When 91-year-old Constance broke her arm last year, she faced the
daunting prospect of being placed permanently in a nursing home.
April 2003. Constance C. awaiting placement in a nursing home while pining for Oscar, her cat
Mark Nowaczynski
Until then, she had managed on her own in her apartment. Six weeks
of government-provided home-care services after an earlier broken
hip had helped her to stay independent. But when that was cut off,
Constance, nearly blind, with heart problems and mild dementia,
had to ask supermarket patrons to read soup-can labels for her,
and sidestepped her faulty memory by marking time on a calendar.
Constance was about to be torn away from the only life she knew
- including separation from her cat Oscar and her lifelong
Toronto neighbourhood.
Then her doctor, Mark Nowaczynski, stepped in.
"They were going to (put) her into the nursing home,"
says Nowaczynski, who was able to get her back to her apartment.
"She was an obvious candidate for home care, but she couldn't
get the help she needed."
At his midtown Toronto office, Nowaczynski speaks passionately
about what he sees as a troubling part of Canada's health-care
system.
"The majority of the home-care budget goes to post-acute home
care. Where does this leave senior citizens who need chronic geriatric
home care?" he says. "Many of them have been left to slip
through the cracks, and are receiving either minimal or no services."
April 2002. Betty J. holding her recently published memoirs. She came to Canada from Scotland as a young woman to marry her childhood sweetheart. Widowed, she lives alone.
Mark Nowaczynski
Since starting his practice in 1992, Nowaczynski says he has discovered
through house calls to his elderly patients how government-funded
home care could better serve seniors in Ontario.
"It's a group of people that came of age during the Depression,
and are used to sacrificing," Nowaczynski says. "I find
it a sick irony that they are being forced to relive the privations
of their youth."
Statistics Canada reports that from 1991 to 2001, the 80-plus demographic
was the fastest-growing segment of the country's population,
soaring by 41 per cent to 932,000. This group is expected to surpass
1.3 million by 2011.
But government home-care spending has not kept up with the numbers,
holding steady at about four per cent of Ontario's health-care
budget, with 2003 4totalling about five per cent. As well, in a
reverse trend from a decade ago, only about 15 to 20 per cent of
this funding goes to chronic geriatric home care.
In May of 2002, a photo project by Nowaczynski focused on the results
of the gaps in the home-care system. A three-page photo spread in
a national newspaper featured images of his housebound patients,
highlighting their cramped quarters and stark living conditions.
Nowaczynski said many patients were reluctant to be included.
"Many said no because they were ashamed," he says. "Here
they are living in grinding poverty, in a bachelor apartment, in
tattered clothes. I told them it was so important to show that this
is the reality in the heart of Canada's richest city."
The photo spread resulted in tremendous public buzz and an award
for excellence in health-care reporting from the Canadian Nurses
Association.
"I've always been interested in social documentary photography,"
says Nowaczynski, who has dabbling in photography since he was a
teenager. "I realized this is a powerful way to get at people."
He has since been meeting with policymakers and key players in home-care
services to discuss improvements to the system. "The whole
point is to stimulate change," he says.
In Ontario, government-funded Community Care Access Centres (CCACs)
are part of what's changing by contracting out home care, but
funding is limited.
Nowaczynski worries that "it's not always about doing
what's right or what's cost-effective."
May 1998. George W., a retired postman who served in the Second World War. He is now housebound and too embarrassed to be seen out on his motorized scooter.
Mark Nowaczynski
Being cost-effective seems to favour home care. The volunteer-based
Ontario Community Support Association, which provides essential-care services to 750,000 Ontarians yearly, illustrated in a report this
year that community support services benefit those with chronic-care
needs at half the cost of care in facilities, and that the value
of this volunteer labour to the Canadian economy ranges from $20
billion to $30 billion.
So far, the publicity generated by Nowaczynski's photo feature
has helped Constance, who was prominently featured, bypass the lineup
at a Toronto assisted-living facility to land a spot along with
Oscar.
Meanwhile, a book of his work, photo exhibits and a National Film
Board documentary may soon be on the horizon for Nowaczynski, who
sees improving home care as his life's work.
"It makes sense to me to do it full time. All of us are heading
this way (getting old), and we don't want to end up like this
(without proper home care)."
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