Close to home

Dr. Elizabeth Christie is a team lead in the Hospital@Home initiative.

Family Health Team launches Hospital@Home

Ontario has just 2.4 beds per 1,000 citizens—about half of the average of European countries. Far fewer than nearly all western nations. Only Mexico, India and Indonesia have fewer hospital beds relative to their population.

Yet with health care costs rising unabated, and just the single solution in response, the Ontario government continues to look for ways to cut beds. Faced with the ongoing pressure of losing beds at Prince Edward County Memorial Hospital, the doctors and the allied healthcare professionals of the local Family Health Team (PEFHT) have embarked on a twoyear pilot program to see if hospital care can be replicated in patient’s homes.

“It isn’t a new way to provide home care,” insisted nurse practitioner Brad Gunn, one of the team leads who have been putting this program together over the past few months. “It is hospital care with daily rounds, nursing, clinical tests and pharmaceuticals, as well as access to most other hospital services.”

All those involved in the patient’s care meet daily via teleconference to discuss care and course of treatment.

The PEFHT launched the pilot program, dubbed Hospital@Home at a press conference last week. Though simple in concept—Hospital@Home requires considerable co-operation and co-ordination between a variety of agencies—each focused on their own tasks and responsibilities.

Nursing care is provided by an agency based in Kingston, with staff living in or near this community. The Community Care Access Centre manages the service, while the doctors and the allied health professional of the County Family Health Team manage the care. It has taken months to work out the service logistics.

But does it make sense? From a care perspective, many folks may well be better served by a hospital care that makes house calls. But questions arise over the transference of caregiving from an institutional setting to a home setting. Are there folks in the home or in the family who can monitor the ill patient effectively? What impact might this have on the health of the caregiver?

And of course the big question is: will it save money? Is it a viable way to ease the overcrowding due to the declining number of beds in the QHC system, specifically at the Picton hospital?

These questions are the subject of a Queen’s University study and report. Researchers from Queen’s are monitoring the pilot program. At the end of the two-year pilot, they will report on the quality of care: was it better or worse? The will also look at the impact on caregivers as well as the cost.

Dr. Elizabeth Christie, president of PEFHT’s directors, said variations of this model have been tried elsewhere with mixed success. Nowhere, to her knowledge, has it been tried in a rural area. Due to the close collaboration of doctors and other health care providers and agencies in this community— many feel that the program stands a good chance for success

So far the Hospital@Home initiative has cared for 27 patients, with the average length of stay of 9.1 days in the program, after which the patients were discharged—either to be cared for at home, or to a another setting.

The average age of participating patients was 73, and collectively the program has saved 246 hospital days. The Hospital@Home program has the capacity to manage the care of 12 patients at any given time.

“By strengthening home support services for frail, elderly and palliative patients and their caregivers, we see increased confidence in their ability to manage at home,” explains PEFHT on its website.

When nurse and team leader Geri Claxton approached Ed White about continuing his hospital care at home, he was a bit wary. He had been in and out of hospitals most of the winter, and unsure that he was well enough to go home.

“I didn’t know what to expect,” said White. “But soon a nurse arrived from St. Elizabeth’s. Overall I felt good about my care. It’s been a long road. But Hospital@Home helped me.”