CARE FOR CANADA FRAIL ELDERLY POPULATION - FRAGMENTATION OR INTEGRATIONS

BUDGET CONSTRAINTS, TECHNOLOGICAL ADVANCES and a growing elderly popul ation have resulted in major reforms in health care systems across Can ada, This has led to fewer and smaller acute care hospitals and increa sing pressure on the primary care and continuing care networks. The pr esent system of care for the frail elderly, who are particularly vulne rable, is characterized by fragmentation of services, negative incenti ves and the absence of accountability. This in turn leads to the inapp ropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe su ch a model, which would have clinical and financial responsibility for the full range of health and social services required by this populat ion. This model would represent a major challenge and change for the e xisting system. Demonstration projects are needed to evaluate its cost -effectiveness and address issues raised by its introduction.