The Other Side of the Bed Shortage

I am spending my day on the other side of the hospital bed shortage. I am sitting with my sister in the nursing home where she is spending the final days of her life. She waited seven months in a hospital bed for this space to become available.
Around us, all is peaceful. People down the hall are playing BINGO. The lady across the corridor has visitors for her birthday. It’s a far cry from the hospital because it’s quiet.

A hospital is a noisy place, day and night. During the day, there are so many people: nurses, doctors, technicians, dieticians. There is all the activity that comes with them. There are also announcements: codes, visiting hours, when the coffee shop is open. There are serious conversations at bedsides and few private spaces. Everyone seems to be hooked up to at least one machine. There are, however, about 12 – 20% percent of patients who are not hooked up and who do not have conversations. These are the people waiting for a quiet space in a nursing home or palliative care or long term care.

Reading articles about Emergency Room wait times or hospital bed shortages, one is given the impression that patients do not want to leave their hospital bed. However, this is not true. Most of them, much like my sister, are relieved to have been moved to a quieter setting. “I’m glad not to be a bed blocker anymore,” my sister says when I first see her in her new home, “I don’t need all the bells and whistles.”

My sister likes this setting in many other ways. She has a view of the Nova Scotia countryside outside her window. There are sitting rooms throughout the residence, with televisions and plants and books – quiet, cozy corners of a type not seen in hospitals. There is a full recreational program and food my sister enjoys. There are two cats.

“The cats are good,” my sister says, “They keep down the mice. You can’t have cats in a hospital.”

“Don’t tell me there are mice in hospitals,” I reply.

“Okay, I won’t,” says my sister who was a nurse, “but you know that’s the kind of thing the doctors never want to hear.”

She goes on to speak about the guilt she had felt when she was “taking up a bed”. She considered that maybe it was because she had been a nurse. She remembered how exasperated she and her colleagues had felt about long term care patients in acute care beds. She hopes she was not too much trouble to the staff when she was still in hospital.

As a child psychiatrist, I have not had to wrestle with bed shortages as other doctors have. Everyone agrees that there is a significant need for long term care beds, but it does seem as though much of the advocacy for these beds comes from the acute care side of the occasion. It comes from the concern that patients are receiving their care not from the relative comfort of a hospital room, but from such places as the corridor of the Emergency Room or closets or any space that can be found. We would all agree that these are not good places to receive acute medical care.

But there is a need for us to be aware that there is also better care available to those patients like my sister who don’t need an acute care bed, but who cannot be comfortably cared for without significant nursing and home care support. People like my sister do not have a lot of energy for advocacy, nor do their families, but it’s important to remember them.

Our lives are important at every stage.

(These are the 2 cats who live at the nursing home. This picture is from Facebook.)

What I Want From Justin Trudeau for Healthcare

It seems as though everyone is lobbying the new Prime Minister on Twitter and Facebook for their own pet promise from the election campaign and, on the day he and his cabinet are sworn in, I would like to add my own request to the clamour. I will warn readers that I am not asking for any grandiose reworking of our existing system. Many are already tweeting and lobbying for that. I am asking for two practical things that would make patients’ care better.

One of the things that Trudeau has promised is to undertake infrastructure investment so there is no better time, in my view, to consider investing in infrastructure for health. Those of us who work in healthcare know that, in this era of governments cutting back on health spending, many hospitals are neglecting upgrades or replacement of aging infrastructure. In fact, anyone who has visited a hospital lately can likely attest to the fact that the infrastructure that supports healthcare is crumbling. Hospitals are naturally choosing patient care over roof repair.

There are two health infrastructure projects that I would like to recommend for Justin Trudeau’s consideration. (I am referring to him casually since that is what most people are doing on Twitter and Facebook and, hey, we’re all friends now, right?)

The first project is the health care infrastructure for long-term care facilities. This proposal was introduced by the Canadian Medical Association in 2012- 2013 for the pre-budget consultations. The CMA recommended that the government invest in both new long-term care facilities as well as in renovations to existing facilities. This recommendation recognized that there was a need to build capacity for long-term care services, a need that still exists today. Their vision was for long-term care residences, assisted living units and “other innovative residential models”. An example of the latter was outlined just yesterday in the Ottawa Citizen: http://ottawacitizen.com/news/local-news/seniors-hub-will-be-a-radical-social-innovation There is no reason that this model cannot be replicated in other parts of Canada as well. Those who are interested in the full Canadian Medical Association Proposal can find it here: https://www.cma.ca/Assets/assets-library/document/en/advocacy/Health-Infrastructure_en.pdf An investment in long-term care facilities has the potential to save thousands of dollars in hospital costs and it will ensure a better life for Canada’s seniors.

My second request is for a fully functional, portable, all-the-bells-and-whistles (technical language) electronic health record (EHR). I want the electronic health record to be accessible to me, to my regular care providers and to any care providers who have to see me on an urgent basis. I want every new test result, every new consultation and each changed prescription to be recorded immediately. It would be great if my care provider could update the information almost effortlessly.

In my view, there is absolutely no reason that the cost of such an impressive tool should not be paid for as health infrastructure since it will pay for itself. I think it might even pay for itself quickly in savings realized from avoiding duplication of tests, savings from e-prescribing and savings from the efficiencies that could be gained from such a foolproof tool. The full benefits of an electronic health record can be found on the website of Canada Health Infoway: https://www.betterhealthtogether.ca/digital-health-in-canada/the-benefits-for-you/diagnosis-and-treatment

Over half the medical practices in Canada are now using an electronic health record but most of these electronic records do not communicate with each other. For example, I have an electronic health record at my hospital but, if my patient is seen in the emergency room at the Children’s Hospital of Eastern Ontario (CHEO), I must wait for a letter by fax or mail sent from CHEO’s electronic health record to know what happened from the perspective of the staff of CHEO.

Also, these electronic health records are not easy to use. I have had to have courses on using the EHR at my hospital and that at CHEO.

I know it’s asking for a lot but I would like to ask Justin Trudeau to get the electronic health record problem solved. It has to be secure, but readily accessible. It should be possible to access the information it contains from anywhere and update automatically to ensure easy follow-up from one interaction to the next. If this sounds like too tall an order for the healthcare sector, then I respectfully suggest that we ask the banks for help. Everything I want in a health record already exists for my financial records, and I can carry the whole thing around with me in one little plastic card.

These, then, are my requests for healthcare infrastructure. As Justin Trudeau and his new Cabinet are sworn in, I join millions of Canadians wondering whether this, or any, government can live up to those first expectations.