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The arrival of COVID-19 has increased the pressure on the Department of Health, the Nova Scotia Health Authority (NSHA), and the Department of Community Services to empty out long-stay patients to make room for an expected surge of hospitalizations.
Two dozen new cases a day — some now involving healthcare workers and nursing home residents — underscore the importance of freeing up beds for people who may require urgent care. At this time, there are still only a handful of Nova Scotians hospitalized due to the virus.
Last month, the NSHA reported 152 hospital beds in the Halifax Regional Municipality are occupied by people who no longer need acute medical care. They could not be discharged because there is/was no appropriate place for them to go. Some are waiting for nursing home placements. Others have complex problems caused by mental illness or addictions. These patients, termed “Alternate Level of Care” (ALCs), have remained in hospital after their treatment for many months or in exceptional cases, more than a year.
One man who was admitted two years ago with a broken hip and a history of addiction issues remains in a private room on the eighth floor of the Halifax Infirmary. A security guard is posted 24/7 outside the door of Patient X to protect staff and other patients who have been subjected to his swearing rants and unpredictable violent outbursts, including assaults on two guards. Patient X walks with a slight limp but the hip healed long ago. We are respecting patient confidentiality by not naming him. There is no homeless shelter or nursing home appropriate for this person, who is in his mid-50s.
That said, there has been significant movement of people out of hospital over the past month. Late last week, NSHA CEO Dr. Brendan Carr said hospitals across the province were at 70% occupancy when usually at this time of year they would at 100% capacity. Those reductions came mostly from cancelling surgeries and elective procedures, Carr explained, although 42 patients have been transferred to nursing homes in the past three weeks.
The Health Authority CEO said 122 beds in Intensive Care Units (ICUs) across the province are currently standing at 50% capacity in preparation for an anticipated surge of COVID-19 admissions two to three weeks following travel from March break.
In the HRM, the Central zone, there is also a coordinated effort among agencies — the Health Authority which runs the hospitals, the Health Department which is responsible for nursing homes, and the Community Services Department which manages income and disability support programs — to whittle down the number of the most challenging ALC patients. These hard-to-house people account for only 3% of admissions but nearly 17% of the time spent by patients in hospital. The cost of a hospital bed is well over $1,000 a day.
Some progress has been made since the arrival of COVID-19. Numbers requested and received from the Health Authority show ALC patients in Halifax-area hospitals (Central Zone) have been reduced to 119 from 152 in February. At least 13 people have been transferred to nursing homes. Of the 30 “most challenging” patients, the NSHA says only 10 are still occupying hospital beds. Patient X is still there.
The Department of Community Services was the lead in finding places for these long-stay patients. A spokesperson for that department declined to provide even general information about where they went. Motels? Homeless shelters? Supportive housing?
“Community Services works collaboratively with the NSHA when patients need the support of our Disability Support Program or other programs that we administer. We cannot speak to specific cases,” said Lynette MacLeod, spokesperson for that Department.
In Dartmouth, 40 bedrooms in four bungalows located on the grounds of the Nova Scotia hospital are generally 95% full. They are occupied by patients recovering from mental illness or opioid addiction.
“In our 2020-21 budget, we’ve allocated over $4 million dollars specifically targeted toward patient flow,” Minister Delorey told the Halifax Examiner when asked what the Department of Health was doing about ALC patients, flagged by the union representing Halifax Infirmary staff back in 2017.
“That work is throughout the hospital system but it includes work that would ensure the optimal flow of patients through our acute hospital system and back into community. That work is important irrespective of what’s happening with COVID.”
Despite several requests, no more details have been forthcoming about how this problem is actually being addressed .
“It’s very much on the radar of the North End Community Health Clinic, the Affordable Housing Association of Nova Scotia (AHANS), and the Departments of Health and Housing,” said Jim Graham, the executive-director of AHANS. “Until COVID-19 hit, we were engaged in conversations about what permanent supportive housing would look like for this group and where it might be located.”
What still had to happen, according to Graham, was discussions with the NSHA about the type of medical support this group would need after discharge. Graham said models exist all over the United States and Canada that include housing located next door or down the street from a medical clinic for individuals diagnosed with mental illness, addictions, PTSD, or chronic poor health. Graham describes one such facility in Denver, Colorado.
“If you had two or more of those diagnoses, you were eligible for a subsidy so you could afford to rent a bed-sitter in the building,” explained Graham. “All the services you needed were either in the building — for example occupational therapy or counselling — or they were just down the street at the health clinic. It was wonderful. The money to lease or buy the apartment building was premised on the savings to the healthcare system of getting these long-term patients out of hospital.”
When this pandemic has finally run its course, it will be worth noting what lessons have been learned and what changes, some long overdue, may result.
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In the same vein, after reading an article on CBC about Italian doctors stating to not bring COVID19 patients into the hospitals. I now wonder why we are not making field hospitals for our potential patients, instead of moving folks still requiring care, out and around.