Health care managers are still puzzled about what caused a spike in the number of alternate level of care patients in hospital awaiting long-term care in early May while, at the same time, making allowances for people most in need to move up wait lists.
The North East Local Health Integration Network has designated several frail, elderly people hospitalized at Ramsey Lake Health Centre as being in crisis so they will get faster access to a long-term care bed.
Early in May, the number of ALC patients at the acute care site of Health Sciences North rose to almost 100, meaning people who did not need to be in hospital were occupying roughly 20 per cent of all beds. That put the hospital at well above 115-per-cent capacity, straining staff and physician complements, posing inconvenience to patients housed in unconventional spaces, and resulting in the cancellation of a dozen elective surgeries.
Overcrowding due to the high number of frail, elderly people awaiting long-term care has been a problem in Sudbury’s hospital system for better than 15 years. Continuing efforts to curb the ALC crisis have resulted in hundreds of schemes to deal with the crush, but the aging population of the Northeast has continued to challenge the system.
In the past, regional health planners gave Sudbury’s acute hospital a crisis designation, often for one week out of a month, during which time ALC patients were a priority for placement in long-term care over people in the community.
This go-around, the crisis designation is being applied to individual patients, with the goal of finding a bed for people who have waited the longest in hospital for one.
Kerby Audet is interim vice-president of home and community care for the NE LHIN. Late last week, she and other health planners were still trying to pinpoint what caused the ALC spike almost three weeks ago.
Monday, there were 83 ALC patients at HSN, about 15 below the high in early May. No other elective or scheduled services were cancelled due to bed shortages in the last two weeks, said HSN spokesman Jason Turnbull.
Audet said 21 individual ALC patients were designated in crisis May 9 or 10. Of that number, 11 were placed in long-term care by May 23. In the community, another 26 people were in crisis as of May 23, making them priorities for LTC placement.
Hundreds more residents in the community and in hospital remain on wait lists for a bed at one of the city’s six long-term care residences, which have a total of 1,554 spots.
Audet said the people in hospital designated in crisis are deemed to be at high risk of becoming ill if they remain in hospital.
“We really looked at it from the perspective of, the longer you’re in hospitals, most often, the more quickly you deteriorate. You’re at risk for picking up hospital infections and so, in particularly, when talking about an overcrowded hospital, we’ve tried to identify patients at the highest risk,” Audet said in an interview last week.
The people in the community who receive a crisis designation are at a very high risk of being admitted to hospital, which would only compound the overcrowding problem.
When hospitals were deemed to be in crisis because of high ALC numbers, there were occasions when families, pushed to their limits, believed that to have loved ones placed in long-term care, they had to take them to hospital first, said Audet.
All crisis patients awaiting a long-term care bed in hospital are told when they receive that designation and they are encouraged to apply to as many long-term care homes as they would want.
“Consider all of them if that’s what you’d like,” said Audet, “but you still have the choice if you only want to pick two or three.”
Audet was one of several health planners still discussing last week why the ALC numbers were so high three weeks ago. Winter ALC spikes are often attributed to influenza outbreaks, but nothing stood out as the cause of this one.
Audet and other health planners are breathing a little easier since the latest spike, but history has shown ALC numbers don’t stay low for long.
“Everybody is still also very alert to the fact that this could creep up very quickly, so it’s not that kind of comfort level where you’re saying you’re glad that it’s over,” she said.
Families are doing their best to help care for loved ones in the community as LTC wait lists are so long, “but there does come a point where they get tired and the need for LTC beds becomes more urgent,” said Audet.
The North East LHIN is working with those families to ensure they have the supportive services they need.
If Audet had any advice for people regarding long-term care and home care, it would be this: plan in advance for your aging years.
“They tend to creep up on us very quickly,” she said.
Most people want to continue living in their own homes as long as they possibly can, but, too often, a medical emergency such as a stroke or heart attack or a serious fall occurs “and suddenly you can’t go home any more despite how much you may want to. So what is the plan after that?”
Audet has noticed a trend where adult children buying homes look for those with in-law suites or those that could accommodate them for elderly family members.
She also urges people to visit retirement homes or long-term residences in advance so when it is time to apply, you have an idea of what you are seeking.
QUICK FACTS
-There are 1,554 long-term care beds in Sudbury.
-In April 2019, 35 people moved into a long-term care bed.
-Fifty-one per cent moved into their first choice on the initial bed offer.
-413 people were placed in a long-term care home awaiting their first choice.
-682 people are waiting for an initial long-term care placement.
-1,095 people are on the long-term care wait list.
Source: North East Local Health Integration Network
