You’ve identified the conundrum. For the want of sufficient LTC beds, patients wait too long in emergency departments, and some of those die. It’s a variation of the proverb about “for want of a nail, the kingdom was lost”.
The government approach to LTC is typical government stuff. It’s expensive, the need seems to be insatiable, and so they ration it. Rationing doesn’t remove the demand for the care, however. People get old and infirm, and some need a lot of care. Needing LTC is the final common pathway for a lot of diseases, in fact for aging itself. Most of the time, it’s personal care (bathing, dressing, feeding, and safe-keeping), rather than skilled nursing care.
There was a notion that people could “age in place”, given adequate supports, and a hope that the home care approach would be cheaper. To that end, much effort goes into ensuring that home care options have been exhausted before LTC options are considered. All that assessment takes time and consumes resources. When the home care options fail, however, as when a frail older person falls at home and breaks a hip, then the person ends up in hospital, where, having been proven to no longer qualify for home care, they await LTC. There’s no quick path from failed home care to LTC that skips the hospital.
Feeling that some people were exploiting the hospital route to LTC admission, many governments refuse to prioritize hospital inpatients for LTC admission, which means that everybody democratically waits an equally long time to get into LTC, even the ones clogging up expensive hospital beds. Further assessments are done, committees decide who gets into nursing homes. This is a waste of time and resources, and harmful to others needing hospital care.
It’s also become a fact that many of those who get into LTC have been on the decline for a long time, so they are nearing the end of life. The average life span for a new admission to LTC here in Nova Scotia is now, as a result, just over a year. You wait months to get into a bed you’ll probably occupy for less than a year! Once you’ve died, your room gets cleaned and sanitized (after your family clean out your belongings), and then the bed is declared available, whereupon a process begins to select the next fortunate occupant. This takes a few weeks, during which the bed sits empty!
As it’s partially government funded (patients are often expected to chip in for their own “room and board” costs, as their finances allow, part of the assessment process involves looking at your finances, as well as your care needs. More bureaucracy!
Finally, you can’t build a nursing home without government permission. As with schools, this leaves them perpetually behind, reactive rather than proactive.
In short, it’s a highly bureaucratic system, much of the (expensive) bureaucracy being there to control costs. Like many things, it probably would work better with the government out of the way.
I was actually thinking about some of your analyses of emergency department bottlenecks while writing this post. The system is unbearably complicated and government certainly isn't always helpful.
It is a trivial matter, but your chart is labelled "85 to 59" when it means "85 to 89".
Who knew that people actually read those labels? :)
Thanks...it's fixed now.
You’ve identified the conundrum. For the want of sufficient LTC beds, patients wait too long in emergency departments, and some of those die. It’s a variation of the proverb about “for want of a nail, the kingdom was lost”.
The government approach to LTC is typical government stuff. It’s expensive, the need seems to be insatiable, and so they ration it. Rationing doesn’t remove the demand for the care, however. People get old and infirm, and some need a lot of care. Needing LTC is the final common pathway for a lot of diseases, in fact for aging itself. Most of the time, it’s personal care (bathing, dressing, feeding, and safe-keeping), rather than skilled nursing care.
There was a notion that people could “age in place”, given adequate supports, and a hope that the home care approach would be cheaper. To that end, much effort goes into ensuring that home care options have been exhausted before LTC options are considered. All that assessment takes time and consumes resources. When the home care options fail, however, as when a frail older person falls at home and breaks a hip, then the person ends up in hospital, where, having been proven to no longer qualify for home care, they await LTC. There’s no quick path from failed home care to LTC that skips the hospital.
Feeling that some people were exploiting the hospital route to LTC admission, many governments refuse to prioritize hospital inpatients for LTC admission, which means that everybody democratically waits an equally long time to get into LTC, even the ones clogging up expensive hospital beds. Further assessments are done, committees decide who gets into nursing homes. This is a waste of time and resources, and harmful to others needing hospital care.
It’s also become a fact that many of those who get into LTC have been on the decline for a long time, so they are nearing the end of life. The average life span for a new admission to LTC here in Nova Scotia is now, as a result, just over a year. You wait months to get into a bed you’ll probably occupy for less than a year! Once you’ve died, your room gets cleaned and sanitized (after your family clean out your belongings), and then the bed is declared available, whereupon a process begins to select the next fortunate occupant. This takes a few weeks, during which the bed sits empty!
As it’s partially government funded (patients are often expected to chip in for their own “room and board” costs, as their finances allow, part of the assessment process involves looking at your finances, as well as your care needs. More bureaucracy!
Finally, you can’t build a nursing home without government permission. As with schools, this leaves them perpetually behind, reactive rather than proactive.
In short, it’s a highly bureaucratic system, much of the (expensive) bureaucracy being there to control costs. Like many things, it probably would work better with the government out of the way.
I was actually thinking about some of your analyses of emergency department bottlenecks while writing this post. The system is unbearably complicated and government certainly isn't always helpful.