Skip to main content

Finding appropriate care for ALC patients in hospital

Today, in the Ottawa Citizen, the Queensway Carleton Hospital reports a big decline in the number of  "ALC" patients, down  from 50 patients a day to 20 or 25.  That is a  50% to 60% decline.

Queensway Carleton Hospital
The story highlights the home first program (where seniors get intensive home care for up to two months) and a decision not to discuss LTC options with patients, or fill in LTC applications.  

It sounds like a more important explanation of the ALC decline was the creation of 24 "restorative" beds at the hospital.   The patients in those beds are the same sort of patients who were formerly ALC (i.e. not requiring acute care but still not ready to go home).   With the creation of the restorative beds program there are now special programs to help these patients become fit and active while they fully recover in hospital.

With this program, these patients are no longer in acute care beds and are no longer waiting for another form or care. As a result they are no longer "ALC".  They have found their appropriate level of care -- in the hospital.

With 24 restorative beds, 24 patients are no longer waiting to go elsewhere. Restorative hospital care would appear to account for almost the entire reduction reported (i.e. 24 of the 25 to 30 bed reduction). 

Note, however, this program did not increase the  number of beds very much.   It appears the program was started in December 2010 – and at that time the number of acute care beds decreased 11 from 211 to 200.  At the same time “Rehabilitation” beds increase from 25 to 38, an increase of 13.  So  apparently some  acute care beds and rehabilitation beds were changed to “restorative” rehabilitation beds. The occupancy of the rehabilitation beds also increased sharply.  In total, bed numbers increased by two.  

Oddly, the current Queensway Carleton target is to have 20% of patients designated ALC.  With 262 beds, that would mean an average of  52 ALC patients, far higher than what they have suggested to the Citizen.  What accounts for this discrepancy remains unclear to me.  

The Citizen also reports a smaller decline in the number of people waiting for a long-term care beds.  That is down 12.4% since September 2011, from 2,672 to 2,341.  This, however, sounds directly related to the decision of the hospital not to discuss LTC options with patients or fill in LTC applications.  

Popular posts from this blog

Deficit? Public spending ain't the cause. Revenue, however...

With the election over, pressure to cut public programs has become quite intense. In almost all of the corporate owned media someone is barking on about it.

Another option -- increasing revenue from corporations and the wealthy is not mentioned.  However, data clearly indicates that Ontario does not have an overspending problem compared to the other provinces.

Instead, it indicates Ontario has very low revenue. 
Ontario has the lowest public spending of all the provinces on a per capita basis (see the chart from the 2014 Ontario Budget below).  So there is little reason to suspect that we have an over-spending problem.  If anything, this suggests we have an under-spending problem.







The Ontario government has also now reported in the 2014 Budget that Ontario has the lowest revenue per capita of any province.  This is particularly notable as other provinces are quite a bit poorer than Ontario and therefore have a much more limited ability to pay for public spending.  (Also notable in this…

Budget underwhelms on health care. Bait and Switch is such a nasty term

Last year the government promised a 4.64% health care funding increase in 2018/19. Then, earlier this month, they announced they would deficit spend to improve hospitals, mental health, home care, and child care.   Three of the four items cited by the government for improvement were part of health care. 

As it turned out the government did in fact promise in today's Budget to deficit spend $6.7 billion. (Due to a $1 billion fall in expected revenue, the extra spend amounts only to an extra $5.7 billion for 2018/19 programs – but that is still a significant chunk of new found cash for program spending.)  
If health care had gotten even a proportionate share of this new $5.7 billion in program spending, it would have added an additional $2.4 billion to health care  --  in other words about another 4% increase.  

But all health care got -- despite the government’s health care rhetoric -- was an extra $284 million. That may sound like a lot but with a total health care spend of $61 bill…

Ford government promise falls far short of solving hospital hallway medicine problem

Tens of thousands of new Long-Term Care (LTC) beds needed just to offset aging
The new Progressive Conservative government in Ontario has promised 30,000 new long-term care beds over the next ten years, often connecting this to their promise to end hospital hallway medicine.  But how does this promise stack up with growing demand for these facilities?
Most people 85 and older live in collective dwellings (LTC facilities, seniors residences, multiple level of care facilities).  The setting with the largest number of elders 85 and older is LTC facilities, with about 35% of the population 85 to 89  years old and almost 40% of the population 90 to 94 years. Older people are even more likely to be in a LTC facility.
The population 85 and older is the main driver of the need for long-term care beds.
An additional thirty thousand LTC beds by 2028 will only partially offset the rapid growth in the 85+ population.  The ministry of finance projects 42.5% growth in the most relevant population (85 a…