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homes over the next 24 months. For hard-to-place seniors with a need for a higher level of care, waits can be two or more the aver- age. In rural areas and Nonhem Ontario, families may be separated by hundreds of kilometres, if there are beds at all. On average, less than 40 per cent of applicants get their first-choice home. Ms Matthews said she is aware “we do have work to do in the access to long-term care homes”. “We know that people are wait- ing along time to get into a longâ€" term care home. But we also know that with the right investments, we can actually keep people at home longer." Ms Matthews says the ultimate solution is to rely more on care at home and to make more use of shorterâ€"term “restorative” beds. By February, Ontario had 813 of the interim beds to which Ms Mat- thews referred, in nursing homes, hospitals or hospital-managed sites, and more are planned, the minisz said. In such placements, the elderly are “building their strength up, they’re getting healthier and are actually, many of them, going home, those who would have otherwise thought they were going into long- term care", Ms Matthews said. The Metroland investigation also found bureaucracy is such an obsta- cle that consultants to the industry and US. military are being retained to help improve the process of mov- ing people into nursing homes. Some efficiency methods being tried in Ontario are adapted from the assembly lines of the Toyota car company. One study counted 160 distinct steps, including access to nine sepa- rate databases, just to move a senior from hospital into a long-term care Done by Orillia consultant leff Doleweerd from observations at Quinte Health Care's Tienton Memorial. that 2008 study â€"- spon- sored by the Toronto-based Change Foundation â€" identified wasteful steps that occur in the hospital before patients leave for nursing homes. Efficiency consultant Ron Bercaw has adapted a Toyota assembly line technique to help streamline the JILL WETSTEIN: The Richmond Hill womapisdisazstedbymelackof choice’andwaltfimas'fo'seniors 160 STEPS process of getting Ontan'o’s elderly for the patient. out of hospitals and into nursing- “HI home beds. Mr. Bercaw first adapted the “Lean” technique to save a fail- ing auto-parts plant he managed in Ohio and then taught it to 30 Ontario hospitals and CCACs in the last 2-1/2 years. His tools include streamlining pro- cedures he executed for the defence industry and at the Pentagon. I (I Mr. 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 direc- tor of clinical operations of Trillium Health Centre in Mississauga. said the [can exercise helped identify waste. In 2009, Trillium had as many as 131 seniors earmarked for nurs- ing-home care in its wards and “consistently gridlocked" emergency room, recalled Ms Bisaillon. Mr. 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 Jill Wetstein of Richmond Hill holds a photograph of her mom, Joyce Hollowell, who died at age 88 in February 2009. It was an “ah-ha moment”, prov- ing Trillium’s processes needed a major overhaul. “We realized that it was just totally flawed," Ms Bisaillon said. Metroland also found those fortunate enough to secure a place- ment are cared for predominantly by overwhelmed personal support workers for whom a lack of provin- cial regulation means inconsistent training, lack of accountability and a backbreaking work pace that often removes the opportunity for mean- ingful personal contact. Nursing home staff in general are stretched to the limit, the result of years of understafling 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-term-care legislation in the works since 2003. ‘AH-HA MOMENT’ STAFF PHOTO/SJOERD \MTTEVEEN What alternate level of (are (ALC) patients pay depends on the situation: > Hospitals have authoiity to charge ALC patients $53 a day â€" the minimum rate patients would pay if in a nursing- home bed. long-term care homes b 625 homes r 75,829 longâ€"stay residents Number waiting for a bed r 25,206 Average Ontario wait time b 109 days Per cent who get Ist dloice home > 39.5 m b ALC fees can also be calculated on ability to pay, so some low-income patients aren't charged at all. b 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"ful| daily rate’.’ Note:York Region is located in LHIN 8 Central flSouthfiast 12 MShIcoeMuskoka CARE LONG-TERM ‘WWWLHMAIothadaammyot memcmmsmmkmmwmzow BY THE NUMBERS HOW FEES WORK 75,829 10,342 4,051 L740 7.156 AucssfliépmfinceJong-tetmcarehomsarehfllto capacity,waitlistsforabedarestaticandpatientswho nobngetneedhospital care are stuck in acute care beds.chhartbmaksdownthemmbetsforeachof Ontario's 14 Local Health Integration Networks. L413 b 153 homes with 19,230 beds Municipal homes fot the aged b 103 homes with 16,473 beds [Map In or neat hospitals, Iatgely in Northem Ontario Licensed homes in Ontafio Private, for-profit: b 355 homes with 40,599 beds Non-profit: 322 b 15 homes with 264 beds b The Ontario Hospital Association says provincial law allows a perâ€"diem to be charged ifa patient can be safely discharged from an acuteâ€"care bed but refuses to leave. b The Ministry of Health says per diems are not regulatedThe Public Hospitals Act gives hospitals the authority to levy fees, but does not specify how much can be charged. b Toronto-based Advocacy Centre for the Eldeny surveyed 220 Ontario hospitals in 2007 on discharge policies and 38 responded. Hovmce-mde avenge prov‘ded by Mimstry of Health hnom m “mum mm with. Monika-('- 2,701 353 105 Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldlmand Brant Central West Mississauga Halton Toronto Central Central 9 Central East 1. South East 11 Champlain 12 North Slmcoe Muskoka 13 North East 14 North West .UN" CHOU! localllealth Integration Networks 109“ f 39.5 107 BEE 52 51