Peterborough’s ALC solution may be within its walls

When Stephen Kylie sat on the board of the Central East LHIN, he recognized that alternate level of care patients were unable to exit the Peterborough hospital for lack of services in the community, particularly long term care beds.

Alternate level of care patients are individuals who have completed their acute care but are unable to go home without other forms of care in place. That usually means either a nursing home bed or home care, two options that have been in very short supply in the Peterborough-area.

The LHIN reported that among the 260 “clients” awaiting placement in the region, including a substantial number at the Peterborough Regional Health Centre, less than 10 per cent had homes to return to.

Kylie likely thought, as his term expired on the board, that the LHIN would come back with a recommendation for more beds in his area.

Instead the LHIN is looking at a more broad-based solution aimed at keeping frail seniors in their homes. For most of the 260, this is coming too late.

There is no question that frail seniors would prefer to stay in their homes, but the infrastructure to allow them to do so has been largely absent. While the government has been focused on moving patients out of the hospital, funding for home-based solutions has been woefully inadequate.

During the meeting the LHIN stated that it was going to return to both Peterborough and Lakeridge Health to try the Home First program again.

Home First insists hospitals send patients home for as long as possible with community supports. These supports are often in place until a nursing home bed can be found. Under Home First, transferring patients from hospital directly to a long term care home is to be considered only after all other community options are considered. In the Central East, you don’t have to consider for very long.

In some regions, those waiting at home for a nursing home bed have been frustrated by the priority hospital patients are receiving in long term care placements. This has been particularly hard on spouses who want to be reunited in the same nursing home.

Given the LHIN had just received a presentation describing how inadequate local resources were, board member Samantha Singh was surprised to see the LHIN was again leaning on hospitals to send their alternate level of care patients home first.

“Is this happening before supports are in place?” she asked at the May 25th LHIN board meeting.

The truth is, the Ministry and LHIN often approve changes to service, ending one method of delivery before another is ready to accommodate the patients.

The classic case is mental health services. For years the government divested services from the psychiatric hospitals under the promise that these services would be re-established in the community. The hospitals were eventually cut to the targets established under the Health Restructuring Commission, but the community-based services never received the funding they were supposed to get. The split was supposed to be 60 per cent community-based funding, 40 per cent institutional-based funding. Today those numbers are reversed.

When Northumberland Hills Hospital closed its diabetes clinic, local residents were promised that these services would be re-established in the community. While the government did improve funding for the nearby Port Hope diabetes clinic, it has never been able to replicate the services that were once provided in the hospital.

So what happens when these services fail patients? They end up back in hospital. And then the hospital gets a visit from the LHIN telling them to get those patients home again. It doesn’t take a genius to figure out the circular nature of this.

The LHIN heard an excellent presentation on how to provide supports for frail seniors in their homes. However, from presentation to reality is a long way to go – especially if there is not sufficient funding to make it happen. You can’t just turn on or turn off a community-based service. Samantha Singh appeared to understand this.

The Health Restructuring Commission made its recommendations in the late 1990s. At least half of the promised mental health community supports are still absent, and for adults, it will be for at least the next three years as the government has decided to focus on children’s mental health.

Paul Barker, one of the CE LHIN’s Senior Directors, said that community agencies can be ramped up and down much more easily than establishing long term care beds. And once you establish those beds, you can’t back out of that “expense.”

Given the new Peterborough Hospital has more space than it is using, it may be time to look at whether the hospital can temporarily use some of that space to establish a long term care facility — at least until those community supports do arrive – or should we say if they arrive. This is exactly what happened at Northumberland Hills Hospital in Cobourg. It ended its “ALC problem” by creating 11 interim long term care beds. A stroke of a pen and the problem was gone.

Having a long term care facility inside a hospital is not new. The Camp Hill Hospital, part of the Queen Elizabeth II Health Sciences Centre in Halifax, has a long term care facility that can accommodate up to 175 veterans. It even has its own garden. Veterans interviewed there say they are very satisfied with care provided. Camp Hill also helps veterans stay in their homes as long as possible, including providing respite care and outpatient geriatric services. Many of the professional supports are available within the building. Nobody argues this is inefficient or that a long term care home has no place within the walls of an acute care hospital.

The Health Restructuring Commission accepted the principle that no mental health bed should close until alternate services were put in place. It’s a pity that governments since have never followed through on that principle, whether it’s the transfer of mental health services or any other community-based health care.

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