Waiting for a nursing home bed in hospital

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.”