Area elderly wait longest to get into care facilities

Area elderly wait longest to get into care facilities

Spots would open up if seniors had more in-home care: experts

BY PAULINE TAM, THE OTTAWA CITIZENJUNE 10, 2009


OTTAWA — Elderly residents in Eastern Ontario wait the longest of anyone in the province to be admitted to nursing homes, a new report reveals, in part because the facilities are overloaded with patients who could stay at home if only they had a little more help.
Compared with the rest of the province, this region has the longest median wait time for nursing home admissions at 169 days. That means half of those on a list to be placed in one of Eastern Ontario’s 7,440 long-term care beds wait nearly six months, while the other half wait even longer.
Those elderly who wait in hospital beds, where they tend to deteriorate physically because they’re not getting the right care, wait 67 days to get into a nursing home. Those who wait in their own homes face median delays of 251 days, the report says.
Even when people get into nursing homes, many don’t get into their first choice of facility, the report by the Ontario Health Quality Council shows.
Again, Eastern Ontario performed poorly, with fewer than 36 per cent of those on the waiting list getting into their top-choice nursing homes. The result is below the provincewide average of 41 per cent.
That puts Eastern Ontario among the bottom five provincial regions for their success rate in placing the elderly in their top-choice homes.
The council — a provincially funded agency established to report to Ontarians on the quality of the health-care system — also finds that even though the province is producing more physicians and nurse-practitioners than ever before, access to family doctors has not improved since 2006.
The council expresses worry that the provincewide waits for nursing homes have doubled in the past two years, from 49 days to 106 days.
“It takes too long to get a place in a nursing home,” the report states.
“Delays in placement can be stressful for the individual as well as causing a heavy burden for caregivers at home. People waiting in hospital for nursing homes can keep other patients from hospital beds and worsen overcrowding in emergency rooms.”
Health officials say the backlog points to a need not for more nursing homes, but for a wider range of affordable housing geared to the needs of seniors. That includes facilities with some degree of supportive care — vans to take seniors on errands and medical appointments, housekeeping services — to help the elderly remain independent longer.
“Part of the issue is that if you don’t have a variety of alternative living options available to people, then they may have no choice but to go to a long-term care home,” said Dr. Ben Chan, the council’s chief executive.
The council points to recent research by Paul Williams, a health-policy analyst at the University of Toronto, that shows up to half of the 76,000 elderly Ontarians who are living in nursing homes don’t need to be there.
Instead, they could be diverted to supportive housing or home care and still get all the health services they need, but at a lower cost.
Williams’ study says one reason people end up in nursing homes is because they face problems arranging transportation or housekeeping.
In the Ottawa area, up to one quarter of nursing-homes residents don’t need to be there, said Oris Retallack, executive director of the Council on Aging of Ottawa.
“If there was enough supportive housing available, you could take 20 per cent of the people out of long-term care because they don’t need to be there, which would mean that there would be that many more spaces for people who do need it,” Retallack said.
Compounding the problem is that while Ottawa has a number of expensive retirement homes for high-income seniors, there are few affordable housing options available for seniors in the middle- to low-income brackets, said Retallack.
Williams is conducting a detailed analysis of nursing-home admissions in Eastern Ontario to determine how many cases could be safely diverted out of long-term care, if the proper home care or daily-living supports were in place to help seniors remain in their own homes.
Chan said other provinces have kept waiting lists short while using fewer nursing-home beds by providing alternative living arrangements. Some places in Ontario are getting people to return home with more support instead of going straight to long-term care, the report noted.
No official from the Champlain Community Care Access Centre, which manages nursing-home admissions in Eastern Ontario, was available for comment on Tuesday.
But in a recent interview, the centre’s executive director, Sheila Bauer, indicated that at least two new programs have been introduced in an attempt to allow seniors to live in their own homes longer.
One program, aimed at seniors who wait in hospital for nursing-home beds, offers them the option of being discharged to their own homes, where they would receive extra medical and physical help while they wait for places in long-term care. About 50 seniors have so far received services under the program, Bauer said.
A second program provides extra medical and physical help for those who already live in their own homes, but are considered at high risk of being admitted to hospital. The risk factors could include frailty that could lead to falls, or chronic illnesses that are not well managed. More than 200 people have so far benefited from the program.
The backlog in nursing-home admissions dates back to the 1990s, when Ontario’s Progressive Conservative government presided over a significant expansion in long-term care facilities. At the same time, home-care services were cut back because of a reluctance by government to pay for in-home services that could not be monitored to prevent fraud, waste and abuse.
With a sudden glut of empty beds, many elderly were admitted to nursing homes even though they did not meet the traditional definitions of physical or mental frailty to qualify.
Under the Liberal government, there has been a decisive attempt to rein in the costly expansion of nursing homes, while improving home care.
Health officials say this shift — reversing a dependence on nursing homes — began principally because home care was considered more humane and less costly.
Also in the report is a finding that 800,000 Ontarians, or 7.4 per cent of the adult population, don’t have family doctors, and about half that number, or 400,000 people, are looking for doctors, but can’t find one. In Eastern Ontario, 7.1 per cent of adults don’t have family physicians and about four per cent are actively looking for one.
The report says one possible reason for the high number of Ontarians without doctors is that an aging population means physicians are spending more time treating patients with multiple illnesses. But another reason could be related to the number of young doctors, particularly women, who work fewer hours to juggle family responsibilities.
In February, the Ontario government unveiled a new provincial hotline intended to help find family doctors for people who need them. But the council indicated that it’s too early to determine if the Health Care Connect hotline has been effective.
“We’re waiting with anticipation as to what the impact is going to be,” said Chan. “At face value, it seems like a step in the right direction.”
Other Ontario health findings
— Of those Ontarians who do have family doctors, only one in three do not get to see their physicians on the same or the next day when they need care.
— More than half of Ontarians surveyed who describe their health as “fair” or “poor” say they wait more than a month to see a specialist after being referred. One reason for the long wait could be the large number of people who are referred to specialists when they don’t really need such care.
— Half of patients needing “urgent” cancer surgery did not get their surgery within the medically acceptable two-week period, including some who waited twice as long.
— Ontario is doing twice as many MRI scans as it did before the introduction of a program to reduce medical wait times. But waits for low-urgency MRI scans have fluctuated between 90 and 120 days for almost four years, well over the target of 28 days. One reason for the long wait could be the high number of patients referred for scans when their conditions are not severe enough, or when another test would suffice. This is the result of no guidelines for physicians to decide whether a CT scan or MRI is necessary.
— eHealth Ontario, which has a mandate to create computerized health records for every Ontarian by 2015, needs to set a clear date for delivery. “To safeguard taxpayers’ investment in this project, there must be a clear definition of what the final product will be, milestones that can be tracked along the way and reporting to let the public know how the implementation is progressing in achieving each of the milestones.” The agency has been under fire for issuing $5 million in untendered contracts, provoking a controversy that has led to the removal of the agency’s head and engulfed Health Minister David Caplan.
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