Solving long hospital wait times requires a fundamental shift in the way we care for the elderly
By David Wiercigroch
and Caberry Weiyang Yu EvidenceNetwork.ca
Hospital
overcrowding is not a new issue. Limited bed spaces have plagued
Ontario hospitals for years and are increasingly straining our system.
Not
only are long wait times a shameful expectation when patients arrive in
the emergency department, providing care in a busy hospital hallway has
become an ordinary occurrence. The problem has become so significant
that the Ontario government added 1,200 hospital beds last fall in response, a move costing $100 million and requiring the reopening of two shuttered Toronto hospitals.
The ALC problem is significant in many parts of Ontario. Around one in seven hospital beds
in Ontario are dedicated to ALC patients. Many ALC patients are
elderly, with a median age of 80, and often live alone. These patients
are incapable of returning home after receiving care at the hospital due
to their complex needs. They deteriorate while waiting in hospital for
placement in a more appropriate setting, most often a long-term care
home.
The median waiting time for ALC patients is 10 days.
ALC
patients are a glaring reflection of our health system's inability to
address the needs of elderly patients with complex health challenges. At
a time when the senior population is growing rapidly, the problem will
only become more severe.
Our approach is not working and it's bad medicine.
Attempts to tackle ALC rates have proven successful in some jurisdictions,
but most approaches focus on small-scale efficiencies and local factors
that have not succeeded in reducing the overall ALC burden.
Today,
the provincial ALC rate remains troubling. Alongside the addition of
new hospital beds last fall, the Ontario government allocated an
additional $40 million dedicated to providing specialized transitional
care and supportive housing for seniors in long-term care and in the
community.
While
this is a good start, a long-term solution will require a fundamental
shift in the way we care for the elderly. It will require involvement
across the health-care system from front-line staff to hospital
administrators and policy-makers. Practices like earlier screening of
functional decline followed up by the arrangement of community supports,
applying best practices in discharge planning and patient flow tracking
systems can all help reduce ALC days.
A clear component of the path forward must be to enable greater access to long-term care.
We know that a major cause of ALC days is a shortage of long-term care spaces. Canada spends 14 per cent of
its health-care dollars on long-term care, which is lower than the
average spent by 10 other Organization for Economic Co-operation and
Development (OECD) countries. A significant investment in more long-term
care spaces is needed to address the chronic shortage and to put
supports in place that reflect increasingly complex health needs.
At the same time, placement of ALC patients in long-term care is not always the best solution.
Many
patients are capable of remaining at home with increased supports and
wish to do so. By bolstering community and home-care supports, our
system can become increasingly patient-centred in its care for our
elderly population and redirect some patients who would otherwise be
placed in long-term care.
Increasing
community supports must also include the often underappreciated members
of the care team - informal caregivers, who are reporting increasing
levels of burnout and their inability to support their loved ones.
Investments should focus on homemaking services, caregiver support and
respite services, and new models of care such as group homes to care for
high-risk seniors.
These
big shifts require courage, collaboration and political will. We must
act now to meet the changing health care needs of our aging population.
David Wiercigroch is a medical student at the University of Toronto and a contributor to EvideneceNetwork.ca,
which is based at the University of Winnipeg. He is a graduate of the
Master of Public Administration program at Queen's University and has an
interest in health system improvement through public policy. Caberry
Weiyang Yu is a medical student at Queen's University and a contributor
to EvidenceNetwork.ca. She conducts research on health-care equity and access to care. |
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Friday, July 20, 2018
Canada's health system fails the elderly
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