Home Care Ontario | Jan 19, 2018
By Jeffrey Ougler, Sault Star
Thursday, January 18, 2018 5:14:40 EST PM
Read the article on-line HERE
There’s no question swelling numbers of alternate-level-of-care patients housed in hospitals are unhealthy for such health-care facilities.
Sault Area Hospital has operated, on average, at 106 per cent capacity since April — with some months reaching 115 per cent — the result of a heightened ALC patient presence, the largest proportion awaiting long-term-care beds.
Such a situation is also not beneficial to the patients themselves, says one official.
In fact, Sue VanderBent, CEO of Home Care Ontario, contends the elderly “deteriorate” in hospital and often wind up worse for wear once a long-term-care bed is secured.
“Elderly people need to move around,” VanderBent told The Sault Star. “They need to do things for themselves. They need to function and interact.”
VanderBent, whose group represents 40 agencies that deliver nursing and personal support worker services, contends the elderly often lose abilities “very quickly.” Even more so when housed in hospital.
“We should not be having a high ALC rate that essentially traps people in the hospital,” she said. “We’re creating more people who have to have a residence in a long-term-care facility, and maybe they didn’t need to.”
ALC rates at SAH have decreased due to locally driven efforts, says hospital president and CEO Ron Gagnon. In an interview with the Sault Star last month, Gagnon pointed to the Senior Friendly Hospital Strategy, whose primary goal is to enhance the care of seniors and reduce their risk of functional decline during a hospital stay. And, in October, Health Minister Eric Hoskins announced $100 million to open 1,235 hospital beds throughout the province and an additional $40 million in home care to prevent people from going into hospital in the first place, and to care for others following discharge.
But both Gagnon and VanderBent argue even more resources must be directed toward health, including home care.
Gagnon applauded the Ontario Hospital Association's pitch for a 4.55 per cent hike to hospital funding for the next fiscal year as warranted — and necessary — given fiscal pressures provincial health-care facilities face. SAH’s head told The Star in December that, particularly from his facility’s perspective, OHA's request is "fair and reasonable" given anticipated inflationary and services burdens, coupled with challenges stemming from the area's dearth of "appropriate" community resources. The "reality," he said, is that Ontario has the fewest acute hospital beds of any province per capita, not to mention the second lowest per capita funding.
On top of general inflation, SAH must contend with regulatory inflation, such as Bill 148, the sweeping Ontario labour reform legislation that includes ultimately increasing the minimum wage to $15 an hour. Gagnon said these changes could cost SAH between $1 million and $1.3 million in the coming fiscal year.
"That's a real example of how policy changes increase costs," he said. "There are other policy changes, which I think are all well-founded, but there is the reality of the costs that come with them."
At the end of November, SAH posted a deficit from operations of $0.88 million, a "slight improvement" from October and "better" than the $2.3-million shortfall for the same period last year.
VanderBent said bolstering home care is not just a health-care matter, but a humanitarian concern.
“(Seniors say) ‘I want to age in my own home, I want to live there as long as I possibly can and, if possible, I want to die there. I want to end my days there,’” VanderBent said. “I think that’s what we all want.”
VanderBent, whose group represents a number of agencies that operate within the North East Local Health Integration Network, said home care receives only five per cent of the “proportional health-care spend” in Ontario, about $2.7 billion out of a $54-billion budget. This proportion has hardly shifted in 20 years, she said.
“To increase our capacity, we have to grow this budget proportionally,” she added.
Some areas of Ontario are “more in trouble” than others, VanderBent said, pointing to the northern portion of the province as particularly concerning.
“There is not an unlimited pot of money somewhere, but there are places in the province that are really, really struggling,” she said.
The end product of trying to accommodate growing client lists is that agencies are forced to “ration care,” VanderBent said.
Visits, in some cases, have been whittled down to between 30 and 15 minutes, twice a week.
“If I were to ask any person what can you do in half an hour, it’s quite challenging when you think about the person you’re going to see, someone who maybe doesn’t see well, hear well, understand things well, needs time to get up out of a chair,” she said.
Some 22 per cent of Sault Ste. Marie's population is over 65, and 74 per cent of SAH's patients are over 65.
"Everybody refers to it as a grey tsunami," Gagnon said in December. "Somebody made the comment, 'Tsunamis ... You don't know they're coming.’ We've known this was coming for a decade."
VanderBent agrees. She contends a chief part of the problem is that governments tend to be more reactive than proactive.
“There’s always a need for money,” she said. “(Governments often) deal with the immediate and not, ‘Let’s spend money today to avoid that problem tomorrow.’ This one is so massive and we have been predicting this for 25 years, at least.”
VanderBent said many seniors, indeed, require long-term care — but with the benefit of beefed-up home care, many more could remain at home much longer.
“There are people, even with the best of intentions of their family, (who) need greater 24/7 care,” she added. “(But) it’s a myth to think everybody past the age of 85 gets dementia and all the issues that come with that. That’s not to say we’re not going to see increasing numbers just because of the demographics.”
More than 700,000 Ontarians received provincially-funded home care services in 2015-16. Nearly all of that service was delivered by nurses and PSWs employed by outside agencies, both for- and not-for-profit.
VanderBent is a fierce critic of Ontario’s plan to get into the business of providing home care directly, which includes creating a new provincial agency that could eventually serve hundreds of thousands of patients. The move would mean PSWs become provincial employees. It could also grab a profound portion of the $2.7 billion in annual publicly-funded home care away from for- and not-for-profit agencies currently providing it.
Critics, among whom are those with agencies that currently do the job, contend creating a government-run, home-care provider would be a bureaucratic nightmare as well as a vehicle for the province to eventually assume delivery of all publicly funded home care.
“We need boots on the ground, we need hands to hold the patient, we need to really support staff to go to people in their own homes,” VanderBent said. “We don’t need paper pushers, we don’t need assessors.”
VanderBent said just launching the effort rings in at about $3 million, money that she contends could be better spent stemming SAH’s overcapacity woes.
“Think what Mr. Gagnon could do with $3 million in his community to address ALC rates,” she added.
On Twitter: @JeffreyOugler