8/27/12

Long-term care industry plans reinvention during austerity

Not all beds in "long-term care" facilities provide long-term care.

"Convalescent care" beds are a form of "short-stay" beds in long-term care (LTC) facilities.  Convalescent beds receive an extra $70.94 more per day than standard long-term care beds.  That's 45.7% more funding than the $155.18 for a standard bed.  


Started in 2005, the LTC "convalescent care" program is now a “Home First Program” that is designed, in part, to reduce hospital Alternate Level of Care (ALC) days.  “As not all patients are ready to return home immediately from the hospital, convalescent care is proving to be a solution suitable for patients that no longer need hospitalization but are still too frail to go home.”   


The LTC convalescent care focus is supposed to be on rehabilitation, daily living activities, restorative care, physiotherapy for strengthening, and “specific client goals that will support their transition back home”.   Patients can stay for up to 90 days, but often stay for shorter periods. 


The for-profit section of the long-term care industry sees convalescent care as a growth part of the LTC industry.   Currently, 76,073 beds in LTC facilities are standard, ‘long-term care’ beds according to the March 2012 “Expert Panel” report sponsored by the OLTCA (the for-profit LTC employer association).   That's 97.7% of the total of 77,863 beds in LTC facilities.

In contrast only 438 beds are convalescent care beds.  There are also a couple of other forms of short-stay beds in LTC facilities:  404 beds are respite/end of life beds and 948 are interim beds. 

The OLTCA Panel suggests rebalancing LTC beds so that the number of ‘long term’ LTC beds would fall  to 70,007 and there would be a significant increase in the ‘short stay’ beds: convalescent care would grow to 3,115 LTC beds, as would the number of interim LTC beds, while respite/end of life beds would grow to 1,557.   

This would increase the number of short stay beds in long-term care facilities by 5,997 to 7,787.  The number of short stay beds would increase 435%.   Not surprisingly, the OLTCA report recommends that they re-consider the use of 'long-term' care to describe the sector.

The OLTCA report proposal would significantly shrink the average length of stay as the length of stay for the short-stay long term care beds varies from 25 to 65 days, while the ‘long term’ LTC beds have an average stay of 3.1 years.   

This would fit well with an austerity government bent on containing the growth of long-term care.   But it would also reduce opportunities for people who need long term care -- and the waits for long term care have already exploded in recent years.

Probably not coincidentally, reducing the length of stay in this manner would also help the for-profit LTC industry maintain their revenue flow (indeed given the extra funding for convalescent care, it would increase funding).  But the industry would also be taking work from the traditional short term stay provider – the hospitals.  There appears to be significant overlap between LTC 'convalescent care' beds and hospital 'assess and restore' beds.  

The OLTCA panel report wants to grow the LTC industry into what have been hospital services.  The report flags three areas of “emerging LTC areas of expertise”: chronic disease management,  "assess and restore" services, and geriatric mental health.  They also wish to radically reduce the number of residents who are moved from LTC to hospitals to get palliative care and suggest that hospital provision of interim LTC beds be "re-examined"

In effect, LTC "residents" would become "patients" as the sector moved into hospital services and the focus of the industry moves from daily care to treatment.  

The OLTCA panel markets LTC as a “mix of public, non-profit and private ownership” with a “healthy balance of collaboration and competition”.  The industry can provide ”services at a guaranteed price” and can “maximize limited resources”.   Flagging the dominance of the for-profit chains, they note that in LTC “there is a limited number of provider organizations enabling economies of scale and capacity to rapidly duplicate and replicate programs and practices across the sector.”

A problem -- and an opportunity -- for the reinvention for the LTC industry is that 35,000 LTC beds must be redeveloped over the “next few years” according to the OLTCA panel.  That’s about half the LTC bed stock. 

1 comment:

  1. Great post. This is a low wage and union busting strategy, in addition to a strategy to shift money and power to the private sector. Many groups, across the political spectrum, argue for continuing care (home/community and residential) as substitution for hospitals without acknowledging that the costs are lower because compensation is lower and workers have less power, either unorganized or in decentralized unions. Hospitals are being redefined, with extended care, rehab beds and psych beds moved to LTC and "community", or just plain cut. Thanks for the post!

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