The Ontario government has always maintained that getting alternative level of care patients out of hospital is so much more cost-effective than having costly beds tied up with patients who have essentially finished their acute care treatment but are otherwise unable to go home.
The question is, cost-effective for whom?
This week a proposal to set up a 25-bed convalescent unit at a Sudbury retirement home fell through when Health Sciences North (formerly the Sudbury Hospital) learned that standards around convalescent care would actually apply to a convalescent unit. Imagine that?
By applying those standards, the convalescent unit would actually cost $1.4 million – money the hospital says it doesn’t have.
Northern Life says Dave McNeil, Health Sciences North’s vice-president of clinical services, told the newspaper that it was hoped the unit would cost between $300,000 and $800,000 a year to run, depending on the patient’s ability to contribute financially to their care.
In short, they were contemplating patients picking up as much as $500,000 of that tab for what would clearly be substandard care. Assuming the 25 beds were full 365 days a year, that would amount to a levy of about $55 a day. A two week stay would therefore cost about $770 without any extras.
On the other hand, if the patient were medically unable to be discharged from hospital, their care would be ordinarily covered under our Medicare system and guaranteed under the Canada Health Act.
The other question that is worth asking is, what kind of care would they be receiving if it didn’t meet standards?
In 2009 the Office of the Chief Coroner issued a warning to the Ontario Hospital Association (OHA) cautioning hospitals about transfers of acute patients to retirement homes. Investigating the death of an ALC patient that had been placed in an unregulated retirement home, the Chief Coroner wrote: “health care professionals should be reminded that frail elderly patients who are totally functionally dependent and have significant care needs are not appropriate for placement in the private care homes.”
The Coroner’s caution resulted in the present set of standards the hospital conveniently overlooked in its rush to shoo patients out the door.
McNeil is now telling the media that he would like the public’s advice on what to do next.
It was clear from this aborted plan that the hospital was willing to put the hospital’s needs before that of its patients.
Health Sciences North might be far more successful if it starts to look at the problem from the other way round. Amazingly, quality care usually turns out to be the most efficient care.
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Convalescent care beds are regulated under the Long Term Care Homes Act and are long-term care beds (and therefore must hold a long-term care license from the Ministry of Heatlh and Long-Term Care). It is NOT legal to charge for these beds. They are limited to 90 days and are not meant to be a a stop-gap for those waiting for a long-term care bed: it is expected the person will be able to go home at the end of the 90 days. While hospitals are no longer using public funds to help pay for retirement home care as a waiting place for long term care (which is what happened in the above-mentioned coroner’s case), hospitals have changed tactics and are making it clear to patients and their families that they can’t wait for long-term care in hospital (not true) and if they are unable to go home, they will HAVE TO go to a retirement home – there is no option – and pay for it themselves – thus believing that they are no longer responsible for any negative consequences to the person because they “chose” to live in a retirement home.