Restorative care in the hospitals: a solution to hospital overcrowding and ALC issues

An Ottawa Citizen story suggests a new, low-tech way of dealing with aging patients in hospitals: restorative care.   Here, through a modest increase in hospital and home care resources, the Champlain LHIN is finding that more patients can return home and that wait lists for long term care can be reduced.

Officials point to the new approach - from rehab to home - as a sign that Eastern Ontario hospitals are finally moving away from a well meaning but paternalistic attitude that assumes all older patients decline irreversibly, when some of them just need a little extra support to help them recover their day-to-day function.

Queensway Carleton officials view the restorative-care program as a better, more cost-effective way to treat seniors, who make up more than half of all the hospital's patients....

Under the program, a specially trained nurse patrols the hospital looking for elderly patients who have been given no obvious plans for discharge, but are considered medically stable enough to be transferred to the geriatrics unit. The emphasis is on identifying seniors as early in their hospital stay as possible....

There (on the unit -- DA), patients who have trouble walking are coached by physiotherapists to stand for a few times a day, or do some sitting exercises. That could be followed by short walks to the bathroom, or daily exercises at the unit's specially designed gym.

Instead of having their meals served to them in bed, patients are encouraged to make the short walk to the unit's dining room, where occupational therapists are on hand, if needed, to help them adjust to feeding themselves again....

The approach is decidedly lowtech and informal, but physicians who specialize in elder care have long advocated for such measures as a more humane way of treating hospitalized seniors.

Until recently, however, a shortage of funding limited the type of rehab services that hospitals could offer. Likewise, limited funding for home-care services meant hospitals didn't always have the option of discharging seniors to their homes.

The situation changed last year when the Champlain LHIN, which allocates provincial health care funding in Eastern Ontario, set aside $12 million to fund 108 restorativecare beds at the region's largest hospitals, including $2.7 million for the Queensway Carleton's 24 beds.

An additional $3.4 million went to The Ottawa Hospital for 30 beds, while the Montfort Hospital received $1 million for 20 beds. By far the largest amount, $4.9 million, went to Cornwall's St. Joseph Continuing Care Centre for 34 beds.

The LHIN also began funding a $3.1-million-a-year "home first" program, which boosts the level of inhome nursing and personal-support services available to seniors in the first few months after they are discharged....

Likewise, the number of seniors waiting in the hospital for nursing home beds has dropped steadily, to 20 from 37.

Indeed, for the first time in years, fewer seniors across Eastern Ontario are being stranded in hospital while they wait for nursing home beds - a sign, health officials say, that the restorative care and home-first programs appear to be working.

New figures from the Champlain LHIN show that since the programs were introduced last fall, nearly four out of 10 seniors languishing in hospitals did not end up going to nursing homes.

Instead, half of them returned safely to their homes with intensive in-home services arranged by the region's home-care agency. The other half were transferred to restorative care programs before being sent home.

Apparently, with the low tech comes the low cost:  108 beds for only $12 million -- that's $304 a day.  More rehabilitation through "restorative care" beds may help resolve the Alternative Level of Care (ALC) issue that has led to such a backlog in our hospitals.

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