Overview: CFHI helps hospitals ‘ACE’ elderly-friendly care

Today, older adults account for only 16 percent of Canada’s population, but represent 42 percent of hospitalizations, 58 percent of hospital days and 60 percent of hospital-related expenditures. Meanwhile, the number of people aged 65 and older is expected to double over the next 20 years.

Older Canadians often arrive at hospitals with many inter-related chronic, acute health and social issues. Yet this population is not always well served by hospital-based models of care, providing an opportunity to rethink how we organize and deliver care for seniors.

Mount Sinai Hospital in Toronto spearheaded the Acute Care for Elders (ACE) Strategy and, as a result, has become one of Canada’s most widely recognized elder-friendly hospitals. The ACE model of care spans the emergency department, inpatient, outpatient and community care, delivering seamless care to older adults.

In its initial years at Mount Sinai, ACE has shown remarkable outcomes for patients, providers and health systems, including a 28 percent drop in total hospital lengths of stay, a 93 percent decline in the occurrence of pressure ulcers, 14 percent fewer readmissions within 30 days, and 11 percent fewer patients remaining in institutional care. Acute care cost savings from these improvements amounted to nearly $6.7 million for Mount Sinai in 2014.

CFHI, working with the Canadian Frailty Network and Sinai Health System, launched a 12-month quality improvement collaborative in 2016 to spread ACE. Seventeen Canadian teams and one international team participated, with Canadian teams each receiving up to $40,000 in funding, and all receiving coaching, educational materials and tools to support the adaptation of Mount Sinai’s elder-friendly practices and models of care to their local contexts. Resources included an online learning platform, educational webinars, an in-person workshop, and ongoing support from the ACE collaborative faculty and staff.

Most teams reported changes in culture because of the ACE collaborative, including changes in how data collection and measurement is perceived; greater compassion for the needs of elderly patients with dementia; and adjustments in daily practices. The shift in culture resulted in improved patient outcomes and more knowledgeable staff.

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