Reducing the use of long term care: just a nice fairy tale?

Alex Munter the newly minted CEO of the Champlain LHIN makes it a bit more clear than is usually the case, that the focus on squeezing hospital beds has now spread to squeezing long term care beds. Hospitals have lost thousands of beds over the last twenty years, while LTC beds have increased. But the focus on diverting patients from hospital beds to home is broadening to include diverting patients from LTC beds.

It certainly is a very worthwhile goal for elders to stay in their homes rather than move to a long term care facility. Where it can be done, it should be done.

But is this new focus just a cover for a reduction in public care? The wait lists for a long term care bed have exploded in the last few years as government has squeezed hospital funding and slowed the creation of new LTC beds. Moreover, the large majority of patients in hospitals designated "alternate level of care" (ALC) are waiting for a long term care bed or for a different sort of hospital bed.

Only a small proportion of ALC patients in hospitals are waiting for home care. Just 139 patients out of 2,492 ALC patients in acute care beds in April 2011. The percentage waiting for home care is even smaller if we look at ALC patients in all sorts of hospital beds: about 200 out of 4,256 ALC patients -- 4.7% of ALC patients. That is a very small proportion of the ALC issue.

In fact, moving all the patients waiting for home care out of hospital immediately wouldn't open up enough beds to deal with one-third of the patients waiting in ER rooms for a hospital bed.

So it is far from clear that this focus can make a major difference to back-ups in the system. It may simply end up being a nice fairy tale that provides cover for governments that are reducing public care, not improving it.

FYI - Munter also notes that the Ministry of Health and Long Term Care estimates that population aging will add 0.7% annually to the cost of health care. That is lower than the estimate of 1% that is usually bandied about.

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