time to take medication and an alert if a dosage is missed.

There’s also the option of an inhome passive monitoring system: a series of sensors that learn the client’s movements and habits then trigger a warning if they detect something out of the ordinary, such as a lack of movement.

All devices report back to a centralized portal that keeps track of patients’ individual health information, collating the data and providing the RCM team with a full picture of how the patient is faring and whether interventions might be required. The team includes a range of doctors, nurses, therapists and social workers, working to constantly review patient charts and data, checking in with patients and families as needed.

Room to Expand

The RCM program now serves clients across Toronto and some additional health regions in Ontario, such as Burlington, Durham Region and Muskoka. Referrals come from Toronto Grace staff, other hospital
networks and agencies connected to Home and Community Care Support Services, the province-wide collection of organizations that provide access to home and community care services along with assisting longterm admissions. With the right funding and support, Tran hopes to take the RCM program provincewide by 2023. It’s a move he says could eventually help more than 100,000 people in the province,
reducing hospitalizations and longterm care admissions, while easing the strain on an already overburdened health-care system.

“It’s a beautiful way of getting people home (from the hospital) and helping those who are at home stay there,” says Tran. “It is not the answer to everything. But it is the beginning of a different type of medical care.”

And, in the wake of COVID-19, a different type of medical care, where aging Canadians can stay in their homes and out of long-term care facilities, seems to be exactly what the province’s aging population needs.

Peace of Mind

Statistics from the Canadian Institute for Health Information, an independent not-for-profit that studies Canada’s health system and the health of Canadians, show longterm care residents accounted for just three percent of all COVID-19 infections, but 43 percent of deaths from the virus. The pandemic turned long-term care homes into at-risk places for an already at-risk population.

And then there are studies like one from the Journal of the American Medical Association, which show patients receiving care at home versus in hospital have a lower risk of hospital readmission, a reduced risk of being admitted to long-term care, and lower depression and anxiety rates. It seems being able to receive care at home is good for your health.

Laurel Franks can tell you how good Toronto Grace’s RCM program has been for the health of her patients. The Toronto Western Hospital social worker has referred clients to the program for almost a year now, primarily connecting them
with the Odyssey pendant. She still remembers the first patient she referred to what she calls the “Toronto Grace falls program.”

“It took away this layer of anxiety for us as his care providers and for him, because he lives alone and really has nobody else in the world,” says Franks. “If he fell or needed support, no one would know for a long time. This is a huge deal to him.
And the peace of mind that everybody felt when he came into the clinic wearing his pendant—I could cry just thinking about it.”

Financial Impact

Franks says medical alert devices from for-profit companies carry a cost that is prohibitive to many of her clients. Neither do these businesses provide the same kind of extended care or services that are possible with Toronto Grace’s program. The cost to patients referred to the RCM system? It’s free.

Compare that with the cost of not investing in an outside-of-the-box (and outside-of-the-hospital) program such as this. Alan Ruth, CEO of GRTHealth, who provides the Toronto Grace with its remote care monitoring technology, adds it up.

“My estimate is that in Ontario, there are about 100,000 plus people who would benefit from access to the Grace’s RCM program,” says Ruth. “For acute level of care patients, if they’re institutionalized, the direct cost is about $800 a day. If
they wind up in long-term care, it’s about $400 a day.

“The cost to build a hospital bed these days is about $1,000,000, and you don’t just build one hospital bed, you build units of 35 or more,” he continues. “Then you’ve got the cost of the build, the cost of maintaining it and the cost to operate. On top of that, there’s the scalability. If I say we need another 35 hospital beds in Toronto, they may not be built in the next three to five years. But if somebody calls the RCM program and says, ‘Hey, I’ve got 35 people I need to put on,’ well, we’re now
averaging about 11 to 15 referrals a day into the program. The scalability from our point of view is technically infinite.”

Accessibility for All

Also infinite, says Franks, is what a remote care program like this, taken province-wide, could mean to the health-care system she has worked in for almost a decade.

“It could mean everything,” she  says. “In a province that’s struggling, it seems common sense. It would change how people feel about aging in place. It would make that opportunity accessible (to everyone). It could mean unneeded long-term
care placements and hospitalizations, shortened hospital stays, and happier, less scared people. It’s multifactorial in terms of how it could impact people.”

For Dawn Tobler and her family, the impact has been deeply personal. Her mother, Shirley, was diagnosed with dementia two years ago and referred to the Toronto Grace for a pendant which she wears like a watch on her wrist. Because she’s prone to wandering, Shirley’s pendant will send a text alert to Tobler or her husband if she leaves set geographic parameters. This is exactly happened early one morning last winter, when they were awoken by a text message at 5 a.m.
from her mother’s Odyssey pendant, showing she was blocks from her building. Tobler called her, told her to stay where she was, then went to bring her home.

“We swear that saved her life or saved her from getting sick or falling,” says Tobler. “It’s reassuring to know there’s a community out there, checking in on her. I appreciate it and know my mum deserves that help.”

Life-Changing Care

Tran’s vision is to move that help even farther across the province, with an immediate aim of supporting 3,000 patients by 2023. If the numbers are any indication, that’s going to happen sooner rather than later. A year ago, 75 patients were
enrolled in the RCM program, but today, it has more than 1,000 patients and over 1,600 referrals. For older patients and their loved ones, says Tran, this kind of remote care could be life-changing.

“Eighty-five percent of our clients are older adults who are frail, and many are marginalized,” says Tran. “This is one way in which they can truly age at home.”

Aging well at home is exactly why White wears her Odyssey pendant. She’s young in looks and at heart, exuding warmth and energy. She organizes regular movie nights with neighbours in her seniors’ residence,along with frequent bridge and euchre sessions. She still drives (one of the few in her building who do), taking friends to doctor’s appointments or the grocery store. She sees her sister often, popping in with a coffee for each of them. She texts her son daily and sees him regularly, and plans to travel by train to her birthplace, Nova Scotia, this summer. Being able to continue doing all of this with a sense of safety and security means the world to her.

“I just feel safe,” White concludes. “I can’t put it into any better words than that: I feel safe