Thursday, January 22, 2009

Provincial Spending will only follow Federal Spending. Will Healthcare be on the Agenda?!

A major factor causing long emergency room (ER) wait times is the high number of alternate level of care (ALC) patients occupying acute care hospital beds, making it difficult to admit patients from the ER to hospital. ALC patients are unable to be discharged because the appropriate level of care they require is not always available.

Not a short term problem

This was released by the Canadian Institute for Health Information's (CIHI) in 2006: There were almost 73,000 patients designated as ALC patients among 2.4 million patients admitted to acute care hospitals outside of Quebec between April 1, 2004 and March 31, 2005.1 This is up by 13.6% from 2003-2004 and 19.6% from 2002-2003.

This was released by CIHI last week (January 14, 2009):
In 2007–2008, there were more than 74,000 hospital stays for alternate level of care (ALC) patients in Canada (outside of Quebec and Manitoba), representing more than 1.7 million hospital days, according to a new analysis by the Canadian Institute for Health Information (CIHI). The analysis, Alternate Level of Care in Canada, provides a first look at patients in acute care hospitals across Canada who no longer need acute services, many of whom are waiting to be discharged to a setting more appropriate to their needs.

Some highlights of the analysis include:
-- The equivalent of almost 5,200 beds was occupied by ALC patients in acute care hospitals.
-- Overall, dementia accounted for almost one-quarter of ALC hospitalizations and more than one‑third of ALC days in 2007–2008.
-- 83% of adult ALC patients were admitted to an acute care hospital through the emergency department, compared to 63% of non-ALC patients.
-- Most ALC patients were discharged to a long-term care facility (43%), while 27% were discharged home and 12% died during their hospitalization.

This is a national crisis in healthcare. Provinces are taking the lead to come up with answers. In Ontario Dr. Alan Hudson and Dr. Kevin Smith are dedicated to the task. The hospitals, community organizations, the associations, the integration networks and the governments are all collaborating.

And the media is even suggesting solutions.
Judy Steed's column is one example
Special to the Star

PROBLEM: In Canada, "bed blockers" – older people stuck in hospital, ready for discharge, lacking the home support they require – occupy 5,000 hospital beds and consume $200 million annually. They clog emergency departments and expand wait times for others.

SOLUTION: Hospitals in Denmark eliminated bed blockers by creating a stiff incentive to get elders moving. Municipalities are required to pay for those who stay in hospital past discharge dates. That got communities working to move seniors on – to rehab or home care.

. . . hospitals agree that community care is the answer. "I'm CEO of the Ontario Hospital Association and we think the solution is in the community," Tom Closson told me when he was CEO of the University Health Network. An effective long-term home care system is the answer, he says – only then will seniors discharged from hospitals and nursing homes be diverted from emergency departments.

Closson and his colleagues in community care and home care know that solutions will require spending and they know that provincial spending will be dependent on federal spending. They are counting on Mr. Flaherty taking note. Not only can investments bolster the economy, they can improve healthcare. Without it, they say, access, quality and human resources to care for the sick will be dramatically affected.