HomeMy WebLinkAboutThe Lucknow Sentinel, 1994-01-19, Page 6Page 6 — Lucknow Sentinel, Wednesday, January 19, 1994
Changes to long-terrncare affect Wingham hospital
by Mike Robinson
Changes to the deftnition'of long-
term health care will definitely
mean changes to the operation of
the Wingham and District Hospital.
Pat Pietrek, director of
rehabilitation ,at Wingham and
District Hospital, says a redefinition
in the new model of health care'
will determine who can and cannot
become a long-term care patient in
hospitals.
Historically, long-term care
hospital patients were people who
opted not to be placed in nursing
homes or people who were.
physically not well.
,People with extra needs, such as
•xygen tubes or specialized feeding
sually remained in the hospital
setting for the remainder of their
lives because nursing homesdid not
have the staff to meet1/4those needs.
However, aside from. those 'extra'
needs, these people are bright and
alert and able to participate in a
'life', said Pietrek.
Numerous provincial government
studies have looked into chronic
care and rehabilitation. The recent
session included 125 public consul-
tations involving 2,500 participants,
site visits to ,38 hospitals
including 18. freestanding .public
hospitals --'and a written survey to
Ontario's 229 public hospitals.
Pietrek said the issue boiled down
to the fact that yery similar, people
were being served in hospital
chronic care wards and nursing
homes:
In order to get the "biggest bang
for the health care buck", the
useage of, long-term' care in
hospitals was re-examined.
One issue was to' look at 'medica-
lly stable' people ,-- who may re-
quire extra care, but, otherwise
stable -- and ask why that extra
care cannot be provided in a less
„`regimented' institution which can
provide equal care and .costs less.
In response, a move was made to
provide additional funding to nur-
sing homes to increase the skills of
nursing home employees to meet
these needs. ;
Two years ago, WDH initiated an
internal examination of chronic care
services and nursing care needs.
Since then, it has identified a
number of patients who could be
classified as medically stable and
who could be cared for within a
nursing home.
Pietrek said for many long-term
patients in the Wingham hospital,
the move was quite a change. "For
some, it (the hospital) was home for
the past eight years."
The idea of moving put stress on
both patients and families; some of
whom did; not ever want to see
loved ones in a nursing home. And
for some, having a loved one in to
hospital is a .way of not coming to
grips with a point that comes in
everyone's life.
But, she explained, the health care
system can no longer afford to let
that practice continue:
Pietrek added that many chronic
care patients placements were quite
successful. For 'them, the nursing
homes provide more of a life and
enables them to take part in more
social and recreational activities.
In the survey of hospital care,
there were relatively few positives
other than the . patient's' medical
well being.
Hospitals ranked; high on security,
but were also listed as lacking
privacy,; recreational and/or social
activities and other items.
A new focus on rehabilitation,
Pietrek said, brings with it the
difficulty in determining what sup-
port services are needed and if the
patient has reaped the most benefit
from the `rehab' department before
going home or being placed in a
nursing facility.
The problem is that: hospitals: tend
to be the most expensive level of
care, yet it often acts as a 'holding
area' until nursing beds are free.
However, it is still felt that
hospitals are the best place for
assessment and rehabilitation, she
said.
Therefore, there is going to be a
real shift in focus for chronic care,
said Pietrek.
In the past, hospitals had acted as
primary care because ongoing
medical treatment was required,
even if the patient was stable.
Now the goal is to determine how
quickly the person can be moved to
another level of service.,
The switch has been happening
over the past few years, said
Pietrek. But there will still be a role
for chronic care wards in hospitals
'where a patient's medical condition
is not stable.
Pietrek explained that the term
`medically stable' is not dependant
on the amount of care required, but
that a certain amount of care will
keep that patient stable.
Those requiring extensive support
for survival would also req am 'in
the hospital setting because of on-
going medical needs.
As for palliative care, the intent
of changes to long-term care would.
try to maintain the individual at
home or a nursing home as long as
possible.
However, Pietrek said there' is a
need forhdspitals to provide respite
care -- a place. to care for chro.ic
care patients for short periods Of
time. ' She explained these types of
beds are needed for patients,, whose
,families are prepared to care for
that person, but an unexpected
situation happens and the family
cannot handle the current load
alone.
' "Respite beds are no good if they
are not immediately' available.;
Yet another, role hospitals, such as
Wingham, will play is that of con-
sultant and, support service.
Hospitals have. the expertise and
plans.. are to have hospitals provide
training and in some cases, equip- -
ment.
. Pietrek said the Wingham hospital
has already worked with local sup-
port groups for training.
In addition, the hospitl houses a
medical library to provide a poten
tial access of information for nur-
sing homes.
"The biggest thing is .that they
will be required toact as hospitals,
not lodging or as homes."
That is one of the ideas that is
hardest for the public to come to
grips with, said Pietrek.
When a family member is not
managing well, assessment should
begin immediately. Under the new
system, "from the moment they
come in the hospital, plans are
being made for that. patient's dis-
charge." •
Even in situations .where a family
is worried about a person returning
to the home setting - where there
may 'be some risks, problems. may
.'arise.
If a person is mentally alert, that
person has the right to choose his
or her own level of risk upon
leaving the facility, and no-one has
the right to take that choice away.
Families may ask the hospital to
act as a controller and deny the
opportunityto gd home., because the
proper supports are not in place;
But the hospitals cannot make that
judgement call, she said
Pietrek noted a new placement
co-ordinator is in place at Home
Care in Clinton. She said that per -
in
be able to get individuals
in . touch . with local volunteer' or
private services:
However thereis a flaw to the
province's plan -- the flow of
money.
If. individuals are to 'remain at
home, extra services are needed --
but the flow of extra monies has
not reached the local agencies in
order to provide those services.
On the home front, WDH is ad-
dressing concerns over providing
activities to chronic care patients in
a number of ways.
The board of governors recently
approved construction of a deck
area to allow personal space for
interaction in addition to allowing
patients access to the outside. Two
adjacent rooms (formerly patient
rooms) are being converted into a
patient lounge and dining area.
Chronic care beds in the Win-
gham hospital were re-ent1y
relocated to provide more privacy
to patients.
Another move 'by the hospital is
in bringing reactivation clinics
services 'room-to-roomrather than
patients going down to rehab ser-
vices. to ' participate in 'group ac-
tivities.
This way the program
kinesiologist or occupational
(therapist has more individualized -
time to interact with patients.
Other individual efforts by
hospital Staff are helping pull things
together to break the hospital
'routine'.
The hospital is' working to provide
the best lifestyle it can, but it will
remain primarily a medical care
'facility. The emotion and spiritual
needs must come afterwards.
In nursing homes, Pietrek ex-
pected .intellectual, emotional and
spiritual needs . would come • first
because 'the patients are medically
Stable.
•
Looking back
While having some renovations
done on their home; Grant
• Chisholm found a Globe newspaper.
dated 1872. The price of a per
annum subscription was $6, _while
single copies sold for two cents
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