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.
Reducing the number of “alternative level of care” (ALC) patients in a hospital may have unintended consequences.
Robert Biron, CEO of the Cobourg’s Northumberland Hills Hospital, told the Central East LHIN yesterday that his current operating deficit may be partially linked to the hospital’s success in reducing the number of ALC patients from a high of 36.8 per cent in December 2010 to a low of 2 per cent in June of this year.
Alternate level of care patients are those who have completed their acute care treatment at the hospital but are not well enough to return home. Wait lists for long-term care beds and home care services have left many hospitals without an ability to responsibly discharge these patients.
Biron says filling the former ALC beds with high acuity patients requires more resources, not less, including advanced nursing care. These are additional costs to the hospital in a year when base budgets are frozen.
Sudbury residents may be a little mystified by Health Minister Deb Matthews recent comments on their emergency room problem.
Health Sciences North recently closed 30 transitional beds in March. These beds were occupied by individuals described as alternate level of care (ALC) – patients who have completed their acute care treatment, but are not well enough to go home.
Now the hospital has among the highest waits in the province for access to its ER.
According to the Sudbury Star, a 17-hour wait in February expanded to a 19.7 hour wait in March. The hospital is fingering the rising number of ALC patients as the culprit.
Some would look at this and see some dots connecting.
Remarkably, in an interview with the Sudbury Star, Matthews said “I’ve been enormously impressed with the way the community has come together to find solutions.”