Lost in the spreadsheet

She has lived her entire 82 years in Milford. She raised her family here. Watched them grow up, go off and have their own families. Her health has been failing in recent years but, other than general fatigue, she doesn’t feel that bad. She volunteers a couple of times a week at the hospital, she has seen much worse. But the cough she’s had for weeks has turned into pneumonia. It has become work for her to breathe. Her nurse practitioner admits her to Prince Edward Memorial Hospital. She knows the place well, has many friends there but doesn’t like being a patient. Doesn’t want to be a bother.

According to the Ministry of Health, a clock starts ticking the moment my hypothetical Milford resident lays her head upon the Picton hospital pillow. Better hospitals in the province can process (treat) pneumonia in couple of days using a prescribed method of treatment known as a “critical pathway”. They know it works. There are volumes of research that shows that patients are as well off, or better, under this method and the hospital gets the bed back sooner. The patient is back on her feet and home—where she wants to be.

But that isn’t how it works out for our Milford resident. She isn’t able to go home yet. Her pneumonia is clearing up, but she is still working to catch her breath. No one is at home to look after her. There is no room at a nursing home for her to go to regain her strength. So she waits in a hospital bed in Picton. She doesn’t want to be there. Nor do her caregivers believe this is where she should be. Meanwhile, hospital administrators wring their hands nervously with every passing hour she languishes in this bed.

Every day she is in that bed beyond the prescribed “critical pathway” counts against this hospital. These are considered, in hospital administration- speak, as “conservable” days. The fact that there is no place for her to go doesn’t enter into the tidy equation. These are days in which the bed could be used for another resident or, better yet,closed and staff sent home.

The poorer the hospital performs against these benchmarks, the fewer resources it receives. As Dr. Christie observes, fewer resources lead to longer stays and rationed care. The downward spiral is nearly complete.

There were 95 beds at Picton hospital in the 1960s. By 2009 that number had been whittled down to just 32 beds. Once the latest round of proposed cuts is made—set to begin as soon as April—Picton hospital may have just 12 beds remaining. Most health care folks admit this is too few to maintain the staff and resources required of a even a modestly functional hospital.

The population of Prince Edward County hasn’t gotten smaller in the past 50 years. It has certainly gotten older. The need has surely grown.

LHIN officials and hospital administrators assure us that community clinics and resources will rise up as the Picton hospital shrinks and fades away—that the services once provided only in a hospital can now be offered more safely, more comfortably and more cost efficiently in a clinic or home setting.

They may be right. Could a birthing clinic provide as good or better care than a hospital battling daily with C. difficile and other bacteria and pathogens lurking in its ductways and crevices? Could my Milford resident receive more appropriate care at a nursing home until she recovers? The answer to both questions is surely yes.

There is nothing inherently wrong with the notion that many services traditionally offered in the hospital might one day be provided in a clinic or at home. But we aren’t there yet. We don’t have this capacity in our community services, the extra room in our nursing homes, or additional staff providing home care services. We don’t have a birthing centre, and it will be months before our residential hospice facility opens its doors.

Leo Finnegan has spent many years working to defend the Picton hospital from QHC administrators who, faced with funding cuts, invariably conclude they must repatriate resources used in Picton to shore up Belleville. He knows as well as anyone that health care is changing and must continue to change. That it has always done so. He isn’t against reshaping how health care is delivered in this community. But he insists it be done right, with this engaged community as part of the solution.

“Put the alternatives in place, demonstrate that they work, then come back to talk to us,” said the former mayor.

This seems sensible.

rick@wellingtontimes.ca