[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.