Patients needing long-term care clog hospitals

Elderly Canadians waiting in hospitals to get a long-term care bed creates a ripple effect of delays in the health-care system, two new reports show.

The Canadian Institute for Health Information's 2012 focus on wait times offers a portrait of people in hospital beds who are waiting to be transferred to a long-term care facility or back home with support services.

On any given day, about five per cent of acute hospital beds are occupied by these "alternate level care" patients, and 85 per cent of them are seniors, said Kathleen Morris, director of health system analysis and emerging issues at the institute.

"If the system were able to discharge people more effectively, that might increase the availability of acute in-patient beds and let the emergency department function a little bit better," Morris said Thursday.

The discharge wait can also trickle down to people in the emergency department who need certain kinds of surgery, she added. Patients who fall and break a hip have a better chance of recovering well enough to walk again if they get surgery within 48 hours, but if quick access from emergency departments to operating rooms is stalled then that's not possible.

Here's what happened to seniors discharged from acute care between 2007 and 2011:

• Long-term care 9.7%.
• Home with support 12.8%.
• Home without support 64%.
• Died 6.2%.
• Rehabilitation facility 6.2%.
• Other 1.1%.

Among those with alternate level care (ALC) days, the percentage discharged to long-term care was 53.5 per cent compared with 6.5 per cent among those who weren't ALC patients.

About one in five people waiting for long-term care wait more than a month, the report's authors found. Waits for those who are able to go home with homecare are closer to a week, on average.

Waiting in hospital can also be dangerous, said Dr. Samir Sinha, director of geriatrics at Toronto's Mount Sinai Hospital.

"People don't move around as much," in hospital, Sinha said. "It can be demoralizing for an older patient, but as well, people can acquire hospital infections, like superbugs, that can make them very ill and sometimes kill them."

Those who were medically stable and diagnosed with dementia or behavioural symptoms associated with dementia were more likely to wait than those without  a diagnosis of dementia.

"Right now in Ontario, our system only funds 58 beds, out of a total of 78,000, that are for patients with specialized behavioural needs," such as those who are aggressive or agitated as a result of a neurological conditions or dementia, Sinha noted.

Going home with support

The culture of expecting to go to long-term care needs to change, said Jill Robbins, co-director of continuing care with Capitol Health in Halifax.

Nova Scotia is one of the provinces funding a pilot program to give patients the option of going home with additional supports, such as a case manager, personal support worker and nursing services, rather than going to long-term care.

"It really does take a community to bring someone home," said Robbins.

But putting those supports in place is cheaper than an acute care hospital bed – about $125 to $150 a day in Nova Scotia for home, versus $800 to $1,000 a day for hospital.

Such programs are based on the idea that it’s better to make the decision to go to long-term care in the calmer environment of home rather than in hospital, Morris explained.

The report's authors highlighted the example of how the local health network in Mississauga Halton applied the same approach, called Home First, and reduced the percentage of ALC patients considered eligible for residential care by 76 per cent over three years.

In the report, seniors were classified based on demographic factors like age and having a spouse, ability to perform activities of daily living like bathing, communication problems, incontinence and mood and behaviour factors.

It was based on data for more than 60,000 home-care clients and close to 30,000 residential-care clients recently discharged from hospital.

The institute’s second report looked at a range of other waits in Canada compared with other developed countries:

• Getting into a family doctor within 48 hours.
• Specialist appointments.
• Emergency department waits.

More than half of Canadians surveyed say they can't get an appointment with their family physician on the same or next day and 15 per cent called that unacceptable.

For elective surgery, 25 per cent of people said they’d waited four or more months. Waits times have improved for five surgeries — cancer care, cardiac care, hip and knee replacements and sight restoration — since 2004 when governments made those priorities.

The overall average wait at emergency is longer than four hours — the highest percentage compared with Australia, the United States and U.K. About one in 10 Canadians wait eight hours or more.