Seniors on stretchers: a health care disgrace

Posted on in Health Delivery System

TheGlobeandMail.com – Globe Debate
Sep. 23 2014.    André Picard

Can we truly claim to have a modern, humane health system when we leave frail, frightened, elderly people for hours, even days, on gurneys in hospital emergency departments?

It’s an uncivilized, disrespectful and disgraceful practice. Yet, it’s been going on, to varying degrees, since the 1970s and, as the population ages, it’s getting worse, not better.

The most recent evidence we have comes from Quebec, where Robert Salois, the provincial health and welfare commissioner, has just released a new report in which he traces the “evolution” of emergency care in the province over the past 10 years.

It makes for chilling reading, especially if you have a loved one like a frail elderly parent or grandparent who routinely needs medical care.

There are two types of patients in hospital emergency departments : 1) The ambulatory who are able to move about and sit to wait for care, and; 2) the non-ambulatory, meaning they need a bed or stretcher, and usually come in by ambulance.

In Quebec last year there were 3.4 million ER visits, including 2.3 million ambulatory and 1.1 million non-ambulatory patients. (Canada-wide, it’s 14 million visits, with roughly the same two-thirds, one-third split.)

According to Quebec’s health and welfare commissioner, the ambulatory spend, on average, 4.6 hours in the ER. Almost all are discharged home, none the worse for wear (and waiting).

The non-ambulatory are a different story.

The true emergencies, the trauma cases that are a mainstay of prime-time TV, have an average wait time of fewer than 10 minutes from the time they hit the ambulance bay. Perhaps we should take some comfort in that, but these “code blue” cases make up fewer than one per cent of patients.

Most people who come to a hospital emergency department by ambulance will be triaged and treated relatively quickly, but then they will wait.

These non-ambulatory patients, most of them frail seniors with chronic conditions like COPD or heart disease, wait, on average, 18.4 hours in the ER.

Remember, that’s an average; waits of 24 to 48 hours are not uncommon. We stick them in hallways, behind curtains or in transformed broom closets. These patients, in their 70s, 80s and 90s, are essentially living on a gurney for days with little or no access to meals, toilets or privacy, and they are often alone.

In fact, the seniors-on-stretchers meme is so commonplace that we take it for granted. The media coverage only tends to start once someone’s grandmother has been in the ER for 72 hours or more.

Mr. Salois calls the situation “preoccupying” – an understatement if there ever was one – and says policy-makers should be compelled to act, for humanitarian as much as economic reasons.

The commissioner makes the point that waits in the ER are not the fault of the ER. The endless bottlenecks are due to problems upstream and downstream. In other words, it’s an engineering issue, not a medical one.

The commissioner estimates that 60 per cent of patients who go to the emergency room should not be there at all.

They should be treated in primary care, by physicians or nurse practitioners. But lots of people don’t have a regular doctor and very few of those who do can get same-day appointments for urgent (but not emergency) problems.

Healthy people wasting a few hours in the ER waiting room is not, in the grand scheme of things, a big deal, though it does not make for good continuity of care.

The real worrisome situation is that of the non-ambulatory patients stuck in ER purgatory.

Some of the gurney-bound are waiting for a hospital bed, but only about one-third are admitted to hospital. Beds are in short supply because there are many frail seniors already stuck living in hospital with nowhere to go for lack of home care or long-term care beds.

The majority of elderly ER patients have the same dilemma: They’re not sick enough to be hospitalized, but too sick to go home alone, or back to a nursing home where there is no medical care.

It’s a perverse scenario that plays out daily and with increasing frequency.

But we know the solution.

We don’t need bigger ERs. We need to shift resources from hospitals into primary care for the ambulatory and home care and community care for the non-ambulatory.

Until we do, our parents and grandparents will continue to fill emergency departments and fester in hospital hallways, gasping for care.

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2 Responses to “Seniors on stretchers: a health care disgrace”

  1. Greg Lesli says:

    The comments are just the tip of the ice burg. Canadians beware, the misery of wait lines has only began. One of the reasons many elderly arrive at hospitals by ambulance is because they cannot get to see the specialist they need for up to two years. I am 70 and diagnosed with severe spinal stenosis and inflammation in my sacroiliac joints. My family doctor sent an urgent referral to Dr. Gurr in London in May 2015 (no response). In late August My neurologist (neuropathy) in London sent Dr. Gurr a report that included that I should be at the top of the list for treatment. In October of 2015, I was given an appointment with Doctor Gurr for December 2016. Considering the wait time for surgery in London is 348 days, I would be lucky to get the surgery I need after a 2 year wait. My wife had a terrible torn tendon in her shoulder. Wait time for surgeon 9 months, operation up to a year later. OHIP’s response, and I quote, “it is not and unreasonable wait time”. The surgeon in Michigan said if she had waited two years she would have lost the use of her arm. OHIP would not pay.I would have much rather contributed the large amount of money to our local hospital foundation. I was referred to a pain clinic in May 2014, my appointment is October 27th. I waited 12 months in 2012 to see an eye specialist at Ivey in London for my severe dry eye syndrome. I attended another pain clinic at St’ Joseph’s hospital praying for earlier help dealing with my pain. Got a call several days later that the doctor Clark would see me in March 2016. I will not be here when people start dying from lack of care. I keep telling my children and grand children if they do anything with their lives….stay healthy, the nightmare has only begun. Why did I contribute through my taxes for 55 years to healthcare that is no longer available???? Twenty years ago I was telling everyone I could that THE PEOPLE had to start making copayments for all services or we were in big trouble…well, we are, good luck.

  2. Having worked alongside social workers in hospital for several weeks now and seeing many seniors on gurneys in hallways, I would have to agree with the author of this article. Not only are they waiting in open, public spaces in the emergency room, when and if they make it to another unit in the hospital for continued care, they are sometimes left with no other option than a bed in the hallway. Some lay in nothing more than a thin hospital gown with a blanket, left to eat their meals, receive care from nurses, and have conversations with their doctors in the open for anyone passing by to see and hear. On one occasion an elderly lady who had been diagnosed with social anxiety was placed in the hallway because there were no other beds available on the unit. The patient frustrated staff when she became “behavioural”, but who could really blame her. It is a very undignified way to receive necessary medical care especially with such a frail, vulnerable population.
    Part of the problem seems to be, as this author pointed out, the lack of community services and facilities to accommodate those with special medical needs such as non-ambulatory patients. Inequalities are highlighted in the hospital setting when a patient has no one to care for them, no resources, and nowhere to go. Social workers and discharge planners scramble to find a solution because they must work against the clock as hospital higher-ups count on beds being cleared in a timely fashion. Perhaps money is unnecessarily spent on state of art hospital facilities with beautiful architecture and art work when it should be used to meet the ever increasing need of housing with specialized care for our growing senior population.
    Teresa Harris

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