It's a little after 10 a.m. and a group of 15 elderly men and women with Alzheimer's disease and related dementias are sitting at a table in front of a large picture window, doing crafts. The delicious smell of muffins wafts in from the nearby kitchen.
The Alzheimer Society Sudbury-Manitoulin runs a day program for those with the degenerative neurological condition in a newly-renovated, $2.1 million facility at Pioneer Manor in Sudbury.
"It's a homey, comfortable, pleasant place to come for the day. It's sort of like a club. It gives the family members a rest so they can recharge their batteries and have the energy to take care of their loved ones," said Patricia Montpetit, executive director of the society.
Her organization also administers a number of other services, including an in-home respite program supplying personal support workers for families at subsidized rates.
It also offers support groups, counselling, a wandering registry, a resource centre and public education.
It operates through provincial government funding, donations and some user fees. The organization recently received $18,000 from the North East LHIN to hire two part-time family counsellors.
Community support programs such as these have been pinpointed by the North East Local Health Integration Network (LHIN) as one of the solutions to the Alternate Level of Care (ALC) crisis.
ALC patients are those who no longer require acute care in a hospital, but continue to occupy hospital beds because they are waiting for placement in convalescent, palliative or long-term care facilities, which are scarce in most northern communities.
Their numbers have been increasing in Northern Ontario over the last few years, especially in the northeast.
"How we fit in with the ALC strategy is we help to prevent crises that would result in admissions to hospital and long-term care placements," said Montpetit. "We help to keep people in the community for longer than would otherwise happen."
Beds
According to statistics compiled by the Ontario Hospital Association in January and February 2008, ALC patients occupy an average of 25 per cent of the beds in acute care hospitals in the North East LHIN.
This is the second highest level of ALC patients in the province, behind the Hamilton Niagara Haldimand Brant LHIN, where ALC patients occupy an average of 27 per cent of hospital beds.
The North West LHIN is tied for third place with the Waterloo Wellington LHIN, with an average of 24 per cent of hospital beds being occupied by ALC patients. The average in Ontario is 19 per cent.
ALC levels are particularly high in the northeast because it has a large elderly population with complicated health conditions, said Remy Beaudoin, CEO of the North East LHIN.
In March 2007, the North East LHIN set up four ALC task forces to study the issue in Sudbury, Sault Ste. Marie, North Bay and Timmins, where there are extremely high levels of ALC patients.
The task forces consisted of representatives of hospitals, long-term care facilities and community support services, as well as other affected health-care agencies.
"Our purpose was to bring around the table all stakeholders that could be involved in clarifying the situation," said Beaudoin. "We wanted the stakeholders to not only be good at defining the problem itself, but be instrumental in implementing the solutions."
They came back with a jointly-written 200-page report in December 2007, which pointed out 74 strategies to improve the situation. The North East LHIN has since compressed the recommendations into a 10-page action plan with six strategies.
The six strategies outlined in the LHIN's action plan are:
-Improved health programs for seniors at home (such as respite programs for caregivers similar to those provided by the Alzheimer Society Sudbury-Manitoulin)
-Prevention of senior admissions to hospital emergency departments (through enhanced case management, for example)
-Accelerated discharge of seniors after completion of acute episode (with a promise to explore opportunities for flexible funding tailored to individual client needs)
-Appropriate community settings and seniors' programs within those settings (the LHIN will further explore how many long-term care, convalescent care and hospice beds, and supportive or rent-geared to income units are needed, and how these will be funded)
-Improved hospital performance related to seniors (for example, looking at implementing social programs in hospitals for ALC patients who are unable to be placed in the community)
-Improved health system performance (such as measuring investment impacts on reducing ALC numbers)
Through these measures, the North East LHIN hopes to reduce ALC numbers by 25 per cent each year for the next three years, said Beaudoin. By the year 2010/11, the average hospital in the northeast should have no more than 13 per cent of beds occupied by ALC patients, he said.
Funding for ALC is going to be handed out as the North East LHIN receives it, Beaudoin said.
Close to $2 million in resources already available to the North East LHIN was given to various organizations between December 2007 and the end of March 2008.
More money from next year's budget will be put towards reducing ALC numbers, he said.
The North East LHIN is also set to receive funding from the province's new aging at home strategy, said Beaudoin.
This funding totals $4.2 million in 2008/2009, $10.6 million in 2009/2010, and $18.8 million in 2010/2011.
A more in-depth study of how many additional long-term care, convalescent care and hospice beds, along with supportive or rent-geared-to-income units are needed will be released in April or May 2008, he said.
Surgeries cancelled
Sudbury Regional Hospital has been struggling with high numbers of ALC patients over the past few years. Because of the problem, elective surgeries have been cancelled on numerous occasions at the hospital and the emergency department is chronically overcrowded.
At any given time, approximately 25 to 28 per cent of the hospital's 507 beds are occupied by ALC patients.
But things may get worse when the city's one-site hospital is completed in late 2009. The new hospital will have only 439 beds, as it is being designed without capacity for ALC patients.
"We've been sounding the alarm bells for the last three years saying we're not going to be at zero ALC in our new facility. What are we going to do?'" said Sudbury Regional Hospital CEO Vickie Kaminski.
"We don't want to be building a new facility, closing the doors on the other sites, and saying we have no room for everybody, and we're in worse shape."
"We're asking for some flexibility and planning and consideration of additional space. We're also forging ahead with the LHIN with their report to get some of the solutions in place right away."
The Timmins and District Hospital is also hard hit by the problem. At one point in February 2008, there were so many ALC patients that 185 patients had been admitted to the hospital, despite the fact that the facility only has funding for 159 beds.
The hospital successfully petitioned the North East LHIN for a Crisis 1A designation to be implemented in Timmins, meaning that ALC patients might be placed in any long-term care facility within the district.
While hospital CEO Esko Vainio said he hopes the LHIN is able to meet its goal of reducing ALC patients by 25 per cent per year for the next three years, he predicts it's going to take a lot of work to make it happen.
What Timmins really needs is 64 more long-term care beds, although the $240,000 recently given to the hospital by the North East LHIN to assess seniors at risk and avoid hospitalization will help to alleviate the situation, he said.
Vainio has met with Minister of Health and Long-Term Care George Smitherman to speak about the ALC crisis on numerous occasions.
"Even if the health minister were to approve the 64 long-term care beds by spring, it would still take two to three years to have them constructed and opened," he said. "This is the light at the end of the tunnel as our health-care team is dealing with these crises on an ongoing basis."
Northwest
In Northwestern Ontario, the greatest ALC pressures are at the Thunder Bay Regional Health Science Centre. This is because patients in the northwest needing complicated care have no
choice but to go to Thunder Bay, said Gwen Dubois-Wing, CEO of the North West LHIN.
A report on the ALC crisis in the Thunder Bay area was written a few years ago, and the North West LHIN is moving forward with implementing its recommendations, she said.
Much like the report and action plan recently released in the northeast, it partly focuses on how patients can be kept in their homes for a longer period of time.
"People think that by throwing money at this, it will deal with the problem. The reality is we need to look at how we do business differently," she said.
"We need to look at the best configuration of services for people, and what would keep people in their homes so they don't end up in a situation where they're an alternate level of care client, and ultimately need a long-term care home."
www.alzheimersudbury.ca
www.oha.com
www.nelhin.on.ca
www.tadh.com
www.hrsrh.on.ca
www.northwestlhin.on.ca
