What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Thursday, September 07, 2006

Nursing Homes, Part of the "Shell Game"

The discussion of health care needs, and the “shell” game as to where the needs are being “stashed”, would not be complete without talking about our “long term” bed allocation.
In order to have any understanding of this situation, we must understand that there is a language in the health care administration field that is unique and changes frequently. The term “long term care beds” is equivalent to the old term “nursing home beds”. I note in the Calgary Herald, Sept6/06, that the term “hospital beds”, now includes beds used for “rehabilitation” and “recovery”, which now are likely to be located, and have replaced many “nursing home beds” in long term care facilities. As an example, the “once upon a time” Glenmore Auxiliary Hospital” which was a facility for long term patient care (not truly a hospital, and the beds were not included in the calculations for “acute” care), with an expanded capability for complex long term care, is now primarily used for “rehabilitation” and “recovery” care, and included in the “hospital bed” to population ratios given in the Herald’s article. I note with interest also, that the figure given for acute care beds in 1990/91 is 2.67 beds per 1000 population which likely reflects the “beds in use” at that time. The truth is that our capacity was much higher since at any time, the hospitals had wards with beds that were not in use, but could be opened up should the need arise; quite different from the existing situation. Don’t you just love statistics and the administrator’s ability to pick and choose their presentations?
To get back to long term care beds, the province had a moratorium on the building of long term “bed building” back in the 1980’s and early nineties. Although mostly privately built and privately owned, the government picks up most of the cost of long term care and therefore decides when beds are needed and when they are not. Like other government activities, they used “guidelines”, and the guideline they had decided on was, I believe, 50 long term care beds (including “lodges”) per 1000 population over the age of 65 years (At one time we were at 57 beds/1000 seniors in Calgary, thus the moratorium). Don’t ask me how they came up with the “ideal”. In any event, with the moratorium, and the push to decrease cost in our hospitals, it soon became obvious to the administrators in the region that money could be saved by transferring people from hospitals to nursing homes (and as mentioned in previous blogs, to the community as a whole). With this, a new administrative animal was born: “The Placement Assessment and Coordinator”. With this, neither the patient, or the family doctor, had any say in where the patient was “placed” for care. The “placement coordinator” decided the patients “needs” and the most appropriate location of their care. As a result, patients were often placed miles from where their loved ones lived and their family doctor of many years practiced. This resulted in many family doctors discontinuing the care of many of their long term patients, and indeed, many of them giving up nursing home care and hospital care entirely. Of equal concern, as a consequence of this downloading policy, units (consisting of many beds) in the “long term care category facility” became specialized areas of care “used” by the hospitals to “dump” patients. I use the words “used” and “dumped” because although these beds were designated beds for: recovery, transition, rehabilitation, and palliative care, little was done to upgrade the facility and augment the personnel to accommodate that increased patient care NEED. Further, little was done to monitor or measure the changing mandate of care and whether it was being addressed adequately or appropriately. Little wonder advocates for the seniors in these institutions are concerned, and news headlines are beginning to appear pertaining to the care of our elders in long term care facilities.
Where we are today in the old ratio of long term beds per 1000 seniors population, the Lord only knows. The moratorium ended some years ago, and since then some beautiful nursing homes have been built, Sadly, most are grossly understaffed for the care expected, and most are sadly lacking in access to investigative management. Where at one time, lodges provided assistance (at reasonable cost) to elderly patients who required health care assistance, (but did not require nursing home care), expensive assisted living accommodation has come on the scene and is a fast growing industry, the cost of which is fully borne by the patient. Whether the beaurocrats admit it or not, health care has, and is changing rapidly, and the chronically ill, the poor, and the frail elderly are bearing the major burden from a cost and care perspective (the very group our system is to protect). We seem to be shocked almost daily by situations arising in our hospitals and emergency departments, an area of visibility. We certainly can keep score of the casualties in the conflict in Afghanistan. Too bad no one can see what is happening in our own communities and the various “invisible” community facilities, and the casualties that are occurring there!


Blogger p said...

And where are the individuals who made those decisions now? Where does the accountability rest for the results of those decisions?

22/9/06 7:07 AM  
Blogger Al said...

There is none. Many of the people involved in the process of camoflaging health care needs in the last 10 to 15 years are still actively working in our health care industry and for the Calgary Region. Many of them, it would seem, are receiving very large salaries and large annual bonuses.
In the meantime, the administrative costs are growing. In 2003, the Calgary Region had three senior executives; now there are nine. In the last three years the budget for administration has far outstripped the population growth and inflation combined.

23/9/06 8:12 AM  

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