More rigor to pin down firm dates to discharge elderly patients no longer in need of hospital care, has drastically reduced the number of seniors at King Edward VII Memorial Hospital (KEMH).
Bermuda Real has confirmed the number of seniors who don’t need to be there, has been cut in half since Health Minister Jeanne Atherden disclosed KEMH was “being used as a residence for seniors” left stranded with nowhere else to live.
Citing a “growing trend for the families of these elderly Bermudians to refuse to take them back home”, Ms Atherden said “all 90 beds” in the hospital’s new Acute Wing (ACW) plus “all of the beds in the General Wing were full” six months after the official opening.
In a Ministerial Statement on March 6, 2015, she told MPs the bed shortage forced the Bermuda Hospitals Board (BHB) to add more beds and cancel appointments for elective surgery. The main source of her “distress” – family refusals to take their loved ones home and vacate hospital beds.
Refusing to “take responsibility for their grandparent, parent or sibling”, the Minister said relatives told hospital staff “they were unable to cope with an ageing relative”, or “they don’t have the appropriate resources at home”.
Despite help to find alternative placements, she said some families were “still refusing to make a decision”, leaving more than 30 seniors listed as “long stay admissions” stranded. “They should be at home – with their families in surroundings that provide a degree of comfort they can rely on,” said the Minister.
A BHB spokeswoman said: “There are still about 15 people on the alternate level care wards who could be discharged if there were community placements or willing families to take them home. These beds cost $1,142 per day on a public ward, or $1,367 for a semi-private bed per day.”
Do the math and you’ll find the total costs are astronomical!
Fifteen patients in public ward beds cost $7,994 a week each. Times that by 15, and it goes up to $119,910 a week. If all 15 patients occupy public ward beds that translates into $6.2 million a year.
When contacted in January, the spokeswoman said: “BHB has successfully reduced the number of long term care patients in its acute care wards (in the new wing), and in alternate level care wards in the General Wing.”
Current numbers are “now very low at any time” due to a “focused and effective case management” approach. “Multidisciplinary teams comprising physiotherapists, occupational therapists, doctors, nurses, social workers and the geriatrician work together to discuss with patients and their families how their care is being planned.
“More rigor is now applied to predicting a date of discharge as early as possible so that preparations can be made for an individual to be discharged,” she said. “There is a more efficient discharge to less acute wards within BHB (called Alternate Level Care wards) for patients who might still need some medical care, but are no longer acutely ill.”
Those patients are “referred from a Hospitalist to the BHB Chief of Geriatrics and Palliative Care who oversees the transfer”. “End of life and palliative care referrals are also helping to develop more personal plans of care for patients who wish no further treatment, either discharging them to Agape House or home,” she added.
Meanwhile, the Health Ministry “remains concerned and vigilant about the number of patients whose discharge from the hospital is delayed due to the lack of family support or involvement”.
“We have seen a decline through efforts by various agencies. And we appreciate that the reasons are complex for each case, and for some families there are no other options available,” a spokesman said.
“The Ministry has tried to address some of the need through HIP and FutureCare’s new personal home benefit, which covers assistance at home so that a patient can be safely discharged and the family can have the resources to care for their loved one at home.
“To date, 51 persons have been approved for the benefit, resulting in better care at a lower cost. Other initiatives are also in development to provide further assistance for long term care in the community.”
He echoed “the need for families to play an active role” as the Ministry “works with stakeholders to address the challenges” in what he termed “a shared responsibility” on the “part of this community”.
The Minister acknowledged “the vast majority of families are responsible and caring people” who “look out for and ensure that their elderly relatives are looked after” while addressing MPs.
She also recognized the issue of costs and affordability as the main key factors as “many individuals and families scrimp, save, and sacrifice to make sure they provide for their elders”. But on the flip side she said there were others who don’t “seem to have the same motivation”.
Topping that list where cases of children employed in professional jobs “who will not help cover the cost of their parents’ residential care”. She recalled one senior’s family who “turned their collective backs and said, ‘They are not my problem – YOU find them somewhere to live’.”
Faced with skyrocketing healthcare costs in an ageing community, Ms Atherden stressed that “long stay social admissions” ultimately carries a heavy price tag for the entire community.
A 75-year-old senior citizen who cannot be discharged even though no hospital care is required racks up a monthly $34,000 hospital bill. If they’re insured 20 percent, or $6,800 is covered by FutureCare – the remaining 80 percent comes out of the Consolidated Fund in the form of Hospital Subsidy.
That’s a big chunk of change forked out by local taxpayers to the tune of $27,200, each month a senior citizen over the age of 74 remains hospitalised. “That’s a real unnecessary cost to the public purse,” said Ms Atherden. “It’s clear that money and services may be impediment to ageing at home.”
Turning that goal into a reality goes far beyond drafting more legislation in her view. The bottom line said the Minister: “There has to be a better way to address this than by trying to legislate caring.”
By Ceola Wilson