Integrated Services and Better Health Outcomes for People in Residential Care is the Focus of a New Study Funded by Margaret and the late Charles Juravinski

With support from the Juravinski Research Institute (JRI), Hamilton researchers, including a Social Sciences professor, have launched a new initiative to improve health outcomes for people living in Hamilton’s subsidized residential care facilities. Lead investigators are aiming to leverage a pilot project of an integrated primary care team tested by McMaster Family Practice and the Greater Hamilton Health Network and based upon the principles of the Integrated Comprehensive Care model developed by partners throughout the St. Joseph’s Health System.

Leading the study are Anthea Innes, director, Gilbrea Centre for Studies in Aging and the Gilbrea Chair in Aging and Mental Health, Professor Health Aging and Society at McMaster University; Chi-Ling Joanna Sinn, a research fellow from St. Joseph’s Health System’s Centre for Integrated Care; and Andrew Costa, the Schlegel Research Chair in Clinical Epidemiology & Aging; associate professor, Health Research Methods, Evidence, and Impact at McMaster; and research director, St. Joseph’s Health System’s Centre for Integrated Care.

The study by Sinn, Innes and Costa has received $1.175 million from the JRI to establish baseline data, implement and evaluate more integrated and accessible ways to deliver health and social services, and develop processes for scaling the pilot program across similar facilities in Hamilton.

Innes said this initiative will help tackle the challenges faced by residents of subsidized residential care facilities.

“This new project will enable us to learn more about the lived experiences of some of Hamilton’s most vulnerable people,” said Innes. “It will help us to work with key stakeholders on how we can work together to begin to address some of the challenges to help improve their experiences of health and social care.”

In 2010, the Hamilton Spectator’s Code Red series shone a light on the staggering health disparities across Hamilton’s neighbourhoods and their link to poverty and other social determinants of health. The series prompted an outpouring of public awareness and organized efforts to improve access to care, but 10 years later, important health indicators such as life expectancy have remained unchanged or even worsened.

Many of the worst-performing neighbourhoods are concentrated in Hamilton’s downtown core, and this area is also home to 39 of the city’s 48 subsidized residential care facilities.

“Amidst the COVID-19 pandemic, it became even more evident that people living in subsidized residential care facilities are a vulnerable population often managing multiple chronic conditions, and yet they face many barriers to accessing primary care,” said Chi-Ling Joanna Sinn, the project’s co-principal investigator. “When they need help, residents tend to receive episodic care at the emergency room or an urgent care centre. Since neither the city that oversees residential care facilities nor the health system who cares for its residents has consistent reliable data on this population, they become somewhat invisible. Their medical history, records and referrals can become fragmented and forgotten, leading to poorer outcomes and the cycle continues. That cycle is what we’re trying to disrupt through this study and the application of integrated care.”

Seeing this phenomenon play out time and time again amidst the pandemic motivated Dr. Doug Oliver, medical director of the McMaster Family Practice to expand his practice into one of these facilities and assemble an integrated primary care team to support residents where they live. This model of care shows great promise in removing barriers to accessing care and improving the continuity of care for residents.

Now, with funding from the JRI, a consortium from Hamilton Health Sciences, McMaster University, St. Joseph’s Healthcare Hamilton and the City of Hamilton are working together with the Greater Hamilton Health Network, an Ontario Health Team, and its Residential Care Facility Steering Committee to learn from the pilot project, embed it with best practices from St. Joseph’s Integrated Comprehensive Care Project, and create a framework for further implementation across other congregate care settings to improve health outcomes for residents.

“Through decades of giving to Hamilton Health Sciences, McMaster University, St. Joseph’s Healthcare Hamilton, St. Joseph’s Villa in Dundas, and more, Margaret and the late Charles Juravinski developed a keen understanding of the complex healthcare system in Hamilton, where its strengths lie, and where there are opportunities for improvement,” said Dr. Julian Dobranowski, chair of the JRI steering and scientific committees. “The JRI was founded to encourage collaboration across that complex system, and this new project is, in part, intended to help address those lingering facets of inequality in access to the remarkable healthcare services our city is home to.”

The JRI was established through Margaret and the late Charles Juravinski’s historic $100-million+ legacy gift made in May 2019. It remains one of Canada’s largest-ever legacy gifts. Since then, the Juravinskis invested an additional $16.5 million which includes the most recent in-life gift of $5.1 million earmarked to support various research projects across the city.