How the elderly and frail are caught in the crosshairs of push to end hallway medicine – Ottawa Citizen

Hospitals are not the right place for them and their families cant care for them at home. The elderly and frail are increasingly collateral damage in the drive to end hallway medicine in Ontario, say advocates and families.

Patients who occupy hospital beds but no longer need acute care, ALC alternative level of care patients are a key factor in hospital overcrowding. But with record waiting lists for long-term care beds and shortages of home care workers, patients and their families say they are caught in the middle and feeling pressured.

This is a crisis, said Melanie Dea of Rockland, who recently experienced that pressure first hand. Her husband Richard Martin, who has Huntingtons disease, was treated at Montfort Hospital for pneumonia in July. By August he had improved, but was on a waiting list for long-term care and Dea could not safely care for him at home.

She said the hospital suggested he go to an Alzheimers unit of a long-term care home. Rea refused because her husband does not have dementia. The hospital began charging him $62.18 a day, a co-payment she says she will not pay. He has since moved to a long-term care home.

Meanwhile, the wife of an elderly patient in the same hospital room was in tears after being told her husband was being discharged, said Dea. The man ended up in the hospital because he was wandering the streets at night and his wife could no longer care for him.

Trevor Mertz of Chesterville, says his mother-in-law felt pressured to move into an Ottawa long-term care home by staff at Winchester Hospital when she was there in 2017.

They said, You have two hours to decide or the spot will be gone. Her stay at the home, with a history of health and safety violations, was a nightmare, according to Mertz. She eventually moved to another home, but died soon after.

You shouldnt pressure people on a Friday, saying you have two hours to make a decision. If I had seen the place, I would have said no.

Jane Meadus of the Toronto-based Advocacy Centre for the Elderly said her organization hears from families on a daily basis who are distraught about having to quickly find a solution for a frail relative being discharged from hospital.

They come to us in tears. It is our biggest thing right now and it is just heartbreaking. It has always happened, but the pressure on people is worse now.

Meadus said some patients are being illegally prevented from applying for long-term care from hospital or forced into retirement homes to wait until a less expensive long-term care bed becomes available. We have got two-tier medicine on the backs of seniors, she said.

Hospital officials, meanwhile, say the hospital is not where frail and elderly patients in need of chronic care should be.

Cholly Boland, CEO of Winchester Hospital, would not discuss individual cases, but said the hospitals philosophy is that it is not good to be in a hospital if you dont need to be.

If you are a person within the ALC category, by definition you do not need to be in the hospital and in general, it is not a good place to be.

Montfort Hospital spokesperson Genevive Picard said patients are charged a co-payment when they are waiting in hospital for a long-term care bed, according to provincial policy. The preference, though, is for them to apply from home. Research has demonstrated that it is easier for people to make important decisions for the next stage while they are in their regular environment and can validate if they can safely remain in their home.

She said she is aware of cases in which people have felt pressured to leave, but added patients will get better care tailored to their needs at home with service providers, in a retirement home or long-term care home. We know that situations such as these are stressful times for the patients and their loved ones.

Leah Levesque, head of nursing at Queensway Carleton Hospital, acknowledged that the transition from hospital to home or institutional care can be hard on families.

I think the bottom line for us is we think patients should be in the right bed getting appropriate care from the most appropriate providers.

That can be easier said than done, though.

The average wait in the Ottawa area for long-term care was 186 days in 2017, above the provincial average of 146 days. In addition, support worker shortages and increasing demand mean home care is not always available or reliable.

Dr. Alan Forster, vice president of innovation and quality at The Ottawa Hospital, said making sure ALC patients get appropriate care is a societal issue.

If we continue to use hospitals as the place of last resort for people and dont figure out an alternative for people who are frail and in need of close attention, if we dont make places for that part of the population, then it will get worse for individuals who are in that situation and increasingly difficult for folks not in that situation.

There are currently between 150 and 200 ALC patients at The Ottawa Hospital on any given day. Montfort has seen a 75 per cent increase in ALC patients in the past three years.

Meadus, meanwhile, said her organization sees daily evidence that families and patients are bearing the brunt of the push to end hallway medicine.

We see people being sent home, families being told to mortgage their house to pay for parents care in a retirement home, she said. The Advocacy Centre for the Elderly also sees seniors being discharged to homeless shelters, motels and transitional homes.

Everyone talks about hallway medicine and those taking up the beds should be in long-term care. But no one ever talks about the effects on those people.

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How the elderly and frail are caught in the crosshairs of push to end hallway medicine - Ottawa Citizen