Injured? just try getting a bed
Kelly Egan, The Ottawa Citizen
Published: Wednesday, March 05, 2008
What are hospitals for?
I'm not sure we even know anymore.
The Ontario Hospital Association reports, in a front-page story, that one in five beds in Ontario is occupied by a patient who should be receiving home care or moved to a long-term care setting.
It is a "critical" situation, we are told, the No. 1 reason that our hospitals are so overcrowded, our services so backlogged.
The situation at the Queensway-Carleton Hospital is particularly desperate: 30 per cent of patients occupying beds have no medical reason to be there, but can't be discharged because no alternate care is available.
Thirty per cent? Amazing. In fact, hard to believe.
It is, too, a delicate issue, the human dimension of which seems to have been lost. It rather sounds like the hospital bigwigs are annoyed that all these sick people keep showing up -- imagine the nerve! -- at their hospitals.
My impression, built on anecdotal evidence, is the contrary: short of having an axe lodged between your eyes, all effort is made not to give you an actual bed. Can't do that. Now you'd be part of the "problem."
A little story:
One afternoon this winter, an acquaintance was taking snow off his roof when he fell off a small ladder, landing hard on his side.
It was a painful retreat to the house, inch by inch, and took almost an hour. An ambulance was called. He was treated promptly at the Civic campus of The Ottawa Hospital and given an X-ray and diagnosis: a fractured pelvis.
At this point, he could not get out of bed or walk without considerable assistance.
He is 62 years old, in good health, but lives alone. At 1:30 a.m., roughly 12 hours after his fall, the hospital called his girlfriend. Come and get him; he's ready to come home.
Understandably, in the middle of the night, she balked.
For the next 48 hours, he was kept in an observation area attached to the emergency department. There was no surgery or cast, or "acute-care" treatment, to direct his way: only rest and painkillers would do the trick.
After two days, he was moved to a nursing home, never having been admitted to an actual hospital bed.
Another surprise awaited there. Although he had his own room, he was on a locked floor occupied by late-stage Alzheimer's patients. He convalesced for a week, watching a marathon of television, before going home, still using a walker to inch along.
I find it staggering. If a man with a broken pelvis -- in pain and immobile -- is not a suitable candidate for hospital admission, then who is?
The curious thing is, hospital patients do not, generally speaking, occupy beds for very long.
The total number of days patients were kept in all Canadian acute-care hospitals declined from 23.3 million in 1995-96 to 20.3 million in 2005-06, a drop of three million days, or 13 per cent, according to the Canadian Institute for Health Information.
The average length of stay in a Canadian acute-care hospital has been fairly constant during the last decade, somewhere between 7.2 and 7.4 days, the institute found. In Ontario, the figure has dropped from eight days to 6.5 over the last 25 years.
The statistics for those being treated for mental illness, meanwhile, show a sharp drop in length-of-stay over the last few years: from 160 days in 2000-01 to about 110 days in 2004-05 in psychiatric hospitals. For general hospitals, the in-hospital stays for mental illness dropped from 40 days to 20 days over the same period. The point is, patients are not lounging about in hospital beds. It just isn't so.
I imagine many of these "bed blockers," as they were once called, are in the same boat: sick enough to need some kind of daily care -- medical, nursing, personal -- but not sick enough to need the full resources of an acute-care, teaching hospital.
Many, perhaps, have no families to send them home to. This is not their fault. They are not a "problem" that large hospitals need to deal with. They're as entitled to decent health care as anyone else.
And, by the way, this so-called problem has been on the radar for at least 15 years, probably longer. What have a succession of governments, and billions of dollars in public money, done to address it? I think language -- the way the issue is framed -- is part of the dilemma, to the point that some of these labels are becoming meaningless.
A man with a broken pelvis, I would say, is in need of "acute care." Yet he did not qualify for a bed, nor was he counted as an admitted patient at an acute-care institution.
What, it is to wonder, are hospitals for?
Contact Kelly Egan at 613-726-5896 or by e-mail, kegan@thecitizen.canwest.com
© The Ottawa Citizen 2008
