If there were an ‘acronym of the year award’ in health circles, 2009’s would be ALC – Alternate Level of Care. They are the patients that health policy planners used to call “bed blockers” until the families of these individuals had something to say about it.
In 2007 the government tightened up the definition of ALC and thereby created an artificial crisis when hospitals suddenly discovered that they were full of ALC patients.
By definition, an ALC patient is someone occupying a hospital bed after his or her acute care treatment was complete. Presumably ongoing care, including rehab, could be conducted elsewhere, like home care or in a long-term care home.
Last year hospitals were facing an inflation rate of about 4.5 per cent, but only received 2.1 per cent. With no room left to cut, and with the LHINs breathing down their neck about ALC, the race was on to clear the beds.
In 2010 most hospitals are still struggling thanks to an impending funding freeze, but now so are the Community Care Access Centres (CCACs) and the long-term care sectors due to the resulting influx of ALC patients.
Don Ford, the CEO of the Central East CCAC, appeared before the Local Health Integration Network January 19th to give an update on what the LHIN described as his “unenviable job.”
Ford is unable to balance his budget due to a massive increase in patients seeking home care in this sprawling region east of Toronto.
Many of these ALC patients are arriving as a result of a LHIN initiative to divert patients from hospital ERs.
Other changes made by the province are also pressuring the budget. The CCACs are being impacted by a removal of a cap on the number of hours of care a home care patient can receive. Ford now has to look for money to pay agencies to compensate contract staff for stat holidays, a recent requirement from the Ministry. There is also the impact of the coming blended sales tax on medical supplies.
Ford said he’s received 3,000 additional clients this year, and has a waiting list of about 2,000. Both low and medium acute patients are waiting for service. Only the most urgent cases are being seen.
He says those who are left to wait often end up back at the hospital as their situation worsens.
He has taken the step of giving his case managers a kind of “bank account” allotment of service that they have to manage, putting pressure on the front lines to determine who gets care and who waits.
In his search for solutions, Ford hired a consultant to conduct a review. Among other findings, the consultant concluded that it wasn’t necessarily desirable from a cost perspective to always divert from the hospital. The cost of providing some rehab services was actually less in the hospital than in the “hospital without walls,” as Ford referred to the CCACs.
When asked by the LHIN about other community agencies that clients could be diverted to, Ford said they were less likely to want to go when they had to pay for their care.
Pay for their care?
It seems no matter how you push around the problem, it always comes back to this.
We can pay a reasonable amount through our taxes and provide quality care for everyone. Or we can cut taxes and leave the most vulnerable to cope on their own.
Ford says he needs another $5-$6 million to operate with, a figure he says is consistent with the level of funding received by other CCACs in the province.
Meanwhile, with a freeze on funding imminent, hospitals in the same LHIN are looking at what services they can divert to the community to save money. They may wish to think twice before assuming the CCAC can take their patients.
OPSEU Diablogue 