Bad hospital discharges among top complaints, Ontario watchdog finds

Theglobeandmail.com
May 11, 2017
By Kelly Grant

Complaints about inappropriate or poorly planned discharges from Ontario hospitals are among the top areas of concern the province’s new patient Ombudsman is monitoring, according to preliminary figures her office compiled for The Globe and Mail.

Christine Elliott, the former Progressive Conservative MPP turned health-care referee, said that about 60 per cent of the more than 1,500 complaints her office has received since opening last July revolve around allegedly subpar communication from officials in the hospital, long-term care and home-care sectors.

But miscommunication is a problem that permeates complaints of all kinds, she added, including those about discharges from hospital, which are in the office’s top five categories of complaint, alongside objections about waiting times, overcrowded hospitals and access to care in remote parts of the province.

“We have heard of situations where people do feel pressured to make decisions [about leaving hospital] and really don’t feel that they’re being treated as an individual or a human being - that they’re just a number and a bed blocker and they need to be moving out,” Ms. Elliott said.

The Globe and Mail reported earlier this week on the case of an 88-year-old widower whose son says a Markham hospital pressured his father to leave, threatening to charge the elderly man $1,100 a day or drop him by ambulance at a homeless shelter.

The Markham Stouffville Hospital, north of Toronto, eventually relented and moved the octogenarian to a transitional care unit, but the incident underscores the pressure that hospitals in the province are under as more elderly patients with complex, chronic conditions fill acute-care beds they no longer require.

“I don’t think there are any hospitals trying to do bad things,” said Samir Sinha, the director of geriatrics at two Toronto hospital networks and leader of the province’s seniors strategy. “The challenge for hospitals is they are in the business of providing acute care. But when 15 per cent of their beds on a daily basis are actually occupied by people that they can’t help transition to a more appropriate setting, it creates stress on the system, it creates stress on the providers and it creates stress on the families who are caught in the middle.”

Patients who are waiting in regular hospital beds for spaces elsewhere – such as in long-term care homes or rehabilitation centres – are designated as Alternate Level of Care (ALC). There is broad agreement in the health-policy world that high ALC rates are bad for patients, who risk infection and physical and mental decline when they lie in bed all day, and for hospitals, which are forced to warehouse new patients in the emergency department or treat them in hallways when wards are jam-packed.

The average ALC rate at Ontario’s hospitals has hovered around 15 per cent for years, but it began to creep higher over the most recent fall and winter, when a difficult flu season compounded the overcrowding problem at some hospitals.

The ALC rate in Ontario varies significantly from hospital to hospital, according to figures obtained through a Freedom of Information request and analyzed by The Globe and Mail.

Some smaller hospitals have ALC rates that averaged more than 50 per cent between 2011 and the middle of last year, including the Atikokan General Hospital (64.7 per cent) and the Geraldton District Hospital (53.7 per cent), both in Northwestern Ontario; and the Renfrew Victoria Hospital (53.8 per cent) outside Ottawa.

Many of the province’s busy urban and suburban hospitals, by contrast, have ALC rates below 10 per cent, which suggests these hospitals are emphasizing timely discharges, and that more long-term care and home-care options are available for patients in cities.

NDP Leader Andrea Horwath, who has been sharply critical of the way Premier Kathleen Wynne’s government has restrained health-care funding in the past, said she and her MPPs are regularly contacted by constituents who have been threatened with exorbitant hospital fees or told their elderly family members will be dropped in the parking lot if they refuse to take them home.

“Families are between a rock and a hard place,” Ms. Horwath said. “Folks have to work, they have to earn a living. They’re not often in a position to drop everything and take care of a loved one.”

After freezing hospital budgets in four of the past five years, the Liberals promised a 3.1-per-cent increase to the sector as part of the largest overall increase in health spending in five years. The government is also promising creative solutions to the ALC challenge, including a voucher program that would help hospital patients awaiting long-term care to move into private retirement homes temporarily.