Blatchford Bashes Health Care and Misses the Point [Part II]

[Continued from yesterday.]

In the end, the problem I have with Blatchford’s column is that it seems exploitive of Mrs. Conley and her daughter. I’m not clear Blatchford isn’t using Mrs. Conley to push her own agenda, i.e. Canadian Health Care as the Fifth Horseman of the Apocalypse. In subjecting the case of Mrs. Conley to a somewhat capricious interpretation of facts and events, Blatchford ends up losing sight of the larger point: care for seniors in Ontario is disgraceful, and fixing it will mean higher taxes.

I’ve written on this first point repeatedly. I’ve seen it up close and personal: seniors from nursing homes, euphemistically and erroneously called “Long Term Care Facilities”, dehydrated and septic, poorly thought out advanced directives, limbs rotting away because no one thought to look under the occlusive dressing and on it goes. Services between hospital and community and hospital and nursing home are notoriously poorly articulated. If you need to spend your last years in a nursing home, your lot will often be misery and suffering, unless you have money or excellent family supports.

Hospitals, in particular, are the last and worst place for seniors, yet we continue to warehouse the elderly in acute care beds till we can find a place for them in nursing homes. At Acme Regional Heath Centre, where I work, around 25% of inpatients are frail seniors awaiting placement. Acute care beds are hideously expensive, so this represents an enormous cost to all hospitals. The chances of elderly patients acquiring a nosocomial infection are large, leading to higher morbidity and mortality.

And frankly, while hospitals do acuity well, when it comes to complexity, they suck. You come in with a heart attack or a broken leg or a kidney stone, we will fix you up and send you on your way. These are acute problems and relatively quick to resolve. Complexity takes time, both in practical treatment and care and in disposition. If you’re a nurse on a medical floor, an average frail elderly patient will not be as acutely sick as a heart attack, but requires more treatment in terms of positioning, skin care, managing foley catheters, feeding, restraints, bathing, walking, and medications. Acute care floors are poorly set up to offer this sort of care. If you’re admitted as a Failure to Cope, with a long list of chronic medical problems, social issues, no family to help, maybe dementia, this requires the mobilization of numbers of experts and outside agencies to treat you: not only the regular hospital phalanx of health care professionals, but social work, discharge planning, home care, nursing homes, and of course, family.

However, I can’t say with confidence services delivered by out of hospital providers is satisfactory. Home care in some parts of the province is plainly inadequate and strapped for resources, and nursing homes aren’t much better. Wages and benefits for nurses in home care and nursing homes are abysmal compared to hospital nurses, and one can’t help but wonder if this impacts patient care.

The Ontario government nibbles around the edges of the issue: the Ministry of Health has issued direction, for example, to ensure more seniors are discharged home from hospital to home with adequate community supports, such as help with meals or housekeeping, in-home physiotherapy and so on. There’s plenty of evidence seniors do better at home than being institutionalized. But the bigger problem is that in a system is strapped for resources, improving efficiency and processes can do a lot, but it’s not a panacea.

Unfortunately, in an era when spending and deficits are the focus of all governments, money to build and support the infrastructure necessary to keep seniors healthy and whole will be lacking. It is not just a case of the provincial government not having the political will to properly care for seniors. Do you think any government, of any political flavour, would risk suicide by proposing a substantial tax increase to fund proper services for the elderly?

This is the elephant in the room that no one will talk about: providing proper care for seniors is going to take significant and sustained expenditures now and into the future. In short, good care for seniors = higher taxes. I’m sure it will be a very cold day on Satan’s front porch before you would see Christie Blatchford, or even the editorial apparatus of the Globe and Mail, argue for that.

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  1. #1 by Matt M on Friday 25 June 2010 - 1102

    This is extremely well though out. I appreciate your views, and am thinking about end-of-life care for my parents, myself, and my wife now because of them.

    Is there any hope that the author of the piece will contact you? Probably not, as journalists tend to hit and then move on.

  2. #2 by Bina on Friday 25 June 2010 - 1106

    Oh, but of course. Their panacea for everything is “let the market take care of it”. They conveniently forget that the “market taking care of it”–BADLY–was the reason Tommy Douglas gave us a publicly-funded health system in the first place!

  3. #3 by Art Doctor on Friday 25 June 2010 - 1349

    You might be interested in attending/ sending someone to this conference:

    Great post.

  4. #4 by Luke on Friday 25 June 2010 - 1848

    I presume you caught this article from last week’s New York Times Magazine. If not it’s a must read.

    What Broke My Father’s Heart
    How putting in a pacemaker wrecked a family’s life

  5. #5 by Maha on Saturday 26 June 2010 - 0139

    I really enjoyed reading this series of posts – they’re a great counter-point to the usual hospital bashing stories out there. It’s horrible to have to take care of a frail senior in the ER during a ‘normal’ shift because their care requires a vastly different environment and nursing skill set. When I’m given report that mentions an elderly person waiting for a nursing home placement or a long term care placement, my heart breaks for them because they’re essentially left to rot in the department for several days. Its very difficult trying to get those patients to eat, toilet and change positions continuously while juggling an onslaught of patients in the waiting room. It’s even harder to explain all this to the increasingly dissatisfied families.

  6. #6 by JennJilks on Sunday 27 June 2010 - 1641

    I have written long and hard about LTC. Not all LTC is like this. You only see the worst ones sending their folks to emerg, and many quietly pass in LTC. My father had a dignified death in LTC. It was his doctor and the nurses who wouldn’t give him pain meds in the LTC. I wrote about all this in my book. I think that we need to look at what LTC is doing right. There are many facilities that are well-run. They are mostly for-profit (500 or so out of 600 or so).

    And they aren’t nursing homes, as nurses are few and far between. We must regulate PSWs, they are the ones in some retirement homes, too, who panic and send a resident to hospital.
    Excellent piece!

  7. #7 by Ryan on Tuesday 29 June 2010 - 1444

    Nice blog !

    Our magazine Family Health & Life covers something similar in Canada. Anything and everything that is non mainstream (health, wellness, natural medicine, alternate healing, yoga, fitness, finances).. and everything that gets people thinking or helps them in some way. Your blog post is great !


    • #8 by torontoemerg on Tuesday 29 June 2010 - 2156

      Thanks Ryan

      Can I write for you?

      And will you pay me? :)

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