Nova Scotia hospitals bill patients $4.8M due to lack of long-term care beds

Nova Scotians were charged nearly $5 million last year to live in hospitals, with the highest bills tallied in the Sydney area, New Glasgow and Halifax, a CBC Nova Scotia investigation has found.

The patients who pay are receiving an alternate level of care, a bureaucratic description for people in hospital who are no longer acutely ill. The category captures seniors waiting for long-term beds in what are called transitional-care units.

More than 30 hospitals in Nova Scotia had such patients last year, according to a database of invoices obtained by CBC Nova Scotia through freedom of information legislation.

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The situation Sandra Dunn of Sydney faced reveals the pressure on patients and the system. 

In late 2012, Dunn's mother, Katherine Henderson — then 97 and suffering from dementia — was admitted to Cape Breton Regional Hospital with an infection.

Henderson recovered, but spent the next six months in hospital because Dunn, herself a senior, suffered a compression fracture and could not look after her mother at home.

"They do the best they can, but they don't have enough," Dunn said.

'A very valuable bed'

Cape Breton Regional is one of three Sydney area hospitals with a ward that is a licensed — but not provincially funded — nursing home.

During Henderson's stay, there was no room for her in transitional-care Unit 3B, so she was put in acute-care wards. She was charged $1,100 a month, which Dunn called "reasonable."

At the same time, she notes her mother took up a "very valuable bed." Dunn said she set up a cot in her mother's room where she would spend nights. 

"It's a place they have to stay, but I don't think it is ideal," Dunn said.

After Dunn recovered, she cared for her mother at home until she was eventually placed in a nursing home. Henderson died in March 2015 at age 100.

Breakdown of billings

Last year about 70 patients a month were billed a total of $1.1 million for alternate level care at three Sydney-area hospitals: Cape Breton Regional, Northside General and Glace Bay. 

The hospital with the single highest total billings, however, was the Aberdeen in New Glasgow. It billed about $640,000, and had an average of 30 patients per month. It is followed by the QEII Health Sciences Centre at approximately $613,000. 

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The 34-odd patients a month who paid to stay at the transitional-care unit in Halifax's Victoria General building could not drink the tap water because of legionnaires' disease in the pipes. In fact, some had to be moved when the building flooded last fall.

Seniors group wants billing stopped

Seniors are being billed for nursing home services they are not receiving, said Bill VanGorder of the Canadian Association of Retired Persons. He said the practice should be stopped. 

"In a long-term care facility, you have access to recreation, to people who come and visit to keep you happy," VanGorder said. "There is socialization where it's medically appropriate. None of these things are available in a hospital — nor should they be."

Some seniors cannot understand why they are billed to stay at a hospital that was free when they were ill, he said.

"Don't charge people who are still in hospital just because you can't find a room for them somewhere else."

How much Nova Scotia hospitals charged patients between October 2014 and September 2015

Province says patients must contribute 

The average payment is $30 to $40 per day, according to Lindsay Peach, Nova Scotia Health Authority's vice president of integrated health services, community support and management.

Alternate level of care patients pay a standard accommodation fee based on income, which is set annually by the provincial government. The maximum for those waiting for a nursing home bed is $110 per day. The maximum for a residential care bed is $65.

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There are right now about 130 people in the province waiting for a long-term care beds who are living in Nova Scotia hospitals, Peach said.

She said she does not accept VanGorder's argument and argues the charge is reasonable.

"What we are really doing is asking individuals to contribute towards that care in the same way as they would if they were going in a nursing bed," Peach said. "It is unfortunate that we're not able to offer them a nursing home bed right away."

The billings do not cover the expense of alternate level care, since the cost of a hospital bed ranges from $600 to $1,400 per day, depending on whether it is acute or transitional care.

Peach said the situation is improving, with the wait list for long-term care dropping by 30 per cent since the province changed how it manages wait lists in March 2015. To cut down on place holders, people are taken off the list if they do not accept a bed when offered.

Since 2003, the wait has dropped by half, Peach said.

"We have seen that shift where individuals are choosing to make the decision to wait in the community," she said.