Flurmedizin dominated the last two election campaigns in Ontario.
Voters had a choice between politicians who promised quick fixes for our clogged hospitals.
Now take your poison.
There are no easy cures for the long-term problems of long-term care. And no painless prescriptions for the short-term crisis in acute hospitals.
Under pressure to take action, the Ontario government says it can evict hundreds of so-called “bed blockers” from overcrowded hospitals, who are accused of occupying up to a third of all wards. The plan calls for patients to be moved far and wide to available nursing homes if they can be discharged — or face $400-a-day fees if they don’t agree to a move.
Ontario’s hospital bosses are firmly behind the move. Unless much-needed ward beds are vacated quickly, a looming surge in flu and COVID cases will spark even more hallway medicine this winter.
Fair enough? Completely unfair, counter the critics.
Opposition politicians accuse the government of a cruel shell game and point out that there are too few beds in many nursing homes – hence the traffic jam. Her argument is that charging a onerous per diem fee amounts to putting older people in facilities that are not their preferred choice and one cannot blame patients for waiting on waiting lists in hopes of getting a coveted spot to get.
Choose your panacea.
The government claims it can solve the problem by billing bedblockers – although there are limited brokerage options. Patients have to choose, they say.
The opposition accuses the government of imposing hardships on seniors – without offering a serious alternative to deal with the ongoing hospital crisis. Patients have no choice, they claim.
But living and saving lives involves tough choices. This applies to individual members of the public, but also to political decisions that affect everyone.
Ontario lacks capacity both Acute Hospitals and Long Term Care (LTC) Facilities. In fact, the deficits have been a long time coming.
All three major parties (and many outside experts) called for efficiency gains in a healthcare system whose costs were spiraling out of control. They tried to turn doctors into gatekeepers, limited the number of study places and kept capacities lean.
But they didn’t bet on COVID. Nor were they ready, even before the pandemic, for a new spike in old-fashioned flu cases that sparked the first wave of hallway medicine with patients stuck on stretchers outside of crowded infirmaries.
Likewise, long-term care has received relatively little attention from all political parties in power, all of whom have relied on the private sector to fill the gaps. Now we are all paying the price for years of willful care home neglect.
With a waiting list of 39,000 names for LTC, finding open spots for these hospital bedblockers won’t be easy. But that doesn’t mean the government has to throw up their hands and do nothing until that list is cleared.
The reality is that both systems, short and long term, are deadlocked for the foreseeable future. Something has to give way, sooner rather than later, and that’s where the hard truths of triage come into play.
Triage can seem heartless, but it can also save the lives of heart attack victims who need help more urgently than those who don’t. It’s understandable that people who can’t make their first few decisions might want to wait until their preferred facility is available, but that doesn’t make the status quo tenable at all costs.
Sometimes personal preferences must give way to public necessity, even when it means undeniable private hardship. After all, you can’t direct an ambulance to take you to a preferred hospital – you’ll go where you’re taken based on availability.
Yes, it feels unfair that people can be shipped to care homes up to 70 kilometers away (even further north), putting family members out of the way. But it’s also unsustainable to block a bed until they get their way.
Still, there’s good reason for the government to reconsider its plan to make patients pay the full fee for costly medical referrals to remote facilities so they don’t get penalized twice. If a nursing home is not on a person’s list of preferred destinations, the Department of Health should make up the difference in costs.
While hospitals have long been allowed to charge per diems for overstay patients — and other provinces already allow it — the latest laws and regulations will legitimize the practice. Hospitals aren’t monstrosities, they’re healthcare providers, and as such it’s to be expected that they’ll enforce all fees with discretion and humanity (they’re not-for-profits, after all, not the dreaded profiteers critics rant about). the nursing home sector).
These measures are not the end of the world. You won’t finish corridor medicine either.
More than crisis management in healthcare, there is an element of political “problem management” at play. You have to see the government do something – anything.
Both sides pose. But doing nothing will get us nowhere as flu season approaches and COVID spreads.