Defend Public Healthcare

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...

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 t here 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 ...

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 fo...

A Windsor hospital has been officially blocked from setting up hospital beds in a for-profit retirement home.  As noted in June , the Hotel Dieu Hospital was trying to create 18 "assess and restore" hospital beds in a for-profit retirement home in Amhertsburg.   The hitch for the Ministry of Health and LTC wasn't the for-profit nature of the home, it was that the home  didn't meet the building and fire code for hospital services.  This despite $300,000 in renovations by the retirement home and nine months of planning.    For the hospital project, the retirement home installed wheelchair-accessible bathrooms, the flooring was changed from carpet to vinyl, and a nursing station, common room and dining room were built. Apparently , the relatively new retirement home was built to a different building code than that required for hospitals and so cannot house hospital patients. The Ontario government has practically made moving work out ...

In May, Hotel Dieu Hospital in Windsor was seeking to establish 18 hospital beds in a private nursing home in Amherstburg.  The beds are so-called "assess and restore" hospital beds, designed to help patients transition from hospital back to home (or, failing that, a nursing home).   Assess and restore hospital beds are supposed to relieve pressure on more expensive to operate acute care beds, while also providing the special services needed to help patients make the return to home.  The hospital itself already operates 15 such transitional beds. In early May, the Ministry of Health and Long Term Care told the Windsor Star , that they were reviewing the proposal, as such a change needs approval under the Public Hospitals Act .   The private nursing home is operated by Seasons Retirement Communities, headquartered in Oakville.  Seasons Retirement   Communities  is a privately held partnership  created  in 2009 which owns and operates ove...

Now there are 96 hospital ALC patients at the Ramsey Lake site of Health Services North. Thats up from 77, as reported April 17. The Hospital closed 30 beds for ALC patients at its old Memorial site in March.  Since then the number of ALC patients at the main site (Ramsey Lake) have ballooned.  The Sudbury Star reports that the number of ALC patients has increased from 40 or 50  in January. The beds at the Ramsey Lake site are not intended for ALC patients and are more costly to operate. With the back up in beds, ER wait times are increasing.  Another 30 ALC beds in Sudbury are scheduled to be closed next March as well.

The Ontario government reports that it is focused on moving patients out of hospitals -- and into the community.  But this is not going well at the Perth Smith Falls District Hospital. The Hospital has designated thirty percent of its patients as "ALC" -- that is, it wants them out. But government organizations charged with this responsibility (the CCAC and LHIN) have not been able to achieve this so far. The result? On one day recently there were 16 patients awaiting admission from the Emergency Departments. Further, some patients who were scheduled for elective surgery unfortunately had their surgeries cancelled and rescheduled due to a lack of available beds.

The Ontario government withdrew funding for 30 ALC beds at the Memorial site of the Health Sciences North hospital in Sudbury.   The Sudbury Star reports that since the beds closed, the hospital has re-opened 6 or 7 beds at the Memorial site, paid for out of the hospital's own funds.  In addition, the number of ALC patients at another site of the hospital has increased from 44 to 77 -- an increase of 33. On Friday,  18 people admitted to emergency were lying in cots awaiting a bed. The result?  The hospital is now designated in 'crisis' and to get it out of crisis, hospital patients will be given priority over people waiting at home for long term care beds.  The hospital beds for ALC seniors, the Star reports, cost $600-$700 per day -- more than twice the cost of ALC beds at Memorial.   The hospital is stuck paying this it seems while trying to eliminate a $9 million deficit by September 2012. It doesn’t sound like the government’s p...

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 medi...

A Canadian Institute for Health Information report indicates that there was a total of  853,316 alternative level of care (ALC) days in Ontario hospitals in 2007-8.  Mostly, these were for patients waiting for a different sort of bed.  The report indicates that  27% of those days are accounted for by patients who were waiting for a complex continuing care or rehabilitation bed. That's a tad over 230,000 days per year. Rehabilitation and complex continuing care beds are different sorts of hospital beds, so again this suggests the resolution of the ALC issue will need improvements in the capacity of Ontario hospitals in those areas. A further 13% of days were accounted for by patients who died while in an ALC bed:  this group was almost always either waiting for a palliative care bed, or waiting for another sort of bed, it appears. Another 40% of Ontario ALC days were for patients waiting for a long term care bed.

Today, the provincial government announced $6.3 million to care for 'alternative level of care'    (ALC)  patients at the Memorial site of the Sudbury Regional Hospital, at least for one more year.   The government characterizes this investment in 60 hospital beds as a way "to make it easier for patients to transition from hospital back home."    The hospital says the "surge capacity beds" will  offer post-acute patients "the assistive care services they require  before returning home safely."  The government  sees the beds as one part of a larger set of strategies and  i ndeed  increasing  community  and   hospital  capacities  is required to reduce the health care rationing reflected in hospital overloads, wait lists,  cancelled surgeries , and  ALC patients . Sharon Richer, OCHU Area 6 vice-president calls this initiative ‘one small step forward.’

The Ontario Hospital Association and the Ontario Association of Community Care Access Centres (which oversee home care) have deepened their alliance by releasing on Tuesday a policy document Four Pillars . Three points of interest. [1] They call for the creation of a single government designated health care bargaining agent. Stability and consistency are essential to collective bargaining within our health system. So is expertise. We believe that having a single organization – a registered employers’ bargaining agent – bargain collectively on behalf of all health sector organizations would ensure that these essentials are brought to bear on every  negotiation, and that efficiencies are maximized.  We believe: (7)  The Government of Ontario should designate a registered employers’  bargaining agent  for the health system This would mean a major change in collective bargaining, likely creating a dynamic towards much more coordinated, if not ...

The Ontario Health Quality Council makes a very common error with its new report, stating that "alternative level of care" (ALC) hospital patients should not be in hospitals.   Well that sounds great (who wants to be in hospital?), but less than 200 patients in our hospitals are actually waiting for home care.  That's less than one patient per hospital facility.  Currently, it is a very small part of the ALC problem.   More hospital ALC patients are actually waiting for a different  sort  of hospital care.   No one talks about this issue -- so the Health Quality Council is hardly alone.  But until we do, we are not going to solve it.  

In November 2007, there were 4,528 "ALC "or alternative level of care patients (i.e. patients waiting for a different sort of care while they are in a hospital bed, usually long term care, hospital rehabilitation care, hospital complex continuing care, or, in some cases, home care).  By April 2011 there were 4,256, a decline of 6%, or 272 patients (although there was also a decline in the number of hospital beds reported ). The decline is significant but quite modest.  Especially when you consider that the numbers did not always decline over that period.  The numbers dipped each spring since 2007 and rose at other times. Only a few months previous to April 2011, the ALC count was much higher:: 4,748 in January 2011. That's 220 more than November 2007, a 4.9% increase .   And from November 2007 to November 2010, the number of ALC patients increased 111, or 2.5% So there are legitimate questions about the government's main ALC strategy -- Aging at Home, w...

As part of the recent public relations campaign by Local Health Integration Networks (LHINs), the CEO of the Northeast LHIN, Louise Paquette, has   told  Northern Life  that  they have reduced the number of alternate level of care patients in the four largest northeast hospitals by half.   The article discusses in more detail the situation in Sudbury.  Here the hospital says the number of alternate level of care (ALC) patients has fallen from a high of 190 to 210 ALC patients to just 91 ALC patients.  That would mean a reduction of somewhere between 99 and 119 ALC patients.   Sounds impressive, right?  Well here's the interesting part.  The hospital CEO credits the reduction to the opening of 116 long term care beds at St. Gabriel's and Pioneer Manor.   The government is practically allergic to opening new beds in hospitals or LTC facilities no matter how much the demand. So, this solution is definitely not typical . And n...

For years, the province has emphasized the use of home care as the solution to the problem of hospital overloads and backlogs . Yet, even after using this approach for years, only a small minority of 'alternate level of care' (ALC) patients are actually waiting for home care (4.7%). A much larger percentage (57%) are waiting for long term care.  But long term care is a service the province is determined not to expand very much. Many other ALC hospital patients are waiting for a different sort of hospital bed than the one they are in.  Out of the 4,256 ALC patients in hospitals, up to about a thousand patients fall into this category. While officials often talk as if ALC patients should not be in a hospital,  in reality, many more ALC hospital  patients are waiting for hospital care than are waiting for home care. Until the announcement last Friday of funding for 221 hospital beds to relieve ER pressures, there was no sign that the Liberal government had a...

A new report indicates that 18% of acute care beds were occupied by patients awaiting an alternate level of care (“ALC patients”).    ALC patients are waiting for a different level of care than what they are currently receiving in the hospital (e.g. a patient waiting for a complex continuing care bed who is in an acute care bed).  While about half of these patients are awaiting long term care, the ALC designation does not necessarily mean that they should not be in hospital. About 47% of the 2,812 ALC patients in acute care beds are waiting for a long term care bed.   Most of the rest of the ALC patients in acute care beds are awaiting other sorts of hospital beds: rehabilitation (385 patients), complex continuing care (229 patients), convalescent care (118 patients), and palliative care (153 patients).  Surprisingly, only a relatively small number are awaiting home care (149 patients), assisted living or supportive housing (83 patients), ...

The Ontario Hospital Association (OHA) reports a surge in patients visiting hospital emergency departments (EDs) in January, in part, because of the flu season. Over January, the OHA noted a 22% increase (150 patients) in the number of patients in EDs waiting for admission to an inpatient bed, and a 10% increase (253 patients) of Alternate Level of Care (ALC) patients in acute care beds. The OHA adds: "Because occupancy levels in hospitals are already at maximum capacity, this influx of patients has pushed some hospitals to take great measures to ensure patients have access to the care they need."   The OHA is collecting data for a February report.     dallan@cupe.ca

ALC issue a crisis to patients, relatives The Sudbury Star Wed Jan 19 2011,Page: A11   Column: Letters to the Editor Re: "ALC a challenge, not crisis" -- Dec. 20. I find it farcical that Denis Roy, the CEO of Sudbury Regional Hospital, says the alternate-level of-care issue is "not a crisis, but a challenge." Anyone who is an advocate for an elderly parent now in the system knows the whole situation is indeed a "crisis" if you're in the midst of living it alongside your parent. It certainly must be a challenging task to address as a health-care administrator, but anyone who is currently advocating for an elderly parent knows, it truly is a crisis. How else do you explain a marked lack of long-term care beds for the very people who built this community into what it is today? They have paid taxes for more than 50 or 60 years and now have to worry continually about where they will live and who will care for them, even as they are facing serious ...

New funding totaling $985,700 will keep 20 beds open at the Cornwall hospital until the end of the fiscal year. This should keep the "transitional care" beds opened in August running until March 31.    "At which time there are other strategies in the works," hospital CEO Jeanette Despatie said . The 20 convalescent beds were created in August to help deal with hospital overcrowding in Cornwall. Just before Christmas, Liberal MPP Rick Bartolucci announced another $1.4 million for Sudbury health care-- another area with severe hospital overcrowding. In this case, the money is dedicated to home care services and  new LTC beds. This announcement follows local campaigns (by CUPE and others) to defend health services. New health care money is often announced just about now -- late in the fiscal year.    So there may be more to come in the weeks ahead.  dallan@cupe.ca