Reta, 95, lives in a retirement home across the street from Newmarket’s Southlake Regional Health Centre. Judy Smith, her daughter-in-law, is not her substitute decision-maker, but the person Reta wants all health decisions to go through. Smith has seen first-hand the impact and value of person- and family-centred care (PFCC) on Reta’s quality of life. In fact, that focused care allowed Reta to achieve her goal last fall to independently walk over the threshold of Smith’s home for her 95th birthday party. A few months prior to that milestone event, the goal seemed out of reach, since Reta had fallen at home and broken both of her ankles.

Fortunately, the soon-to-be centurion and her daughter-in-law were introduced to the Southlake at Home Program, which identifies elders who would not do well in hospital for a prolonged stay, and with intense case management in the home, are discharged to their own environments.  

Smith, who has since become a Southlake patient and family advisor, says the program was a game-changer for the family. The care “…was co-ordinated…it was goal focused,” she says. And “…because of the co-ordination, because of the trust, and the soft transitions along the way, Reta met her goal.”