Hamilton-Niagara region loses 181 complex care beds in faulty “right-sizing” plan

Fifty-eight more complex care beds are scheduled to close after the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) approved a plan that will take “continuing” out of “complex continuing care.” That brings to 181 the number of complex care beds that have been cut since last December.

Under the new plan complex care patients will be limited to those seeking between 45 and 90 days of care, including those seeking end of life care.

The HNHB LHIN claims it is right-sizing the number of beds based on a formula that takes into consideration the number of alternate level of care (ALC) patients occupying the beds, an adjustment for population growth, a calculation of unmet need, and an assumption that 92 per cent of the beds will be occupied at any one time. The task force does not give us the data in which they made these calculations.

Instead of looking at average occupancy to determine present use, the LHIN task force simply took a one-day snapshot which indicated 590 complex care (CC) patients were occupying beds. These patients fit the new definition of complex care, and therefore would not include ALC patients.

At present there are 686 beds available. 590 patients represent an 86 per cent occupancy rate – considered by many health administrators to be full occupancy. Yet somehow the report also claims between 35 per cent and 38 per cent of the beds are occupied by ALC patients. How could that be, given it adds up to 121 to 124 per cent?

At 92 per cent occupancy, CC patients would occupy 577 beds based on the new target of 628 beds – that’s 13 beds less than their one day snapshot. In addition, if they calculated for a five per cent unmet need, based on 590 patients, they would need to find an additional 29.5 beds. They claim their calculations also include population growth. Unless “growth” was negative, this definitely does not add up.

The task force neglects to report on what the average length of stay presently is for a complex care patient. Given they knocked “continuing” out the title, one would expect many of these patients to be long-term. What happens to these patients is never defined.

How the LHIN and the hospital determine which CC patients are ALC is an interesting question, given new criteria for overall admission to CC includes completion of the acute phase of illness, completion of the major portion of diagnostic tests, and the fact that the patient is no longer requiring acute daily medical intervention by a physician. This is very similar to the definition of ALC.

The report also redistributes beds by sub-region within the LHIN. The biggest loser would be the Niagara region, which would lose 41 beds. This compounds other losses under the Niagara Health System. Hamilton would lose 24 beds and Brant would lose 18 beds. Burlington would gain 23 beds while Haldimand-Norfolk would gain two beds – just months after cutting 10 complex care beds.

The plan also envisions a greater role for the Community Care Access Centres, which are to provide assistance to hospitals in placement of individuals currently designated ALC into more appropriate settings. However, with no new long term care beds and home care at capacity, it is unclear where the CCAC would be placing these individuals.

The task force needs to give us the complete formula on how they made their calculations. A back of the napkin calculation would suggest there is a reason the numbers have not been filled in on the report – it’s because they don’t add up.