It’s a sad reality that many seniors who are admitted to hospitals will suffer from a life-altering functional decline while in-hospital.

For these seniors, functional decline can mean a loss of independence, a reduction in quality of life and even readmission to hospital. With seniors making up 73% of the Humber River Hospital’s patient population, this is a significant concern for the Hospital and our community, especially with an aging population.

“Through HEART we screen senior patients when they are admitted so that we can identify those at risk of losing function while they are here,” says Denise Scott, a physiotherapist who helped create and implement the program. “These patients are eligible for daily therapy for restoring mobility.”

In September 2018, the Hospital launched Humber’s Elderly Assess and Restore Team (HEART) to help frail, at risk seniors transition successfully from hospital care back to their daily lives. Our goal is to help ensure that these seniors leave Humber with the same—or improved—functional skills.

We are proud to report that the HEART program is working!

Currently, 100% of HEART patients are released with at least the same level of function as they had at when they were admitted. In fact, 34% of these patients went home with better functional skills!

HEART is comprised of a physiotherapist, an occupational therapist, two rehabilitation assistants and a registered practical nurse. Together, these professionals work to minimize functional decline so that upon discharge, seniors are as close to their own “baselines” as possible. In essence, this means that they are able to complete the vital daily tasks—like showering and preparing meals— that they were able to manage at the time they were admitted to Humber.

Through HEART, all patients over the age of 65 are screened within 24 hours of admission to the Hospital by one of the HEART program’s physiotherapists or occupational therapists who ask the patients a series of questions about what their lifestyles were like before they came to the hospital.

Currently, 100% of HEART patients are released with at least the same level of function as they had at when they were admitted. In fact, 34% of these patients went home with better functional skills!

“This team screens senior patients when they are admitted so that we can identify those at risk of losing function while they are here,” says Denise Scott, a physiotherapist who helped create and implement the program. “These patients are eligible for daily therapy for restoring mobility. In the coming months, we will be able to monitor their progress on the Seniors Care tile in the Command Centre.”

At-risk patients receive ongoing reassessments and therapies. HEART professionals work in collaboration with inpatient teams in the delivery of additional treatment over the course of seven days. Patients and their families receive teaching, information and referrals to ensure a successful discharge, and are followed up with after they return to their daily activities.

“Helping seniors transition back into their communities and preventing them from ending up back in our ER is an important part of providing quality seniors care,” says Geriatrician Dr. Calvin Cheng. “Humber’s Elderly Assess and Restore Team is helping to ensure seniors maintain or even improve their levels of independence while they’re here.”