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Health Links: Better care comes in many forms

In the summer of 2014, Gaye Rudolph was hospitalized because she was having difficulty controlling her diabetes. She was also struggling to take care of herself at home. Her diabetes, combined with pulmonary hypertension, chronic back pain and decreasing eyesight was making it hard to eat right, monitor her sugars, take medication and get to all of her important medical appointments.

During that hospital stay, her family and physicians began discussing the possibility of Gaye moving to a long-term care home, but she wanted to stay in her condo. A retired nurse, it was difficult for Gaye to go from the person giving health advice to the person receiving medical advice.
 
Shortly following this hospitalization, Gaye was enrolled in the North York Central Health Link and slowly, with the help of her Health Links Care Coordinator, Lauren Lindsay, life began to get better.

“Health Links brings family physicians, nurse practitioners, specialists, hospitals, Community Care Access Centres and other community services together to improve the care of complex patients,” says Lauren. “As Care Coordinators, we are the eyes in the home. We see aspects of the patient's life very clearly, like what supports they have or don't have in place.”
 
Gaye Rudolph is feeling much more optimistic about her health, day-to-day life and future since being enrolled in Health Links.
 
Gaye Rudolph, left, with her Health Links Care Coordinator Lauren LIndsay, right, is feeling much more optimistic about her health, day-to-day life and future since being enrolled in Health Links.

In the months since her hospitalization, Gaye, her sons and hermedical care team including a nurse practitioner from North York General Hospital's Centre for Complex Diabetes Care, met to create a care plan that would improve Gaye's overall health and help her stay at home.

Today, Gaye's diabetes is under better control in part because a nurse now visits her every week to check her sugar levels. She has had a thorough eye exam and been diagnosed with cataracts that will hopefully be corrected with surgery.

Gaye is feeling much more optimistic about her health, day-to-day life and future since being enrolled in Health Links.

“I know my health and life are better today because of Health Links,” says Gaye. “You know that saying ‘many hands make light work?' Well, I believe this is true. The progress I've made is because of all the people helping to take care of me together: my family, Lauren, my doctors, and the nurses who visit me at home together.”

Health Links is a new model of care that makes it easier for people who rely on our system the most, such as seniors and people with complex chronic conditions, to access health care.

Talk to your care provider to see if Health Links would be appropriate for you.

If you are a care provider, visit the North York Central Health Link to learn about referring patients into Health Links.
 
February 3, 2015

The Pulse banner This article first appeared in the February 2015 issue of The Pulse, North York General Hospital's community newsletter. Learn more