Waiting for a nursing home bed in hospital

Lisa Priest — Mon, 24 Jun 2013 14:00:00 +0000

The Question: My Mother has been in hospital for the last five weeks after a sudden deterioration. She is not able to go home and needs 24-hour care. It has been suggested we put mom in a retirement home where they say they will provide 24-hour support. She is not yet medically stable and she is unable to walk, toilet herself, bath herself or take her medication without prompting. She has become cognitively impaired also. I am really concerned about moving her to a retirement facility to wait for a long-term care bed. She does not even know how to push the nurse call button. We don’t want her in the hospital any longer than necessary but I am very concerned for her safety and well being.

The Answer: If you are on a list for long-term care home, you stay on that list, no matter where you are residing – a hospital, home or retirement facility. According to Anne Marie MacLeod, operations director of the Holland Orthopaedic & Arthritic Centre at Sunnybrook, you do not lose your spot.

“The retirement home is often the next best choice, because they do have some supervision and they are not on their own,” Ms. MacLeod said in an interview. “If you put them in the retirement residence, where they are getting regular meals, help with activities of daily living (such as bathing) and some activity, they can do quite well.”

Your mother is what is called in health care circles as an “alternate level of care” patient, which means the hospital is not the best place for her. Depending on her choice of homes, the wait for a bed could be months or even years.

Her circumstance is faced by thousands of patients every day. According to a Canadian Health Services Research Foundation report, an estimated 7,500 hospital beds, representing 14 per cent of all acute care beds in Canada, have patients in them, awaiting care elsewhere.

From a system perspective, when patients are waiting in hospital beds, other patients have operations postponed, long delays are encountered in emergency and some patients have to be re-routed to other hospitals.

It sounds as if you recognize that the hospital is not the best place for your mother and the most preferred option – a long-term care facility – is not available. A retirement home concerns you because the level of care is not there.

“Two of the main reasons why people are admitted to long term care is cognitive impairment and incontinence of some sort,” said Donna Rubin, chief executive officer of the Ontario Association of Non-Profit Homes and Services for Seniors.

Ms. Rubin said that most retirement homes would not welcome medically complex patients unless the necessary support could be obtained. It is usually purchased through the home or an outside agency, she said, adding, “for a variety of reasons, they are generally not equipped to provide that level of care.”

The post Waiting for a nursing home bed in hospital appeared first on Your Health Matters.

Stuck in Hospital: When Patients are Waiting for Another Care Setting

Lisa Priest — Mon, 01 Oct 2012 16:57:00 +0000

The Question: My mother is an elderly woman with Alzheimer’s admitted to Sunnybrook a few weeks ago and she is now ready to leave. None of the retirement homes I have visited so far seem to be suitable for her but I’m actively looking for one. What will happen to my mom in the meantime?

The Answer: Each day, there are 70 to 75 patients at Sunnybrook like your mother: with her acute problem treated in hospital, she is now awaiting placement elsewhere – be it a rehabilitation facility, long-term care home, complex continuing care, palliative care – or her own home with extra help. In your mother’s case, it’s a retirement home equipped to care for patients with dementia.

Her circumstance is faced by thousands of patients every day. An estimated 7,500 hospital beds, representing 14 per cent of all acute care beds in Canada, have patients in them, awaiting care elsewhere, according to a Canadian Health Services Research Foundation report.

When patients are in beds, waiting for alternate care, it has a domino effect on the system. Operations are postponed, there are long delays in emergency and some patients can’t even get into Sunnybrook – and are sent to other hospitals in the province or even to the United States – because the hospital is literally full and beyond. There are days in this hospital when it is operating at 110 per cent occupancy.

“We need to have a system when the person needs rehabilitation, long term care or home with all the supports, they immediately have access to the right type of care at the right time in the right place. The system is presently being improved upon, but it isn’t 100 per cent yet,” said Lois Fillion, operations director of Sunnybrook Health Sciences Centre. “There are still delays in the system which results in all being caught in a juggernaut.”

When an alternate level of care [ALC] patient, such as your mother, is identified, Ms. Fillion is able to track her in real time, including the health care facilities she has applied to and whether those institutions have accepted the referral or not, and whether that has been done within five days of the patient’s request.

“These are real people with real needs and when you hear their stories, you want to cry,” said Ms. Fillion, poring over a thick binder of hospital statistics in her office. “How can we work together to meet the needs? I think it means the system has to look at every case, we have to customize the service to meet the needs.”

Patients, in particular, are caught in a terrible spot: knowing the hospital is not the ideal place to convalesce, they stay, waiting for placement. On a late August day, one patient had been waiting 268 days at one of our other sites, the Holland Orthopaedic & Arthritic Centre; two others had been waiting 274 and 262 days respectively at the Sunnybrook site.

While there is no one fix, the Home First program has been able to help patients such as your mother through a specialized team led by a community care access coordinator, who supports and assesses care needs of the patient and family within one to two days of discharge from hospital. That coordinator has access to health care professionals and community support services to support your mother, while you search for acceptable accommodation. Since its inception in fall 2009, it has helped reduce emergency room visits and numbers of those on long-term care wait lists.

While at Sunnybrook, your mother will get physiotherapy to keep her mobile but hospitals are not great places to be, unless you absolutely have to be there. That is especially the case for patients with dementia, who may be bothered by the bright lights, continual changing of staff and unfamiliar surroundings.

“In the case of some patients who arrive at Sunnybrook, their family members may be in crisis themselves and burned out from the responsibility of caring for their loved one 24 hours a day,” says Noreen Dawe, professional leader for social work at Sunnybrook. “The health care team works with families to support and inform them about available resources that may allow them to continue caring for their loved one at home for as long as possible.”

For more information on HomeFirst, please visit:

http://www.torontocentrallhin.on.ca/Page.aspx?id=5796

The post Stuck in Hospital: When Patients are Waiting for Another Care Setting appeared first on Your Health Matters.

alternate level of care Archives - Your Health Matters

Waiting for a nursing home bed in hospital

Stuck in Hospital: When Patients are Waiting for Another Care Setting