Rebecca Boonstra and Shantal Cloufer, two of 14
LPNs at the Boyle McCauley Health Centre in Edmonton
WE DON’T WANT OUR MEDICARE TO BE THIS WAY. A man dies after six hours in a cold hospital corridor, waiting for medical attention. A woman with broken bones, cracked ribs and internal bleeding waits nearly two days for surgery in a hospital “holding area.” Patients are stashed in offices, given stretchers in hallways instead of beds, even told to lie on the floor.
What was once unheard of and unacceptable is now commonplace. We even have a name for it. It’s called “hallway medicine.” No hospital is immune.
In one Ontario hospital—Brampton Civic—more than 4,300 patients in one year were treated in the hallways.
It is more difficult to get admitted to an Ontario hospital than anywhere else in the country.
Canada lags behind the OECD (Organisation for Economic Co-operation and Development) average of hospital beds per capita, and Ontario lags well behind the rest of the country.
More hospital beds only part of the answer
All this is clear evidence that we don’t have enough hospital beds for the people who seek medical care at hospitals. What is not clear is why that is.
Is it because of deep cuts in public spending on health care? Or, is it because we send too many people to hospital to begin with—simply because there is no other place for them to get the care they need?
The answer is yes. We do need more hospital beds. But, we also need to stop using hospitals as the first—and last—resort for all medical care. It’s an approach that can only create problems.
For example, people who need long-term care don’t need to be in a hospital. But, an absence of enough long-term care facilities leaves them with nowhere else to go. So, they stay in hospital while waiting for alternative facilities to become available. In Ontario alone, around 3,200 patients requiring an alternative level of care are parked in those beds.
There are almost 7,500 “alternate level of care” (ALC) patients in Canada. These are people who have been discharged but continue to live in hospitals because they have nowhere else to go, for lack of long-term-care beds and home-care spots.
Blaming Medicare is a misdiagnosis
It is clear we will need more than money for more beds to fix this. We will need to complete the full Medicare project, as set out by Tommy Douglas, the father of Medicare. We will need to move forward into what he called “phase two.”
Douglas said this would be more difficult than the first phase of making medical care available to all. He said the second phase would be “to alter our delivery system to reduce costs and put an emphasis on preventative medicine.”
In other words: the second phase of Medicare will be delivering health services differently to keep people well, so we will only go to hospital when we really need to.
The ER overcrowding problem won’t be solved in the ER, nor will the hospital overcrowding problem be solved in the hospital. The real solution lies in treating patients in the right place, at the right time, with the right level of care.
This multi-pronged approach to the problem is essential. Canadian Doctors For Medicare published a comprehensive set of practical suggestions in 2012 for transforming our healthcare system, some of which bear directly upon the hallway medicine crisis—improving community-based primary health care, for example, and public wellness initiatives.
Retrofitting and building new long-term care facilities would obviously relieve the pressure on acute care resources, and new technologies are already improving everyday life for seniors in their own homes. Expanded homecare programs could play a significant role as well.
Many working examples of how to improve Medicare
The Women’s College Hospital in Toronto has created an acute ambulatory care unit. Patients there are referred directly by a provider, avoiding the dreaded ER visit. Instead, they make an appointment and are in and out of hospital within 24 hours.
This is just one example of smarter health-care delivery. Another is, after a patient is hospitalized, to ensure they get a couple of visits from a home-care nurse, an approach that dramatically reduces readmission.
In Edmonton, the Boyle McCauley Health Centre has been making community-based care a reality for 39 years. It is a non-profit community-owned and operated health centre.
The centre’s 85 staff include licensed practical nurses, doctors, nurse practitioners, social workers, medical office assistants, psychologists and outreach workers. Together they form four similar interdisiplinary teams. The teams provide person-centered primary health care for vulnerable Edmontonians with complex needs.
The Hamilton Family Medicine Mental Health Program increased access for mental health patients by 1100% AND decreased psychiatry outpatients’ clinic referrals by 70%.
The program staff includes 22 psychiatrists, 150 family physicians, 114 Nurses and Nurse Practitioners, 20 Registered Dietitians, 77 Mental Health Counsellors, 7 pharmacists and provides care to 340,000 patients
The only permanent way to to alleviate hallway medicine is to take the pressure off hospitals. The best way to do that is to bolster services in the community, so we can keep ourselves healthier longer and turn trips to the hospital into exceptions again—rather than the rule.
That was part of the whole medicare ideal right from the beginning. We’re halfway there. It’s time to finish the job. It’s time to move forward into phase two, to expand and improve our Medicare and make it into what we always intended it to be: a medical care system that is even better at preventing illness than at curing it.
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