The head of the Ontario Hospital Association said solutions to the alternate level of care crisis will be found by looking outside the four walls of the hospital.
“The biggest issue when we talked to hospitals last February was the high number of ALC patients in hospitals,” Tom Closson told Northern Life. “The reason there are so many (ALC patients) there is because we don’t have the right mix of community services to make sure those people get cared for in the appropriate setting.”
The health care system defines ALC patients as patients who’ve been admitted to the hospital because they need short-term, intensive treatment for an illness or injury or because they’re recovering from surgery. Afterward, they need an alternate or lower level of care more appropriately provided by a long-term care facility, home care or palliative care, to name a few.
Closson noted the ALC problem goes hand-in-hand with the problem of long waits in the ER.
“That’s because patients can’t get through the ER because ER departments have many admitted patients who can’t get a bed in the hospital because there are no beds,” he said.
Closson said the Ministry of Health and Long-Term Care, Local Health Integration Networks, hospitals, long-term care homes and Community Care Access Centres have to work together to find solutions to the problem. Some of the solutions he offered are:
Standardization:
“We’ve created 14 LHINs and they’re all tending to do things in their own way. The Ministry initially has encouraged that to some extent by putting in place very little in the way of what needs to be standardized across the system,” Closson said. “I can understand why they would do this because the whole concept of regionalization is to try and enable decision-making closer to the point of service rather than having it made centrally at Queen’s Park. On the other hand, we don’t want to have 14 different health care systems in Ontario.”
He said there should be a standard way of determining the right mix of acute care beds, nursing home beds, home care spaces, assisted living spaces, etc.across the province. You start, he said, by looking at the age and gender of the local population and go from there.
“This kind of work was done during the time of the health services restructuring commission 10 years ago but it hasn’t been updated and it hasn’t been followed since then.”
Take the cap off home support:
In the past, there’s been a cap on the number of hours of home care that can be provided for people who are at home and who are waiting for a bed in a long-term care home or who are receiving palliative care.
The Ministry said in May this cap would be removed, but has yet to announce when the Community Care Access Centres will get the funding to do it. “So if you’re in a hospital bed and you’re supposed to be going to a nursing home and all the nursing home beds are full, the Community Care Access Centre would send you home with unlimited home support while you waited for a long-term care bed to become available,” Closson said. “What would happen in many cases is the patient would never go to the nursing home because they’d stabilize at home and then be able to carry on at home with a lower level of home support.”
Consolidation:
“I think we’re going to see consolidation of services on the clinical side as well as the administrative side throughout the province,” Closson said. “And I think we’re also going to see greater use of community services and less use of hospitals.
(Taking care of ALC patients in hospitals) is not only more expensive but it’s not likely to be providing them with as good care. We’ve got lots of opportunity to streamline the system but we’ve got to be willing to make some big changes.
Clearly there will be more care in the home. We’re really underusing care in the home or care in assisted living kind of environments where there’s more congregate housing. That’s a more efficient way to provide home support to people because the home support worker isn’t spending as much time travelling from place to place. When a person needs help all they have to do is call and the person’s there to help them.”
New committee:
For 20 years, long-range planning for hospitals was done by the joint planning and policy committee, Closson said. Now that the province has set up Local Health Integration Networks, Deputy Minister of Health and Long-Term Care Ron Sapsford will strike a new committee made up of the Ministry, LHINs, hospitals and other service providers. The ALC crisis will be one of the items on its agenda.
