In Canada, “bed blockers” – older people stuck in hospital, ready for discharge, lacking the home support or alternate accommodation they require – occupy 5,000 hospital beds and consume $200 million annually. They clog emergency departments and expand wait times for others. Also known as ALC or alternate level of care patients, they languish in hospitals because there is in most cases nowhere else to send them for appropriate care. Do you want this for your clients or your own family?
A few weeks before Christmas my 99-year old aunt fell getting up from her chair and broke a hip. She was taken to a major teaching hospital in Toronto where the hip was successfully mended. That’s the only good part of the story. When she was admitted they told my cousin, her daughter, that my aunt would be out in 21 days. My cousin said to herself: Wow, they must have some pretty sophisticated software – or something – to know exactly how long my mum will be in hospital.
Turns out they weren’t right. My aunt was in for over a month and every day she was in the hospital she lost ground. For 2 weeks after her surgery my aunt had no physiotherapy because there was no-one to provide it. So each day she became more frail, weaker and less able or inclined to get up. As much as my cousin pleaded for help to get her mother up, or at least to change her position in bed so she would not develop bedsores, her pleas invariably were ignored…staff had no time, or it was not the right time….And don’t ever look for help between 3:00 and 4:30; the shift leaving at 3:30 is too busy writing in the charts and the oncoming staff are too busy reading the charts.
But this was only one problem. Another one loomed – where could my aunt go after leaving the hospital? She could not return to her lovely retirement home, as she had lost too much mobility while in hospital. All the rehabilitation beds were full, so she was left in a holding pattern, in limbo; not getting the care she needed in the hospital but unable to access the rehab care she needed because there were no rehab beds.
So every day my cousin spent her days at the hospital (time off work) providing the care and support that hospital staff should have provided. Finally a bed became available at a well-known rehab centre and my aunt was moved there. Even there she has continued to deteriorate. Why? For the first 2 weeks she was there, she received no physio. Why? You guessed it – no staff. When she finally did begin treatment she got and still gets half an hour every 2 days. Unbelievable.
More weeks later she is still there, still waiting for an assessment to determine whether rehab will help. If not she will be sent to a holding ward until a long term care facility bed can be found for her – God knows where. My cousin can afford to hire a PSW (personal support worker) since there she is no longer paying for retirement home care; at least now she can go back to work, although she still spends way too much time at the rehab centre.
Summary: In early December my 99-year old aunt was independent; she could move around, get in and out of a car and enjoyed a good quality of life. Today she is being moved from bed to bed, a frail, bewildered woman with an unknown and frightening future…if indeed it is any future at all.
Lessons learned:
- Never get sick or need hospital care from approximately December 1-January 15.
- Charts rule; patients do not
- Our health care system gives priority to younger patients, not the elderly who cannot speak up for themselves.
- Make sure you have discussed health care emergencies with family; no-one should go into our “care” system without an advocate