Peer Review reveals need for co-operation

Working together. That's what it's going to take to bring Health Sciences North's alternate level of care (ALC) patient rate down to 10 per cent by 2015, according to hospital CEO Dr. Denis Roy.

Reducing ALC numbers to 10 per cent was one of the goals outlined by Hamilton Health Sciences CEO Murray Martin in his recent peer review report examining Health Sciences North.

As of Oct. 26, there were 96 ALC patients at the hospital's Ramsey Lake Health Centre site, working out to 20 per cent of its 454 beds. Just a week ago, the ALC numbers were actually as high as 106 patients.

But this goal is going to require a closer partnership between the hospital and its health-care partners, Roy said, as well as co-operation from patients and their caregivers.

“If we all have the same priorities, I think it is achievable,” he said. “Martin mentions in his report we should make ALC our priority one. If Health Sciences North is the only one making it its priority one, it won't work.”

Health Sciences North CEO Dr. Denis Roy, seen here speaking at the hospital's annual general meeting June 21 as board chair Russ Boyles looks on, said during an editorial board meeting with Northern Life it's going to take co-operation with other health-care partners to solve the ALC patient crisis. Photo by Heidi Ulrichsen.

Roy, along with Health Sciences North chief nursing officer and vice-president of clinical programs David McNeil, recently sat down to discuss the peer review during an editorial board meeting with Northern Life.

Martin recommended Health Sciences North, the North East Community Care Access Centre (CCAC) and St. Joseph Continuing Care Centre each designate a senior leader to be part of a leadership team assigned the task of identifying and implementing strategies and priorities to deal with the issue of ALC patients.

ALC patients are those who no longer need acute care, but remain in the hospital while they wait for long-term care or other types of community care.

With so many beds occupied by ALC patients, hospital resources become stretched, one symptom of which are long emergency room wait times. The issue also caused the cancellation of so many elective surgeries in September that the surgical schedule had to be scaled back.

Among the strategies to reduce ALC patients recommended by Martin is the idea of sending more of these patients home.

A few years ago, the Community Care Access Centre launched a program called Home First, which is supposed to provide enhanced home care services for those leaving hospital.

However, there hasn't been sufficient uptake of the program, according to Martin's report.

Physicians are sceptical the program, which sees personal support workers provide the home care patients need to stay out of hospital, has the capacity to ensure their patients can be safely discharged.

He recommends that Health Sciences North and the North East CCAC work together to “re-launch” the Home First philosophy, and determine the requirements to provide 24/7 home care for those enrolled in Home First.

But both organizations have limited funds with which to work.

As the province shifts its hopes for health care reform to community health services, this sector, including home care, did receive a modest four per cent per year increase for the next three years.

Hospitals, in contrast, are dealing with a zero per cent funding increase.

McNeil said there are “major resource issues” that make would make 24/7 home care difficult in this area. The North East CCAC doesn't have the money to deal with “the number of clients that we think would require 24/7,” he said.

The problem with the peer review is it “didn't evaluate the capacity of the community to actually achieve that.”

Martin also recommends a re-think of the hospital's discharge planning process, which involves both Health Sciences North and CCAC staff.

McNeil admits discharge planning does have some “significant gaps.”

“So we're looking at the patient from the time of admission to 60 days after they leave the hospital and trying to map that out,” he said. “Over time, we'll just continuously improve on that process.”

The hospital, the North East CCAC and some of its service providers, including Bayshore and the Red Cross, will be meeting next week to talk about how discharge planning can be improved.

Martin's report also speaks about the sub-categorization of ALC patients.
 

 

I think as we're moving forward with this change in policy direction, we may be subject to criticism.

David McNeil,
chief nursing officer and vice-president of clinical programs, Health Sciences North

He said too many of them are being categorized as being destined for long-term care facilities, and not enough as being destined for their own homes.

ALC patients waiting for long-term care often end up spending long periods of time in the hospital.

At Martin's suggestion, if staff want to put an ALC patient on a long-term care waiting list, it now has to be approved by McNeil and Frankie Vitone, senior director of client services at the CCAC.

The managers and their staff look at whether or not the appropriate supports are in place for ALC patients to be in their own homes.

“The first week we looked at it, we didn't approve anybody,” McNeil said. “We said 'We don't have enough evidence that you've actually looked at all the care options for these patients in the community.' That starts to drive it.”

Part of the equation in figuring out whether patients can go home may be if private home care services are a cost the family could afford, whether that's through private insurance or out of their own pockets, Roy said.

“In the portfolios David is looking at once a week with the CCAC vice-president, there are certain things that will need to be looked at,” he said.

“One is access to private finances and services. If that has not been done, then the whole work has not been complete. Before calling that patient long-term care, that needs to be completed.”

Sending patients home isn't necessarily going to go over well with the public, though, he said.

“I think as we're moving forward with this change in policy direction, we may be subject to criticism,” McNeil said. “Those are difficult conversations to have with patients and families.”

As for Martin's suggestion the 30 remaining ALC beds at the former Memorial Hospital site stay open six months after their current closing date of March 31, 2013, Roy said that likely won't happen.

First of all, even if the North East Local Health Integration Network (LHIN) were to keep funding the beds, as Martin recommends, current funding levels mean the hospital is operating the beds at a loss, he said.

“The 30 beds are in a standalone unit, and therefore it has to have its own infrastructure,” Roy said.

“Having an infrastructure induces costs that we were not normally have if the patients were in the main building. Therefore, at the current amount of money we get, we don't cover all those costs.”

He'd also like to use the area these beds currently occupy for a geriatric day hospital, called a Program of All-Inclusive Care for the Elderly (PACE) unit.

There doctors would make sure the seniors' medical conditions are under control, and they'd take place in recreational activities to boost their spirits. The program would also provide respite for caregivers.

Roy said it has the potential to keep the frail elderly healthy, decreasing the chance of emergency room visits and delaying admission to long-term care.

If the LHIN doesn't agree to fund the ALC beds currently occupying this area of Memorial at the appropriate level, “we will close the beds,” Roy said.

“Let's face it, the way this is being driven now is to correct the present problem,” he said.

“It doesn't look at the future. The future is not in keeping those beds. If we don't close those beds, they will always remain open, and will prevent us from going forward.”