Treat ailing elderly as patients not ‘bed blockers’
TheStar.com – opinion/editorialopinion
Published On Fri Jan 07 2011. Michael Hurley, President of the Ontario Council of Hospital Unions
Four years ago, my mom — blind, sick from heart disease, but fiercely independent — fell in her apartment. My sister found her unconscious two days later.
She spent three weeks in hospital. Her final days of life were spent as a “bed blocker.” This came with a spate of indignities. Fluids weren’t pushed, vital signs weren’t taken. Blood work wasn’t done. She wasn’t toileted and became incontinent — a complete humiliation for her.
She deteriorated rapidly, but there was a steady push on our family to send her home or to a nursing home. Even though my sister — a nurse — advocated daily on her behalf, she was neglected in our health-care system.
When she slipped out of lucidity and out of consciousness, tests were done and we were called to see a cardiac surgeon. He told us that my mother had had two undiagnosed heart attacks while in hospital and now was too weak for surgery. He was very kind and apologetic. She was dead within 36 hours.
Like my mother, many elderly patients are acutely ill. But the general assumption is that they are wasting precious health-care resources. Since these patients are often long-lived, and since few families complain in the fog of their grief, the active discrimination against this age cohort passes unnoticed.
Ontario’s hospitals are operating over their capacity. Nineteen thousand beds have been closed over the last 15 years. In Sudbury, patients sleep in broom closets. Ours is the most efficient hospital system in Canada — operating with $260 fewer dollars per citizen, with the shortest lengths of stay and the fewest beds and staff per capita of any province.
Successive governments in Ontario haven’t had the courage to take on the doctors or the drug companies or the private care corporations, which are driving up health-care spending. So most of the efficiencies have been made in the already efficient hospital sector, where a permanent revolution has been in effect for 20 years, with ongoing restructuring, downsizing and privatization. Now, war has been declared on the “bed blockers” so that another 5,000 beds can be closed.
But the real problem is that too many hospital beds have been closed. There aren’t enough beds for all of the acutely ill people who need them.
At 90 years old, with congestive heart failure, diabetes and arteriosclerosis, Alice MacPherson was given two months to live by her doctors. She needed palliative care so that she could die as peacefully as modern medicine will allow. A Windsor hospital threatened to bill her $600 a day — they needed her bed and they wanted her out. There is no compassion and there is no empathy.
The fact that MacPherson was dying didn’t matter to the hospital or appear to matter to the Ministry of Health. What mattered was getting her out of hospital and into a nursing home or retirement home where, guaranteed, there is less care than needed in her last days.
MacPherson belonged in hospital. So did my mother.
For those patients who are pushed out, they are sent home where home care is increasingly difficult to get and where caregivers turn over at the rate of 57 per cent a year. The government’s “Aging at Home” strategy might as well be the “Aging Alone” strategy.
In a cruel twist, hospital patients are now being sent to retirement homes. The Toronto Stardid a great service with its investigation into the deaths of two residents at a retirement home in Toronto. Retirement homes are not regulated and they are run for profit.
A meta-analysis of death rates in public and for-profit hospitals and dialysis clinics by Drs. P.J. Devereaux and Gordon Guyatt, published in the Canadian Medical Association Journal, found higher death rates in for-profit facilities because the owners skimped on regulated staff and/or on supplies like blood-cleaning products.
Danny Henderson, unable to feed himself, should never have been sent to a facility as understaffed as the retirement home he was discharged to. This “bed blocker” died of severe malnutrition, according to the coroner who did his autopsy.
The retirement home that Henderson was discharged to had no toilet paper. Residents used their hands to wipe themselves and shared a communal towel. The posted menus bore no resemblance to the meals served.
And yet the Ministry of Health continues to force the discharge of hospital patients to retirement homes and pretends that this case is an anomaly.
Two years before Mr. Henderson’s death, another “bed blocker,” discharged from an Ottawa hospital to a retirement home, was found frozen to death in a field near the facility. No one noticed she had wandered off.
Families whose moms and dads are being pushed out of hospitals when they are too sick to leave should call out publicly for help, as Macpherson’s son has done.
Physicians have a responsibility to reassess their role in discharging acutely ill patients.
Hospital staff, too, must step up and defend the generation that fought World War II and built medicare. They deserve our best efforts to make them well.
If that’s not possible, they deserve a kind and gentle, attentive and loving end of life. They don’t deserve the dehumanization foisted on them by governments’ health policy choices that underlie the “bed blocker” label.
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