Visiting seniors in their homes, Dr Rosenberg and his team focus on their quality of life.
MEET TED ROSENBERG, a doctor who focuses on the elderly and only does house calls. His medical model is a geriatric game-changer for many in the Capital Region.
Rosenberg does not even have an office, at least not one open to the public. His frail and elderly patients don’t have to struggle with cars and buses, medical buildings and waiting rooms because he and his team only see patients in their own homes. “You get a better assessment of people in their homes,” he explains.
Dr Rosenberg measures Minnie Currie’s blood pressure in her home
Rosenberg’s vision puts patients first with a focus on keeping them in their homes as long as possible, even offering patients the option to die in their own homes, when and if possible. “Fifty to sixty percent of our patients die at home,” says Rosenberg.
On one hand, he has moved the needle back in time to when doctors routinely saw patients in their own environment. On the other hand, he fully leverages the digital age and is even ahead of his time. He always visits patients with his laptop to update files for his team members. He also frequently arranges for medical tests in patients’ homes, tests usually only available in hospitals, such as an EKG, a spirometry, a bladder scan, and an ultrasound to measure circulation in people’s legs.
Rosenberg’s rationale for home-centred care is that people are more relaxed in their homes and reveal a more accurate picture of their health than in a doctor’s office. “You see how much they smoke, you see if they have rotting food in the fridge, you see them move about, you see their needs and you see how they are as a whole person,” he says.
His company, Home Team Medical, is an integrated home care approach to health care that focuses on the continuity of care for senior citizens. Rosenberg’s team consists of two part-time doctors, two registered nurses, a physiotherapist and a rehabilitation aide, with referral resources of dieticians and occupational therapists, all with the sole purpose of improving a person’s quality of care and quality of life.
The continuity of care is critical to his model of geriatric care. The Home Team’s nurses and doctors normally see patients every four to eight weeks. For those who are acutely ill or facing unstable chronic conditions, the appointments will be as frequent as required until they are better. It’s a model of constant care that helps keep people out of hospital and in their homes.
A study conducted by Rosenberg and his team, published in the Journal of the American Geriatric Society, concluded that “Primary Integrated Interdisciplinary Elder Care at Home (PIECH) may reduce acute hospital admissions and facilitate home deaths. There was a 39.7 percent reduction in hospital admissions, a 37.6 percent reduction in hospital days, and a 20 percent reduction in emergency department admissions.” Most experts would agree that this is likely saving the health care system money.
With such impressive statistics, one might presume a grand welcome for Rosenberg’s approach, but the doctor says it’s been a long and difficult journey building the practice into what it is today.
His initial inspiration stems back to the 1980s and his early days as a doctor in northern Manitoba, flying into remote villages and making house calls on the back of snowmobiles. Later he worked as director of a geriatric day hospital in Winnipeg. In 1997, he moved to Victoria to work as a consultant physician in a regional community geriatric medical program.
Home Team Medical was born in 2003 when Rosenberg ventured out from the security of a position with the local health authority to create the practice with his wife Liza Zacharias and Vikki Hay, a registered nurse who was the director of care at Oak Bay Lodge. “I was very interested and excited as I could see that this practice would fill a gap in service to seniors living in the community,” says Hay, who also took a risk by leaving a stable job.
Rosenberg and Zacharias re-mortgaged their house and struggled in the face of stiff opposition. “After a year we almost threw in the towel. The [government] fee levels didn’t support it and the government didn’t like us making house calls,” says Rosenberg. “We didn’t have enough patients.” But an article in the newspaper helped turn things around with new patients seeking his services.
Besides the company not having an office, which was viewed as inefficient, the economics of the enterprise raised eyebrows. The model is part private and part public medicine. Patients pay a modest monthly fee that covers everything. That has been a tough pill to swallow for many in the medical profession. “I was like the devil undermining the system,” says Rosenberg. But it’s that formula, he argues, which gives him the autonomy to make responsive, patient-centred business decisions, such as buying medical equipment or hiring compatible people, without having to go to a committee for approval.
Another key piece of the practice is treating caregivers as part of the package. Not only are trips to the doctor’s office eliminated, family members can also stay in touch with the team digitally. “We get dozens of emails a day from family members with various concerns and Ted replies to each and every one,” says Zacharias, who heads up coordination and administration duties.
In the interest of full disclosure, here is where I come clean. A few years back, my elderly mother went through several months of falls and repeated hospital stays. She needed more care and I needed more help. After she became Rosenberg’s patient, her health improved and her pain was better managed, resulting in a better quality of life for her. And for me, being able to communicate by email directly with the doctor gave me a peace of mind I had been missing.
Today, Home Team Medical has about 300 patients and as it has grown, so too has its waiting list. But exceptions are made, if a person is suffering from severe health issues. And that compassion guides the team in other ways, too. “We have people who are on very fixed incomes and we do waive fees because they can’t afford it,” says Rosenberg.
As Rosenberg looks forward to the future, his eyes light up when he talks about what’s next. The team is piloting an expanded health assessment that will measure a range of issues from pain, anxiety and depression, to memory, mood, sleep, grip strength and gait speed. “For example, we have known for a long time that gait speed is an extremely good determinant of risk; the slower the gait the greater the risk. We are also going to measure their quality of life, which is perhaps the most important goal and health outcome for elderly people. No one is routinely doing that,” he says.
Another cutting-edge measure that Rosenberg is exploring is genome technology and how it can help guide medication management. “I want to test everyone’s genome and then look at the drugs they are taking in the hope of eliminating unnecessary drugs and medications that may put people at risk,” says Rosenberg. “Adverse drug reactions are one of the biggest causes of morbidity and mortality in older people in the Western world.”
He hopes that one day there will be more teams using his model and that the service could be provided 24/7, as so many seniors lack home care options. But that may be an uphill battle, as the field of geriatric medicine is struggling to attract new doctors—a worrisome issue as Canada’s greying population is growing at an accelerating rate. Recent census numbers from Statistics Canada show seniors now outnumber children for the first time in the survey’s history.
Rosenberg is doing his bit to help shape the next generation by teaching at the University of British Columbia. “A lot of what I do is teaching, and I take on residents and medical students,” says Rosenberg. “We want to see the next generation value looking after old people in their homes and see how interesting and rewarding it is.”
There is no doubt that Rosenberg is a pioneer in a very conservative landscape. With a little nervous laugh, he resists the moniker, preferring instead to be seen as “tilling the ground”—as he heads out the door to make his rounds.
Writer and journalist Bill Currie’s career spans more than 30 years, mostly with CBC TV National News. He now writes about people, places and politics at curriesnotebook.weebly.com.