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Name
Rasika Wijeratne

Thu, 07/28/2016 - 12:52

I can’t thank enough Dr.Archer for opening this topic for discussion. There’s no need to add any more about how ALC issue hinder assigned function of different hospitals. I do want to add that it is heart breaking to watch these patients wait, wait and wait..and eventually die in the hospital. They never get a chance to enjoy a variety of food, breathe fresh air, have a quiet sleep and receive care from consistent staff that knows them or live in a place they can call ‘home’ before they die. Thank you for sharing MOHLTC guidelines about placing patients that indicate ‘ Individuals with the highest health care needs and those in hospital are given first priority to a nursing home bed’ because I have seen just the opposite, ‘patients in the hospitals are considered “cared for” therefore they become lower priority’. Guideline also indicate ‘However, if you reject a bed offer from a home on your list, you will be removed from all waiting lists and you will be forced to wait 6 months to reapply for nursing home placement’ this warning was given to one patient who was considering rejecting a bed of his choice list in 2012, but few patients who rejected beds on their lists thereafter faced no consequences. I wonder where/when did these rules change? It has become increasingly difficult to find any specific information regarding this placement process; the system has become fragmented and unaccountable. Your data clearly show that this LHIN needs more LTC beds. But, to my surprise, every discussion/ town hall with the representatives from the LHIN starts with the line ‘more nursing homes is not the solution’, then it goes on to mean ‘it is the hospital’s problem’. Hospitals need to unite and advocate with force; this blog is a good start. I would like to add 2 more tools to your toolset to cut the ALC Gordian knot; 1. Subsidised retirement homes/assisted living units: I see a significant number of ALC patients with relatively simple medical conditions who can be cared for in a supervised environment with provision of meals, showers and medication administration. But they instead wait for LTC simply because they can’t afford a retirement home. I understand the current strained financial climate, but subsidizing a retirement home access might be more economical than letting them occupy an acute care bed. 2. Better planning for patients on Hemodialysis: Patients transferred from peripheral hospitals for critical illness needing urgent Hemodialysis later become ALC at KGH and remain at KGH. They are either unfit to receive HD at a satellite unit or go on a waiting list when fit enough for satellite units. Discharge planning for them is extremely challenging because the additional need of transportation to KGH for HD. Some LTC homes claim they can only take a limited number of HD patients again due to transportation costs. Our Nephrology colleagues would have a better understanding of the situation. Lastly, I agree we have to raise public awareness because they have politicians’ ear. We should also engage in more Goals of Care discussions and help patients to Choose Wisely.

Name
Rasika Wijeratne
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