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15 · Wednesday, June 16, 2010 OAKVILLE BEAVER · www.oakvillebeaver.com Nursing homes staff are stretched to the limit Continued from page 6 His tools include streamlining procedures he executed for the defence industry and at the Pentagon. Bercaw's "kaizen" (change for the better) events help health administrators see unnecessary steps that prevent the free flow of the elderly into nursing homes. Susan Bisaillon, executive director of clinical operations of Trillium Health Centre in Mississauga, says the Lean exercise with Bercaw helped identify waste. In 2009, Trillium had as many as 131 seniors earmarked for nursing-home care in its wards, and a "consistently gridlocked" emergency room, recalls Bisaillon. Bercaw had staff place coloured sticky notes on a wall to recreate every step in a patient's journey to either a long-term care bed or home. There were 82, and only 16 added real value for the patient. It was an "ah-ha moment" proving Trillium's processes needed a major overhaul. "We realized that it was just totally flawed," Bisaillon says. Metroland also found that those fortunate enough to secure a placement are cared for predominantly by overwhelmed personal support workers for whom a lack of provincial regulation means inconsistent training, lack of accountability and a backbreaking work pace that often removes the opportunity for meaningful personal contact. Nursing home staff in general are stretched to the limit, the result of years of understaffing and a steady influx of older and sicker residents. That trend will continue. In a decade, the first of the baby boom generation will hit 75. By 2036, the number of Ontarians 75 and over will rise to 2.2 million, from 850,000 today. New regulations come into force next month in a modernized piece of long-termcare legislation in the works since 2003. Ministry officials hope the regulations will spur significant change. Once in a home -- despite the system's ailments -- most residents rate the care as satisfactory, according to a 2009 survey by the Ontario Health Quality Council. Getting through the door remains the major challenge. As the backlog grows, hospitals find it harder to break gridlock created by those who no longer need acute medical care, but cannot be moved on to other forms of care. Health system slang for these patients is "bed blockers." Up to 20 per cent of acute-care hospital beds are filled by such patients, officially labelled as in need of an Alternate Level of Care (ALC). About 60 per cent of ALC patients occupying Ontario hospital beds are waiting for long-term care. The crisis that landed them in hospital -- a stroke, a fall -- has passed, but their next stage of care cannot be arranged, because a placement is not available. It's aggravating for hospitals because ALC patients trigger backlogs in emergency rooms, Licenced Homes in Ontario · Private, For Profit: 355 homes with 40,599 beds · Charitable, Non-profit: 153 homes with 19,230 beds · Municipal homes for the aged: 103 homes with 16,473 beds and on already-crowded wards. "When we have acute-care beds filled with people who aren't going anywhere, it's like trying to function as a significantly smaller hospital," said Helen Gibson, patient care director at Lakeridge Health in the Oshawa area. Lingering in hospital after a medical crisis is over also puts seniors at higher risk for hospital-borne infections, such as C. difficile. Their general health can deteriorate because they're not active or getting the care or stimulation required. Hospitals have become aggressive about getting seniors out of these beds. Many have developed policies encouraging patients to accept the first long-term care bed that becomes available, with hefty fees threatened for those who don't comply. Experts question whether high-pressure policies are ethical, or even legal. Health ministry managers, hospital officials and elder advocates who met in 2008 to examine first-available-bed policies concluded they "have no basis in legislation." Policies "often differ from hospital to hospital and are developed and applied in an inconsistent fashion across the province," the group said in a report of its proceedings, obtained by Metroland. In certain cases, actions that resulted from such policies "may contradict" law, the report said. Jane Meadus, a lawyer for the Advocacy Centre for the Elderly, argues that many hospital policies break the law by "constraining" the patient's right to choose freely -- including requirements to choose homes with short wait lists, or by "placing unlawful pressure" on patients to choose a home they don't want. "It's not a jail. We don't send them there. It's their home. It's not going to be much of a home if you didn't want to go there," Meadus says. Second World War vet Paul Parkin, 93, of Oakville was the "textbook case" of someone who resisted hospital pressure tactics while he waited in OakvilleTrafalgar Memorial Hospital for an area long-term care bed. Parkin was originally hospitalized in January 2009 and given leave to depart in May. Even with the threat of a $700 per day charge looming, the war vet refused to budge because the only available long-term care facility was in Etobicoke. The vet held firm and on July 27, 2009 he was moved to West Oak Village LongTerm Care Centre. Sadly, he died nine days later. A new regulation under the new Ontario See Changes page 18 How hospitals determine fees What ALC patients pay depends on the situation: · Hospitals have authority to charge ALC patients $53 a day -- the minimum rate patients would pay if in a nursinghome bed. · ALC fees can also be calculated on ability to pay, so some low-income patients aren't charged at all. · If a nursing home bed becomes available and a patient refuses to leave the hospital, officials can charge a much larger fee, a per diem or "full daily rate." (Toronto Baycrest is an example of a hospital with a formal policy: a fee of $1,745 a day applies to patients who refuse an available nursinghome bed. Baycrest, however, has "yet to encounter a situation" in which the fee was levied, a spokesperson said.) · The Ontario Hospital Association says provincial law allows a per-diem to be charged if a patient can be safely discharged from an acute-care bed, but refuses to leave. · The ministry of health says per diems are not regulated. The Public Hospitals Act gives hospitals the authority to levy fees, but does not specify how much can be charged. · Toronto-based Advocacy Centre for the Elderly surveyed Ontario hospitals in 2007 on their discharge policies, and 38 responded. "The threat of a per diem is made in the discharge policies of 89.5 per cent of the hospitals who responded to the survey," the centre said, noting that fees ranged from $277 to $827 a day.