Peer review should focus on community supports - Dr. Peter Zalan

On July 9, the North East LHIN appointed Mr. Martin, the CEO of Hamilton Health Sciences, to undertake a peer review of Health Sciences North.

He is directed to examine the flow of patients out of the emergency department and into the rest of the hospital, through to discharge.

The review should not stop there. Patients would flow out of hospital faster and be readmitted less often if the necessary community services, housing and medical services were available and easy to access.

The average wait time for long term care placement in Sudbury for the lowest cost accommodations varies from 49 days at Extendicare Falconbridge to 350 days at St Joseph’s Villa and 371 days at Pioneer Manor.

The number of ALC patients at Health Sciences North continues to slowly increase, in parallel with the increasing number of folks over 75.

Nevertheless, 30 beds closed in March at the Memorial site and the remaining 30 beds will close in 2013. Sudbury had 629 hospital beds in 2001 and 459 today. There are no new long-term care facilities under construction and none in the planning stage in our area.

The intent to cease building new long-term care facilities is based on evidence. In Denmark, no new nursing homes have been constructed since 1987 and the number of hospitals has dropped dramatically.

Instead, a varied range of supportive housing adapted for the elderly have been developed: the number of such dwellings increased from 3,300 in 1987 to 58,300 in 2006.

In Sudbury, we are building supportive housing units at Finlandia and in Walden. Unfortunately, these are “one-of” projects and will not be sufficient to meet the need. Health, social and housing needs are inseparable.

If money is scarce for retirees, meeting housing costs may leave little for nourishment toward the end of the month. In turn, inadequate nourishment and lodgings can cause illness and hospitalization.

Lack of socialization causes loneliness and depression.

Consider the following complaint: a high-needs person goes home with adequate home care. Their needs do not change, but the hours of home care decrease; the family either picks up the slack, applies for long-term care, or sends the patient to the emergency department.

Why does this happen?

The 2011 North East LHIN Report on Personal Support Occupations identified concerns surrounding training, compensation, retention, and working conditions of the workforce.

While this problem remains unresolved, there has been a dramatic increase in the demand for services in the community, which will only increase as our population ages.

While the provincial budget for community services is set to increase by four per cent, this will come nowhere close to meeting the need. Overall, care in the community gets 4.5 per cent of the health care budget.

For too many elderly patients with chronic diseases, medical follow-up consists of visits to the Walk-In Clinic for renewal of their medications.

The repeated emergency room visits and admissions to hospital by the same patients indicate the need for more co-ordination and services in the community.

An adequate number of assisted living units and properly resourced home care would make an immediate impact.

In summary, we understand that the answer does not lie in building more long-term care facilities and more hospital beds.

The answer lies in caring properly for our seniors, disadvantaged, handicapped, and chronically ill in the community. We know what needs to be done. Commit the resources to make it happen. Bring on the peer review.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.

Posted by Vivian Scinto