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.”

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No Need to Sell the House When Searching for a Nursing Home

Lisa Priest — Mon, 21 Jan 2013 15:28:00 +0000

The Question: My mother is searching for long-term care home for my father and because of the expense involved, she will probably end up selling her house and looking for a new place for herself to rent. I can’t imagine that this is the best way to go – it just seems like we are extending my father’s hospital stay somewhere else at our expense and now my mother is going to be out of her home. At least at the hospital, my parents are not draining their resources paying for my father’s care.

The Answer: It can be daunting to search for a long-term care facility at the last minute when returning home is no longer possible for your father. You also face the sad reality that your parents, after being together for years, may not be able to live together any longer.

Though it seems like a nursing home is costly compared to the hospital, the monthly payment is only for the “living portion” – room and board – of the facility as the medical care is still funded by the provincial health plan. The fees for these homes – there are about 630 in Ontario – include among other things, meals, bed linens, having medication administered, and assistance with the essential activities of daily living. There are additional costs with cable television and hairdressing.

According to Donna Rubin, chief executive officer of the Ontario Association of Non-Profit Homes and Services for Seniors, a spouse will not be forced out of their home to afford long term care.

“There is certainly no need to sell a house,” Ms. Rubin said in a telephone interview. “If you can’t afford it, the government steps in and provides the long term care home with a subsidy on your behalf, so there really is no need to sell the family home. In fact, if the spouse is still living in at home, a ‘special circumstances’ application may be made to reduce the resident accommodation charges even further.”

The fees for nursing homes are regulated, costing in Ontario per month $1,674.14 for a basic room: $1,947.89 for a semi-private room and $2,274.86 for a private room. The short-stay or temporary stay at a home costs $1,083.75 per month, according to 2012 figures from the health ministry, the latest available.

Retirement homes – where about 40,000 Ontario seniors reside – can also be an option, though their residents generally tend to be healthier. The cost of these homes ranges from $1,200 a month to $6,000 a month.

In some cases, it can be worth exploring the cost of hiring help inside the home, such as a personal support worker – especially if it will keep the couple together for longer, according to Betty Matheson, patient care manager at Sunnybrook Health Sciences Centre, who manages specialized geriatric services.

“The costs do vary for care at home, depending on the services you require,” said Ms. Matheson. “The family should weigh the affordability of care in the home, compared to the costs of a nursing home. That way, your parents can spend their days happily in their own setting.”

That hired help would almost always be in addition to any funded help you may receive, such as that through the community care access center.

“I would really explore all those options and see what’s the best for you and your family,” said Ms. Matheson.

However, she pointed out that not all people are candidates for staying at home with hired help.

“If dad is in such a state that behaviorally he is not safe at home – he wanders or becomes aggressive,” she says “Sometimes there is no option except a nursing home for the safety of everybody involved.”

Ms. Rubin, whose provincial association represents not-for-profit long term care homes, seniors’ housing and community service agencies, offered several tips on what to look for. She suggested you ask about the ratio of staff to residents and how many residents are under one personal support worker – the ratio for the latter typically ranges from 1 to 10 to 1 in 13.

She recommends that you go to one of the homes you are interested in and spend time observing staff. Is it a welcoming atmosphere? Do staff members know the names of the residents? Is the facility clean and in good repair? Is the call bell within easy reach? Does the food look appetizing? What kind of volunteer support does it have for any number of activities, including feeding? She also suggested that you try to determine how committed the home is to maintaining the independence of its residents: incontinence programs and other programs to regain function – such as eating and walking – would be ones to seek out.

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Waiting for a nursing home bed in hospital

No Need to Sell the House When Searching for a Nursing Home