Nova Scotia researchers eye improvements to health-care system post COVID-19

Nova Scotia's health-care system had challenges long before COVID-19 entered the province, but several researchers say the disease has helped highlight shortcomings and could also be the catalyst to improvement.

Katie Aubrecht, a professor in St. Francis Xavier University's sociology department and a Canada research chair in health equity and social justice, has long studied dementia care.

Recently, her work has focused on mental health in rural communities and the challenges faced by patients and their caregivers.

With public health orders in the last three months forcing the shutdown of many community groups and organizations, Aubrecht said it became increasingly important to log what services are available and highlight gaps.

Her team is one of the groups that recently received money from a $1.5-million COVID-19 Nova Scotia research fund.

Virtual map

Her plan is to create a virtual map of all the dementia-related supports for people and their caregivers across the province. They will also document how those supports have changed due to the virus.

"We know that some communities experience health disparities," she said, noting that some might be shaped by location and others by race and ethnicity.

Once those disparities are identified, Aubrecht said the tool can be used to lobby officials about where and how to augment services. That approach was recently used with success in Ireland and people involved with that effort are consulting with Aubrecht's team.

Long-term care has received much of the attention during the pandemic with respect to gaps in the system.

But Aubrecht said there are legitimate concerns about continuing care because some community groups and services might not be able to reopen when public health orders lift, or their ability to help could be limited due to physical distancing rules.

Too often, she said, it's taken for granted that families can provide care for loved ones with dementia. She said that simply isn't always the case, in part because of how complex the condition is.

"It's going to impact communities in a significant way," Aubrecht said of the possibility some supports won't survive the pandemic.

"If we're really talking about the fabric of community, the programs that are offered, social support groups, they bring people together."

Dr. Nabha Shetty, a Halifax-based internist, also sees opportunity to improve health care in the face of the virus.

Along with colleague Dr. Paige Moorhouse, Shetty received funding to help implement and expand the use of a program Moorhouse developed called palliative and therapeutic harmonization, or PATH.

They'll use their research funding to try to scale and adapt the program so it can work across the province.

Shetty's focus is on frail, elderly patients, a demographic that wasn't well served by the structure of the health-care system even before COVID-19, she said.

The aim of PATH, which was developed before the pandemic, is to provide more holistic care for those elderly patients and help them, their families and primary-care providers consider treatment options that make the most sense.

"Instead of thinking about, 'How can we fix this,' we instead think, 'Should we fix this and will fixing one thing make the rest of the situation worse,'" said Shetty.

Seeking to improve communication

PATH also strives to break down communication barriers that exist between long-term care staff and people working in acute care, something COVID-19 highlighted.

"We already knew the long-term care sector was so divorced from acute care, but now there was all this pressure to care for people on site without providing a clear means of supporting the doctors who are going to be managing that care," said Shetty.

With PATH, Moorhouse and Shetty hope to improve the reach of internists who focus of geriatric care so communities that don't have that kind of specialization can gain access for patients without necessarily requiring them to leave their place of care.

Ironically, the pandemic has helped accelerate improvements, beginning with expanded virtual care, said Shetty.

"The geographic separation has been bridged and also the facility separation is being bridged."

As part of their research, Shetty and Moorhouse will work with EHS, Continuing Care and emergency departments to improve connections.

There will also be advocacy for a universal patient medical record, so what Shetty and her fellow specialists have access to when they see a patient is the same thing the patient's family doctor or other provider sees when the patient is at home.

"The fact that we don't have a single, unified health record that spans from community to the hospital is crazy."