OPSEU Diablogue

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.

They lined up at the Central East LHIN January 19 to warn of impending cuts in the event of a funding freeze. Ontario Shores CEO Glenna Raymond says a freeze would take them from a $1 million surplus to a $4 million deficit. While $2 million could be found in “efficiencies” and increased hospital revenues (ie. parking rates), Raymond said they would have to cut services to balance their budget. Rik Ganderton, CEO of the Rouge Valley, said he would have to cut $2.5 million in services in the event of a freeze. Rouge needs to run a surplus to cover capital costs not funded by government. Last year Rouge spent $3.5 million to replace boilers at Scarborough Centenary Hospital. … Hospitals are not the only health providers in trouble. The Central East CCAC reported they couldn’t balance their budget until March 2011. CEO Don Ford told the CE LHIN he had a waiting list of 2,000 clients. The CCAC is only taking the most acute patients. CE LHIN Chair Foster Loucks said Ford had an unenviable job. He could have added, except for his. … Meanwhile, with no expectation they’ll actually get it, the CE LHIN has put together a business plan that calls for 10 additional staff. CEO Deborah Hammons she said she wanted the Ministry to know what it takes to get the work done. … At the same meeting Loucks expressed frustration over the ability of the LHIN to transfer funds based on local priorities. “I’m concerned that we’re being turned into bureaucrats here,” he said. OPSEU has argued from the start that the LHINs would be carrying out Ministry directives with very little local control. The Ministry, in turn, claims every unpopular decision is made by the LHIN. Some would say this is by design. Want to send the government a message about freezing hospital funding? Go to http://www.avoidingzero.ca

Responding to articles in the Globe and Mail and New York Times that question the effectiveness of commonly used physiotherapy treatments, the Canadian Physiotherapy Association says there is scientific evidence to support the use of ice, heat and ultrasound in treating injuries.  The published stories suggested such modalities were “voodoo treatments.” …. Ontario Health Minister Deb Matthews is not ruling out the possibility of a funding freeze for the province’s hospitals. Speaking to the Globe and Mail in December, Matthews said “I know that hospitals are really being challenged by it, but our fiscal reality is that we’ve got to really take a hard look at every dollar we spend.” Health executives quoted in the story say there is no room to cut without compromising patient care. OPSEU is maintaining a web site to allow the public to quickly communicate with their MPP on this issue.  Go to www.avoidingzero.ca  …  According to a local Ottawa newspaper, the Ottawa Hospital has frozen wages for non-union managers in anticipation of this year’s funding restraint. The Ottawa East EMC also reported Michel Bilodeau, CEO of the Children’s Hospital of Eastern Ontario, as saying there is no room left for cuts. “There’s not much more we can do that does not affect patient care,” he said. “Anything we can think of would have to be taken over by the Hospital for Sick Children in Toronto or parents would have to go to Montreal. Essentially, the health system would not save anything.”  …  Ken Tremblay, the Chatham-Kent Health Alliance CEO, is changing jobs. He will become the new CEO of Peterborough Regional Health Centre. Tremblay is notable for his controversial third-party review of the Quinte Health System in 2008. Tremblay ruffled feathers in the community when he called on local Mayors to resign from the board of QHC if they could not accept a plan that meant significant cuts to service. The political fall-out was intense. One wonders about the welcome from Peterborough’s present Mayor.  … Former Health Minister David Caplan is expected to be given a new cabinet post after resigning from the health portfolio last fall. His fall from grace was predicted in the June 27, 2008 edition of Dialogue. At the time, we stated “Caplan’s appointment comes at a time when many issues are coming to a head, leading some to suggest that he will become the fall guy for many unpopular decisions resulting from George Smitherman’s time at health.” With LHINs, P3 Hospitals, nursing homes scandals and community outrage over home care contracts all generating bad news, who would have predicted e-health to be the final straw that brought him down?  Having spent time in the penalty box, as the Toronto Star put it, Caplan is expected back.