OTTAWA — Ontario’s problem with elderly patients stuck in hospital beds where they don’t belong is the worst in Canada, says a provincial report, and the Eastern Ontario health region has more problems than most.
People stuck in hospital — informally called “bed-blockers,” but more officially known as “alternate level of care” (ALC) patients, recognizing that it’s not their fault they’re stuck — are one of the health system’s biggest problems.
Often frail and elderly, they arrive at a hospital with a crisis, such as a small stroke or injuries from a fall, and then don’t recover well enough to go home, but have to wait, sometimes for months, for spots in nursing or retirement homes. Hospitals are expensive and not very good at caring for people who don’t have acute health problems and, while those beds are full, they aren’t being used for other people who really need hospital treatment.
The situation is bad and will get worse as the population ages, the report says. The health system simply isn’t designed to handle large numbers of people who need ongoing support for chronic conditions, and the evidence is in our hospitals. That’s where people get caught when they fall through the cracks.
The report by Dr. David Walker, the province’s lead adviser on the ALC-patient problem and the former dean of health sciences at Queen’s University, was submitted in June. The Ministry of Health quietly posted it at the end of August. “Ontario has the highest Alternate Level of Care rates in Canada, and data indicates that this has remained relatively unchanged between 2008 and the third quarter of 2010/2011,” it says.
In Eastern Ontario, about 18 per cent of all the days spent in hospital are consumed by ALC patients, and the trend is upward. That’s not nearly as bad in some other parts of the province (the report says it’s more than 30 per cent in northeastern Ontario), but it’s worse than the provincial average and nearly double the rate in and around Toronto.
According to the agency that co-ordinates home care in the region, 531 people who didn’t really belong in hospitals were stuck there as of last Friday, taking up about 13 per cent of 4,149 beds in all.
The area covered by the Champlain Local Health Integration Network has an unusually high number of ALC patients waiting for nursing-home placements. That’s where 88 per cent of those patients go when they’re finally discharged, according to the report, compared with a provincial average of 82 per cent.
To prepare the report last spring, Walker visited seven LHINs, three of them that had success dealing with ALC patients and four that were having trouble. He doesn’t go into detail about the ones with trouble, but the Champlain LHIN isn’t included in a section on best practices other regions should copy, even though improving care for seniors in the community so they can stay out of hospital has been a declared priority for the LHIN almost since it was founded five years ago.
Ottawa West-Nepean Progressive Conservative candidate (and former Citizen columnist) Randall Denley pointed to the Walker report Monday morning as an example of plain mismanagement of the health-care system by the Dalton McGuinty Liberal government.
“To keep someone in a hospital bed costs $450 a day,” he said. “A long-term care bed costs $130 a day. Home care is $70.” Money can be saved and Ontarians kept healthier and happier, and there’s no excuse for the government not to have done it, Denley said. Senior health-ministry officials with some knowledge of local circumstances could do a better job moving money out of hospital budgets and into home-care services than the local LHINs seem to, he added.
“Health care is the provincial government’s responsibility and they have to deliver the goods,” he said.
His opponent, Liberal incumbent Bob Chiarelli, said his party was very aware of the problem and was tackling it, but “you can’t do everything 100-per-cent all the time. This thing evolves.”
The McGuinty government has spent billions on new hospitals and improving home care, plus creating 9,000 new long-term-care beds and renovating the rooms of 35,000 more, and has promised funding for doctors to make house calls again. Before this government, Chiarelli said, the province had no formal aging-at-home policy at all, let alone one that needed improving.
One idea the province is exploring is providing certain support services — even in privately owned apartment buildings where most of the residents are elderly — so that a senior citizen who has high blood pressure and suffers a dizzy spell, for instance, could be treated at home easily and quickly rather than having to arrange a home visit or head to the ER.
Chiarelli said his 88-year-old sister lived with him after just such a crisis and, although his family doesn’t get any home supports for her, he’s personally well acquainted with the needs of seniors who can stay out of permanent care arrangements with just a little help.
The report points out that the health system shouldn’t find out that people need nursing-home care or more home supports when they show up in emergency rooms. Hospitals aren’t equipped for frail elderly patients’ complex needs and then two mutually reinforcing things often happen: To get a patient out of hospital, he or she is quickly designated as needing a nursing home space and, at the same time, he or she can quickly deteriorate — making the need for a nursing home a self-fulfilling prophecy.
Walker’s report recommends “three immediate, short-term, high impact strategies.”
First, hospitals with severe ALC problems should receive funding for beds specifically designated for people who can be treated and discharged within three days, to help keep people moving through emergency rooms.
Second, work harder on “Home First” programs aimed at keeping ALC patients out of nursing homes at almost all costs; instead, find and fund whatever community supports they need.
Third, launch an “intensive case management program” to keep ALC patients from becoming “long-stay” ALC patients, whose prospects for getting out of hospital are dim.
Provincial agencies are forbidden to give interviews during the election campaign, spokeswoman Carole Ouellette said, so nobody at the Champlain LHIN could discuss the Walker report.
Last spring, though, the Champlain LHIN’s chief executive Alex Munter wrote an op-ed for the Citizen on the subject.
“(F)rail seniors who could be at home, in supportive housing or long-term care, too often end up staying in hospital because it’s the only resource available,” he wrote. “There is unparalleled attention to this issue now. It’s the most striking change I observe between today and when I was on the District Health Council in the 1990s. Our LHIN is working with hospitals, the Community Care Access Centre, long-term care homes and community agencies to better connect services so people get the right care, in the right place, at the right time and at the right cost.”
Just before the formal election call, the LHIN announced it would spend $730,000 more a year on vans to transport seniors to medical appointments and day programs, the sort of thing Walker recommends to help people stay in their homes just a little bit longer.
“The Champlain LHIN’s overall strategy is keep seniors healthy and independent in their own homes, and this project is an integral part of that goal,” the announcement said.
dreevely@ottawacitizen.comottawacitizen.com/greaterottawa
No comments:
Post a Comment