Personal care home shortages hurt elderly, brings on waits across hospital system

Myrna Driedger, MLA Winnipeg Manitoba Progressive Conservative (PC) caucus
Myrna Driedger
Broadway Journal

The gridlock, as the elderly wait for suitable living places elsewhere, backs up acute care and emergency room operations in our hospitals. Action is needed.

The expression “hurry up and wait” is never more apt than when used in reference to the task of finding appropriate homes for seniors who can no longer look after themselves at home. Mom and dad have been managing at home, but their well-being is increasingly at risk as dementia or other health problems begin to appear. It’s when that fall happens or the dementia becomes unmanageable that we “hurry up and wait”.

Once needs can no longer be managed at home, a home care case co-ordinator will review other options such as assisted living, supportive housing and companion care. If it is decided that moving to a personal care home is the best option, steps will be taken to complete an application for long term care. The case co-ordinator then completes an application form in consultation with the individual, family and health care team (See wrha.mb.ca/ltc/pch/paneling.php).

Chart A
Residents awaiting PCH placement 2015
in hospital 91
in community 210
Residents placed in a PCH bed 2015
From hospital 24
From Community 10
www.gov.mb.ca/health/rha/erstats.html

The waiting time to access care in a personal care home can be long; I know of people who have been waiting for over a year. Chart A (top right) shows the number of residents awaiting placement in Winnipeg this year during the week of July 22 to 28 and the number that were actually placed. As you can see there were 210 people waiting in the community and only 10 could be placed in a personal care home. Of the 91 waiting in hospital, only 24 were placed (www.gov.mb.ca/health/rha/erstats.html).

As of April-May 2015, there were 1,081 people awaiting placement in Manitoba for a personal care home; Chart B shows where they are waiting.

Chart B
Waiting in Hospital Waiting in Community Waiting in Other Total Waiting
385 579 117 1,081
www.gov.mb.ca/health/rha/erstats.html

System backed-up
There is ongoing concern that acute care beds in Canada are occupied by seniors who are waiting to be discharged to a more appropriate level of care. These individuals, who no longer require acute care services, are commonly designated as alternate level of care (ALC) patients. The ALC designation is an important challenge both for individuals and for the health system.

Traditionally, the ALC issue has been seen primarily to mean patients waiting for placement in residential care. Seniors awaiting placement may experience decline in their overall health and well-being, and there has been a recent shift in thinking to focus on increasing the capacity of the community care sector to meet their needs.

According to a 2013 report by the Manitoba Centre for Health Policy, the proportion of patient days deemed “ALC” in all hospitals is almost 17 per cent. Close to half the patients (49 per cent) were waiting for a place in a nursing home, and this group used the vast majority (86 per cent) of all ALC days.

The problem spreads
There aren’t enough long-term care beds in Manitoba. This creates a bottleneck in hospitals, which in turn is backing up emergency rooms. In the same Manitoba report, researchers estimated that if we could have instantly transferred all Manitobans then in hospital who were approved and waiting for a place in a nursing home or supportive housing, it would have freed up about 264 acute care beds.

Alternate level of care patients’ use of Manitoba hospitals amounts to almost 180,000 days of care each year, on average. The hospital beds they occupy in other circumstances would have been used by patients requiring acute care.

Boomers born between 1946 and 1965 make up approximately one-third of the Canadian population, or roughly 10 million people. The front edge of this generation reached their 65th birthday in 2011. By 2031, boomers will range in age from 65 to 85, with the largest bulge – those born between 1959 and 1961 – near the tail end of the boom. The largest boomer health care effect will not be felt until this group reaches age 75 in the year 2035.

Need a new approach
So far I have referred to the difficulties seniors face accessing a personal care home. Once they are in a home, such issues arise as violence and the inappropriate use of psychotropic drugs on residents with dementia. After more than 60 homicides in care homes over the past 12 years and with violence on the increase, nursing homes across Canada are coming to see the need to change the system.

The current system of institutionalization is now seen to be creating and promoting violence. More and more nursing homes in Canada are therefore starting to move toward a model that deals in other ways with dementia among the elderly.

By 2036 our province is expected to need between 5,100 to 6,300 more personal care home beds according to a recent study by the Manitoba Centre for Health Policy. There are urgent problems here and they require solution quickly.

Myrna Driedger is MLA for Charleswood and Conservative health critic.

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