Sudbury explores creative ALC strategies

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The Sudbury Alternate Level of Care Community Steering Group and the North East Local Health Integration Network (NE LHIN) have received the green light from the Ministry of Health and Long-Term Care to use Memorial Hospital as a temporary care site for Sudbury Regional Hospital's alternate level of care (ALC) patients.

The Memorial site will house 136 ALC patients for an interim period of up to 12 months following the hospital's long-awaited one-site consolidation in early 2010.

Crisis levels

The transition will help alleviate some of the city's ALC problems, which reached crisis levels last year when the number of ALC patients peaked.

"Thirty per cent of the acute surgical medical beds were occupied by ALC patients," said Dr. Peter Zalan, Sudbury Regional Hospital's chief of critical care and co-chair of Sudbury's ALC Community Steering Group. "People got very upset so we felt we had to do something."

Another wrinkle in the fabric is that the new hospital will have 36 fewer acute medical surgical beds than the current hospital's capacity and was not designed to accommodate ALC patients.

Aware that the problem would only get worse, a steering committee was formed last December to try to resolve Sudbury's ALC problems. It is made up of representatives from the Sudbury Regional Hospital, North East LHIN, City of Greater Sudbury, St. Joseph's Health Centre, the Community Care Access Centre, community volunteer service organizations, gerontologist Dr. Jo-Anne Clarke and former MPP and mayor Jim Gordon.

"We felt the only way to get some kind of positive resolution was to act together and pool all of our resources and abilities to speak as one voice - as a community," said Zalan. 

Sudbury's increase in alternative level of care patients didn't occur overnight. It is a symptom of a national shift in demographics. The elderly are outnumbering young people across Canada because of an aging boomer population. Zalan described it as a totally predictable problem and anticipates other LHINs across Ontario will experience similar issues.

"We knew that the population was aging. Demographically, the projections were there," he said. "It was no surprise to anyone, but nobody was burning down the barn and there were always other things to spend money on."

Currently, in the Sudbury area alone, there are 900 people on the waiting list to get a bed in long-term care nursing home, according to Kim Morris, director of communications and public affairs, Community Care Access Centre. These staggering numbers are comprised of three groups: people from the community, those already in nursing homes awaiting their first choice, andALC patients.

Since the formation of the committee, there have been a host of creative solutions to deal with Sudbury's elderly population. The opening of two long-term care facilities is being viewed as part of the solution, according to a NE LHIN press release.
 

Aging population

The North East LHIN has the second highest proportion of seniors aged 65 plus. It is projected that this region will have a 24 per cent increase in its senior population between 2006 and 2016. With that in mind, the steering committee developed a 10-point priority plan.

"We're looking at this problem from every angle. It is a multi-faceted approach," Zalan said. "The idea is to have a whole range of services so you get the right service for the right person in the right place, because different people have different needs."

Some of the programs promote prevention to keep people healthy so they avoid becoming ALC patients. One example is the Aging At Home program, which employs the Identification of Seniors-at-Risk tool to assess seniors who enter a hospital emergency department to determine if they could be returned to their homes with a suitable level of support to maintain their independence.

Through this program, Sudbury Regional Hospital screened about 4,400 patients. Eighty per cent were assessed as high-risk seniors, of whom 30 per cent had some type of intervention. The intervention may have been education about help lines or meals on wheels. Some asked for assistance or direct referrals to services and some agreed to a referral to the North East Community Care Access Centre.

The City of Sudbury has submitted a proposal for six housing projects under the Canada Ontario Affordable Housing Program, which was designed to help develop affordable housing.

Denis Desmeules, Greater City of Sudbury's manager of housing services, said two of the six proposals were for supportive housing units, a 79-unit project for Sudbury and a 64-unit project for Walden. These units would provide a level of care that would meet seniors' needs that require more than home care, but less than a long-term care facility offers.

Another preventative program is the Nurse-led Outreach Team, which is being piloted at Pioneer Manor. It involves nurse visits to assess, order tests and deal with patient problems to avoid visits to an acute care facility.

ALC wrap-around services have accommodated some elderly people by placing them in private retirement homes with the assistance of a government subsidy.

A task force is being set up to look at specialized services like rehabilitation in northeastern Ontario. Zalan emphasized the importance of immediate rehabilitation as a way to avoid functional decline by seniors who suffer fractures. "It is critical early in your illness that once you start getting better, you are intensively rehabilitated," Zalan said, but unfortunately, the North East LHIN area is deficient in those services.

Human resources and the shortage of workers who provide support to aging people is another issue under consideration.

"There is already a shortage of personal support workers," Zalan said.

"We will require more of these people, more occupational therapists and physiotherapists, more nurses, etc. Then we will have to train people, so we have another committee meeting with Cambrian College and the university to see what kinds of enrolment and plans are required to meet the human resources needs of the future."

As more people enter into their golden years, the ALC steering committee will continue to move aggressively and implement a variety of projects to cope with the region's aging population.

Zalan is pleased with the committee's outcomes achieved thus far.

"I think it is pretty exciting that all these folks with different backgrounds are working together, involving the city and the province and coming out with positive results."  


www.nelhin.on.ca/Page.aspx?id=824
www.ccac-ont.ca
www.city.greatersudbury.on.ca