Hospitals in Ontario are planning to provide health care services to more seniors in their own homes and house patients who no longer need acute care in retirement residences and hotels, as they brace for a potential second wave of the coronavirus.
The pandemic has highlighted an urgent need for alternative care for seniors, say health care experts. The elderly can’t languish in acute-care hospital beds or be transferred to unsafe nursing homes.
The experts say more hospitals should copy an innovative home-care program at Southlake Regional Health Centre in Newmarket, north of Toronto. The program is at once a window into how one hospital has helped seniors be discharged quickly and return home with health care support, and a stark reminder of the uneven pace of progress elsewhere.
During the first wave of the coronavirus, hospitals cancelled most elective surgeries to clear space for a surge of critically ill COVID-19 patients that never came. Hospitals also emptied beds by discharging many patients to retirement and long-term care homes.
This time around, they have less flexibility for dealing with patients who no longer need the acute care services of a traditional hospital but are unable to live independently.
“This is about transitioning from crisis management, which we did in the spring, to living with COVID,” said David Pichora, chief executive officer of Kingston Health Sciences Centre and member of a government committee planning for the next wave of the pandemic. “Nobody wants to go back to what we were doing in April.”
Patients who no longer need acute care are filling up hospital beds once again, primarily because hospitals can no longer discharge many of them to long-term care homes, where more than 1,800 residents in Ontario died from COVID-19.
These patients, known as alternate-level-of-care (ALC), occupy just over 5,100 hospital beds, about the same number as before the pandemic when overcrowding was a chronic problem.
The province’s Chief Medical Officer of Health, David Williams, issued a directive last month preventing long-term care homes from accepting new residents or readmitting previous residents to wards, where up to four individuals share a room. The order does not affect existing residents who live in ward rooms. Slightly less than one-third of Ontario’s 78,443 long-term care beds are in older homes with wards.
The Kingston region in southeastern Ontario is losing 300 of its 4,000 long-term care beds as a result of the new admission restrictions, Dr. Pichora said. His hospital admitted 78 patients to long-term care in June, about a third of the normal volume.
Hospitals also will do everything possible to avoid cancelling surgeries again, said Dr. Pichora. There are no data in Canada linking cancelled surgeries to mortality rates. In the U.S., the National Cancer Institute predicts that tens of thousands of excess cancer deaths will occur over the next decade as a result of delays in treatment caused by COVID-19.
Kingston Health Sciences is one of several hospitals that have found alternatives for ALC patients by leasing empty space in other buildings. It has installed 30 beds in a retirement home and is looking for more space. Queensway Carleton Hospital in Ottawa has retrofitted a floor in a hotel with 32 beds. North York General Hospital in Toronto has 20 beds in a retirement home, and is working with community groups to care for these patients.
“This close partnership between sectors has to continue after COVID,” said Joshua Tepper, CEO of North York General.
The Ontario Hospital Association is urging the government to earmark additional funding for home care and for more hospitals to lease space in hotels and retirement homes.
A Ministry of Health spokeswoman said the government is working on a plan to help hospitals manage capacity, including looking at using hotels and other alternative sites beyond Sept. 30.
Samir Sinha, the director of geriatrics at the Mount Sinai and University Health Network hospitals in Toronto, said the pandemic is an opportunity for government to expand home care, a less expensive option. The province spends $103 a day on home care services, compared with $182 a day for residents of long-term care, government figures show.
“If you ask anybody,” Dr. Sinha said, “they will say I want to stay in my home as long as possible.”
Several hospitals, including Kingston Health Sciences and North York General, have introduced home care programs similar to the one at Southlake, the first of its kind in Ontario.
Patients who have participated in the 16-month-old Southlake@home program wait less than a day to return to their own homes, once they no longer need acute care, said Arden Krystal, CEO of the hospital.
Judy Smith’s 95-year-old mother-in-law, Reta, was one of the first patients to participate in the Southlake program. Twelve days after Reta was rushed to hospital in March, 2019, after she fell in the dining room at her retirement home, fracturing both ankles, she was back in her own apartment.
A team of nurses, occupational therapists and personal support workers provided care to Reta for 14 weeks, until she could go to the dining room for meals on her own, using her walker.
“I had high standards for care,” said Ms. Smith, a retired geriatric nurse. “This program met those standards.”
The program initially helped Southlake reduce the number of ALC patients, but these beds are once again filling up. Today, ALC patients occupy roughly 20 per cent of the hospital’s 525 beds. As a result, Southlake is also exploring using neighbouring retirement homes for some of these patients, Ms. Krystal said.
“Because of what happened in long-term care many families are somewhat reluctant to jump to that now,” she said. “They don’t want their loved ones to become endangered.”
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