Series on Health Care for Elderly, Part 3:
Interim Solution to Bed Crunch?

Officials hope regulated nursing home spaces for ailing elderly will ease hospital overcrowding

By Pauline Tam, The Ottawa Citizen

February 18, 2010

Canada

On the third floor of the newly opened Valley Stream Manor are 74 beds that regional health officials hope are a partial answer to overcrowding, cancelled surgeries and long emergency-room waits in Eastern Ontario hospitals.

And in a region with the province's longest waits for nursing-home beds, but a surplus of high-end retirement homes, the beds are seen as a short-term fix for a lack of affordable and supportive housing for seniors.

The 74 beds are reserved for elderly patients while they wait for permanent spaces in nursing homes. Instead of occupying hospital beds that are desperately needed by surgical and emergency patients, select seniors are transferred to Valley Stream Manor's custom-designed unit, located across from the Queensway Carleton Hospital.

Unlike the rest of the home, the third floor is a provincially licensed area for elderly patients in need of "interim long-term care." That means it is expected to have all the facilities and round-the-clock care available in a nursing home. 

Provincial Health Ministry inspections are to ensure standards are followed and that any care gaps closed.

Historically, Ontario's 533 interim long-term-care beds have been in hospitals or licensed nursing homes, which are funded and regulated by the government. 

Valley Stream Manor is among the first in the province to operate as a partially licensed retirement home.

The arrangement appears to meet the call by Dr. Andrew McCallum, Ontario's top coroner, for tighter controls on such private-care facilities after his office investigated the 2008 death of an Ottawa woman.

The 92-year-old died in part because she was moved from the Queensway Carleton to the Prince of Wales Manor, a retirement home in the city's southwest that, at the time, was not licensed to provide the same level of care as a nursing home.

According to provincial inspections of the retirement home conducted two months after the elderly woman's death, the facility fell short in a number of areas.

Among other things was a shortage of properly trained staff, including the lack of a registered nurse on duty 24 hours a day, seven days a week, as required under provincial regulations. Also absent was a director of care who could deal with any complaints raised by patients or their families, said the report obtained by the Citizen.

Officials at the Prince of Wales Manor said they voluntarily submitted to the provincial inspections to determine what services and standards were needed to bring the care to the same level as a nursing home.

Since last September, when McCallum issued his report, Ontario's Health Ministry has moved to close the regulatory loopholes and start licensing facilities such as the Prince of Wales Manor, said Dr. Roger Skinner, the regional coroner for Eastern Ontario, who reports to McCallum.

Health Ministry spokesman Andrew Morrison said the chief coroner's recommendations are being taken "quite seriously."

Valley Stream proprietor Frank D'Amato, who also owns the Prince of Wales Manor, said he's encouraged that the ministry is "working with us and supporting the project."

Last month, Valley Stream Manor began accepting patients discharged from the Queensway Carleton and The Ottawa Hospital. The hospitals, along with the Champlain Local Health Integration Network, the region's health authority, are providing $3.6 million over the next year to fund the 74 beds, as well as the staff and services that are supposed to come with them.

Valley Stream Manor will also receive co-payments from each patient who is transferred there. The payments, up to $19,000 a year, are equivalent to the base rate for a licensed nursing-home bed.

D'Amato recently gave the Citizen a tour of Valley Stream Manor's third floor, and pointed to a number of features and practices he said had received the ministry's stamp of approval. His statements were supported by the most recent provincial inspection reports of the facility, released to the Citizen by 
Valley Stream Manor and the ministry.

The reports showed that between Jan. 18 and Feb. 4, Valley Stream was visited three times by provincial inspectors.

On the first visit, the day before Valley Stream began accepting its first hospital patients, inspectors noted that, with a few exceptions, the facility's third floor met the standards of a licensed nursing home.

Among other things, it had a designated administrator and director of care to oversee all residents and any problems that arise. And a "specialty-care" firm had been contracted to provide education and support to the home's administrators, nurses and support staff.

Also in place, as required by regulation, were a formal system to document the care plans of each resident, a registered nurse on duty around the clock, official nursing policies and procedures, and pharmacy and equipment services. 

Additional patient visits by a nurse practitioner and social worker from The Ottawa Hospital had been arranged.

Subsequent visits by inspectors showed a small number of practices had not been put in place. They included a system to weigh and measure the height of each resident regularly; ministry-approved menus of meals and snacks; and an infection control and surveillance program.

The region's health chief maintains the lessons learned from the Prince of Wales Manor are being applied to Valley Stream Manor.

"We're very confident that the care here is going to be as good as it is in any long-term-care home," said Dr. Robert Cushman, chief executive of the Champlain LHIN.

He is keen to develop similar partnerships with other area retirement homes. He said interim long-term care provides better environments for the elderly, who risk losing mobility and contracting infections the longer they remain in hospital.

Compared to a space in hospital, which costs more than $1,000 a day, a retirement home bed, even subsidized, is far more affordable at between $150 and $250 a day, he said.

Susan McDowell, a Queensway Carleton administrator, said the interim-care program has cut down cancelled surgeries at the hospital. And the waits for emergency patients to be admitted to acute-care beds have dropped from nearly nine hours to less than two, she said.

Nonetheless, McDowell acknowledged that transferring elderly patients to retirement homes is an imperfect solution. "If we didn't have to have an interim placement, we wouldn't. (But) the system itself doesn't have enough subsidized assisted-living, long-term care homes, et cetera. So we have to have that interim spot so that we can continue our acute-care business."

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