History of the RGPs

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In the mid 1980s, the provincial government developed a strategic plan for a comprehensive system of health services for the elderly (A New AGEnda). Part of the plan was to use the expertise developed by the academic health sciences centres to help improve the quality of geriatric services provided by Ontario's acute and chronic hospitals. Over a period of five or six years, the Minister of Health established regional geriatric programs in each of the province's five academic health sciences centres:

1. Ottawa
2. Kingston
3. Toronto
4. Hamilton
5. London

In its Guidelines for the Establishment of Regional Geriatric Programs in Teaching Hospitals, the Ministry of Health defined a regional geriatric program as: "a comprehensive, coordinated system of health services for the elderly within a region" with the objective of: "assisting the elderly to live independently in their own communities thereby preventing unnecessary and inappropriate institutionalization."

According to the guidelines, each academic health science centre would develop a "regional geriatric assessment unit" and an array of associated clinical services.

The original guidelines saw regional geriatric programs as the clinical service arm of academic geriatrics in health sciences centres. At the time that these "service" programs were established, the academic health sciences centres were promised additional provincial resources to support their broader role in geriatric education and training. However, apart from the 10-year grant to McMaster University to establish the Educational Centre for Aging and Health, the centres received no funding to enhance geriatric education. As a result, the regional programs had to stretch their budgets to provide both service and professional education.

Working from the same guidelines, the five academic health sciences centres have developed different kinds of programs to meet regional needs. They have used different structures and strategies to achieve the guidelines' objectives. For example, the Southwest RGP (based in London) has a catchment area covering three District Health Councils and ten counties, and focuses primarily on providing consultation, education, community development and evaluation, as opposed to delivering services directly. On the other hand, to meet the needs of the elderly in Metro Toronto, the RGP has put more emphasis on treatment and rehabilitation. For example, it has:

1. developed multiple sites for each service type, making it easier for people to get services close to home, and
2. developed geriatric rehabilitation units and internal consultation teams, which have become critical components of the program.

Unlike some of the other regional geriatric programs, the Toronto RGP is incorporated and has established a Board of Directors. This change was designed to give the RGP some independence from its member institutions, to avoid its being focused solely on hospital-based geriatric services, and to allow it to bring together a broad range of geriatric perspectives (hospital and community-based) and speak with one voice on behalf of the geriatric needs within Metro Toronto.