Profile of “hidden world” wins acclaim

Barbara Kermode-Scott

Toronto family physician and photographer Dr Mark Nowaczynski loves making housecalls. He also loves taking photographs. For the past 8 years he has made housecalls—entering the lives of the frail elderly—with a stethoscope in one hand and a camera in the other. Dr Nowaczynski’s mission is to document the “hidden world” of the house-bound frail elderly to bring attention to the needs of what he sees as a growing and under serviced population. He has discovered that photography is a powerful tool for advocacy and education.

In November, the National Film Board of Canada documentary House Calls, featuring Dr Nowaczynski, received national acclaim (www.nfb.ca/housecalls). House Calls, Dr Nowaczynski explains, takes you into the world of the house-bound elderly and shows you first-hand the daily struggles that they deal with and the huge benefits of providing home-based care if you give people the option to age in place.

The film won the prestigious Donald Brittain Award for Best Social/Political Documentary Program at the 21st Annual Gemini Awards Gala in Vancouver, BC (the Geminis celebrate excellence in Canadian television). In 2005, House Calls was recognized with a Freddie Award (Caregiving) in New York, NY, at the International Health and Medical Media Awards.

Dr Nowaczynski has learned that many seniors would rather remain in their own homes, even if this means compromising their basic needs by living in difficult circumstances, isolated and house-bound with no help. Many have been lost to follow up or are unable to continue to make office visits to their doctors because they have become house-bound, too chronically ill, too frail, or too cognitively impaired. They have fallen through the cracks.

“When we are old we become invisible. We lose our health. We lose our mobility. We lose our independence. We are institutionalized or become house-bound and retreat into our homes, disappearing into a forgotten and hidden world,” says Dr Nowaczynski, an Assistant Professor in the Department of Family and Community Medicine in the Faculty of Medicine at the University of Toronto.

Dr Nowaczynski spends a substantial portion of his week doing house-calls and regularly takes University of Toronto family medicine residents on calls. It’s very important to train the next generation to see the benefits of housecalls first-hand, but it is also critical to be able to make a business case to them for doing this kind of work, he argues.

Providing home-based care to frail seniors is not only humane and necessary, it is also cost-effective, he says, pointing out that “aging in place” is much more cost-effective than any form of institutional care. Doctors should be given the tools and incentives to provide home-based geriatric primary care through alternative payment plans, he suggests, adding that providing this type of patient care is “hugely satisfying.”