6/24/13

Why are fewer hospital patients waiting for LTC?


Ontario hospitals report a significant decline in the number of patients in hospital beds who are waiting for a long term care bed.  This has been the main category of the so-called "hospital bed blocker" -- the Alternative Level of Care (ALC) hospital patient -- so it is a significant change.  From November 2009 to March 2013, the number of patients waiting for LTC was reduced by 1,282 patients, an astonishing decline of 41%.

This sounds like a victory for better management, but the real story appears to be more complex.

This has not happened because a decline in the relevant population. As noted earlier, the 85 and older population is growing very quickly.

Instead, this coincides with a decline in the number of people (at home and in the hospitals) on long-term care waiting lists of 5,000.  As of 2012, we are down to only 32,000 people in total waiting for a long-term care bed, according to the Auditor General.

Both of these reductions in wait lists coincide with a narrowing in the definition  in 2010 by the government of who is even allowed to join the wait-lists for long-term care.

So, it is, perhaps, not so surprising that the number of hospital patients waiting for LTC has declined.  Indeed, the Auditor General declared in his recent review of LTC placement that the decline in people waiting for LTC in 2011 was primarily due to the tightened restrictions (see page 191 of his review).  Since 2011, the decline in  community and hospital patients waiting for LTC has been modest.

While the decrease in the LTC wait list in both the hospitals and the community was significant (overall a 15% reduction), it was much more marked for patients waiting in hospitals for LTC  (which saw the eye-popping 41% reduction noted above).

Judging by results, the main goal was to get patients waiting for LTC out of hospital beds.

A little after these changes to long-term care, there was a sharp increase in the number of patients in hospital waiting for home care and assisted living, starting quite abruptly in July 2011 -- presumably as a result of changes in government policy, the narrowing of long-term care wait-lists included.

As a result of the increase in patients waiting for home care, or assisted living, the decline in ALC patients is not nearly so marked as you might expect given the decline in patients waiting for LTC.

From a little over 400 patients waiting for home care or assisted living in June 2011, that wait list increased to 900 hospital patients by March 2013.

Acute Care ALC patients: With the decline in the number of patients in hospital waiting for long-term care, there are now more patients in acute care hospital beds waiting for other forms of hospital services. Seven-hundred and sixty patients in these beds are waiting to move into long-term care facilities, while 798 are waiting for other, non-acute hospital services. 

Despite this, hospitals are often described as "not the best place" for Alternate Level of Care (ALC) patients. In fact, hospital ALC patients are often simply receiving the wrong sort of hospital service, or are in the wrong sort of hospital bed.

Most of the acute care patients in this ALC category are waiting for complex continuing care and rehabilitation -- hospital services, which as noted in the last post, are being cut.

Fewer acute care patients are waiting for home care or assisted living services.  Only 567 acute care patients are waiting for home care or assisted living, considerably less than the number waiting for other hospital services or LTC services.

Photo by Sal Falko

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