Friday, February 20, 2009

wait times

A much-lauded announcement, dulled only by the arrival in Ottawa of President Obama! A major newswire release: Ontario Health Care Wait Times. The Ontario Government is providing options to those who require health care - alternatives to crowded emergency rooms.
  • Family Health Care Providers
  • Family Health Teams
  • Walk in Clinics
  • Community HealthCentres
  • Telehealth Ontario
I must admit to some skepticism. It remains, at best, rhetoric, as this article on Mental Health Care says. Marion Wright, of CMHA says, "Two areas need attention. First, case-management services. Second, safe, affordable, supported housing." To demand that hospitals decrease wait times, with a dearth of health care professionals at all levels from PSWs (in LTC and for Home Care) to nurses to family physicians does not seem possible. We lack human and physical resources, at this point. An emergency room doctor, in a small town, interviewed by CBC explains that wait times mean nothing if you are waiting for tests for more complex issues, i.e., cardivascular issues. The tests require repeating for certaintly. It is hospital beds that we are in desperate need of...

This chart shows the baseline data, hours spent in emergency waiting rooms, from which they will aim at improving:
It is important to establish data. But we know from education that simply testing, and demanding improved test scores (through EQAO), will not improve the delivery and mastery of curriculum. The confounding factors are too immense: language barriers, poverty: poor nutrition, lack of support services, limit the ability of a student to learn. Similarly, by simply reporting on wait times, we are not going to decrease them without interventions.

The government suggests that their proposed interventions will work: a Hospital Performance Fund, Process Improvement Programs - to increase patient flow, Dedicated Nurses to ease ambulance offloads. The latter will simply release EMS crews to go back out on the road, and will not increase the number of beds.

"Measuring and reporting the time patients spend in ERs - collecting
information, reporting the time people spend in the ER on a public
website, measuring and rewarding improved performance, so that
Ontarians can see the steady progress being made."
This is the means by which the political beast can tell us that they are doing a good job. It will result in hospital shopping, such as we have seen in schools where parents shop for houses in areas where schools have good test results. It won't help those who have no choices and no options.

The most complex problem are those who require Alternate Levels of Care (ALC - or bed blockers), those who cannot go home to recuperate, who have comorbidities that preclude simple Home Care, or may not be able to recover from illnesses or diseases. Chronic care is a huge issue. One is discharged as soon as possible, with Home Care, or other supports in place. Going home may not be an option.

The government plans on spending $94 million on the Aging at Home Strategy, this is not entirely new money. This process began in 2007, on a 3-year, $13 million budget that has not transformed health care for seniors. They plan on spending more money on Personal Support Workers (PSWs), and homemaking services. In the meantime, we do not have enough trained workers to fulfill these roles. The same issue is a problem for nurses and physicians. The announced development of 1750 new LTC beds across the province will not magically appear.

With more than 500 for-profit LTC homes in Ontario, out of 640 or so, we have no assurances that these homes will be able to a) find enough employees and b) deliver the quality care that our aging population deserves. I remain skeptical! Seniors still need a basket of services from transportation, Home Nursing care, Meals on Wheels, homemaking, driveway shoveling, and many other ADL and IADLs, that simply are not available on a dependable, consistent, reliable basis from any coordinating agency. CCAC, through the LHINs cannot manage such coordination of services. When we deliver our Meals on Wheels, we do the sidewalk, phone for a snowplow, arrange for transportation to doctor's appointments. There are huge gaps across the province that remain unmet.

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