Like many elderly people who can no longer live on their own, 89-year-old Marielle Carriere was looking forward to moving in with her son and his family.
Arrangements were made to surrender her Sudbury apartment, while her son made room in his Newmarket home for his mother’s arrival. Everything was going quite smoothly when, suddenly, Mrs. Carriere became sick: very sick.
“She suffered congestive heart failure,” explained her son, Dan Carriere. She was taken to the Sudbury hospital where it was discovered she also had a serious urinary tract infection. Shortly after, C. difficile was also diagnosed.
“She was dying,” said Mr. Carriere, who remembers getting the phone call — that phone call — from the hospital. “We came to see her ... and it was a wrenching experience. She was so weak, so pale.”
Mr. Carriere had the Sudbury apartment cleared out and made arrangements for his mother to have a medical transfer to Southlake in Newmarket, where she could be close to the family, as was originally planned. She would be especially close to her son here: Dan Carriere is the president and CEO at Southlake.
“She received excellent care in Sudbury,” emphasized Mr. Carriere. “But, as the lease on her apartment expired while she was in the hospital, she wasn’t a resident of that community any more and it was important to us to have her close by: she needed constant support and attention.”
Close by is something many families prefer for their sick or aging loved ones, but as demand increases for long-term beds, it’s an ideal that is getting harder and harder to accommodate.
“We are in a critical position: 13 per cent of our acute care beds are being used for long-term care patients,” said Mr. Carriere. “Ordinarily, this would be three or four per cent.”
With news of other hospitals enduring longer wait times for surgeries or having to limit important care services, such as emergency in-take, Mr. Carriere is justified in his concern about how this trend may impact the community at large: Southlake serves a very large area and has an almost exclusive duty-of-care to its residents.
As well, with a mandate to deliver advanced levels of care in cardiac, thoracic, mental health, neonatal care, pediatrics and, soon, cancer, Southlake’s responsibility to residents of York Region and South Simcoe County is substantial. As the local population grows, there is increased pressure on all hospital services, directly affecting how hospital beds are used.
“There is a flow we need to maintain,” explained Mr. Carriere.” We must have acute bed capacity to care for patients requiring specialized levels of care. No other hospital in York Region or Simcoe County deals with this reality to the extent that Southlake does.”
To simplify: patients come in, get treatment and then go home. That’s what acute care is about. When patients come in and stay, months — potentially years — in acute care beds, that lowers the flow of treatment to other patients. The longer a patient stays, or the more long-term patients there are, the greater the impact on the overall flow.
“It’s about putting people in the right location, for the right care,” explained Mr. Carriere. Long-term care patients need long-term care facilities with specialized staff. Acute care patients need timely access to acute care services.
Like many hospitals in high growth communities dealing with these issues, Southlake Regional Health Centre has decided to introduce strict discharge policies for patients who no longer require acute care and are deemed ready for transfer to a long-term care facility. To be fair to all patients, the policy is applied “without exception”.
Although there is genuine empathy for the inconvenience and disruption this may cause some families, alternatives are not available.
Mr. Carriere has special understanding of what this new policy means to families: his mother rallied her strength during her stay at Southlake, making what her son called a “miraculous” recovery. Still, he acknowledges, she is not well enough to come home. Under the discharge policy however, she is no longer eligible to stay at Southlake either and was transferred to a long-term care facility for convalescent care. This was not her choice or preference but the facility had a bed that was available immediately and offered the level of care she required.
Under the discharge policy, patients will be transferred to the first available long-term care bed. Although patients and families will have the option to select a preferred facility, they must accept the first available bed and wait in that facility until a bed becomes available in the facility of their choice.
For now, local facilities will accommodate most discharged patients. “We are doing what we can to have patients located as close to their families as possible,” said Mr. Carriere, but cautions growing demand for long-term care beds has Southlake broadening the scope of potential placements and that “expanded geographic choices” are being considered for the future.
“Ideally, we’d love to be able to care for everyone who needs us,” said Mr. Carriere. “It’s really not our choice: everyone, and everything, has limits. We have decisions, certainly, but we don’t have choices that are going to make everyone happy.
“On a personal level, I know that doesn’t help. Having all the insights in the world doesn’t change the despair of looking into our mother’s eyes and telling her that she has few choices about where she has to live. It has a lasting effect on you to watch your parent surrender their independence.”