Hospital system too uncoordinated to deal with influx of seniors, patient advocates say
The case of an elderly Toronto-area man left by an ambulance service in an empty house was an outrageous mistake, patient advocates say. But it is probably also a harbinger of what Canadians can expect in an overcrowded and uncoordinated health-care system struggling with an influx of seniors.
“This kind of event will happen over and over again,” predicts Sholom Glouberman, president of Patients Canada. “The hospitals don’t take responsibility for anything that happens outside the hospital. And that’s the way the system has been structured.”
On Monday, an ambulance service discharged Tadeusz Czubak, 89, from Trillium Health Centre in Mississauga, Ont., to his empty home, instead of returning him to the retirement home where he’d come from and where his family had placed him for temporary care while recovering from knee surgery.
The ambulance service left him at the house and asked a neighbour outside shovelling his driveway to check on him periodically since no one was home. The neighbour found the heavily-medicated Czubak collapsed on his stairs and called the family.
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Czubak is now back in hospital, suffering from blood clots and an infected knee.
“When they can’t get this right, what else aren’t they getting right?” asked Susan Eng, vice-president for advocacy at the CARP, a non-profit group dedicated to seniors issues.
A grey tsunami
Hospitals across the country are struggling to handle the rising number of seniors entering the system. Nearly five million seniors live in Canada, comprising nearly 15 per cent of the population. And those numbers are growing quickly as the bulk of the baby boom generation hit their 60s.
This group also accounts for the majority of patient days in a province like Ontario — and the number of seniors is expected to double in the next 20 years.
“The system needs to ready itself to deal with this,” says CARP’s Eng.
Those in the health-care system say they are well aware of the so-called grey tsunami that’s coming, and are scrambling to improve how they deal with the complex medical and care conditions associated with seniors.
At the Trillium Health Centre, for example, a 2011 report points to their own preparations. By 2016, the facility predicted it would be serving an area with the highest concentration of seniors in its entire health region.
The report focused on trying to avoid the kind of costly and potentially harmful re-admission that happened in Czubak’s case, and called for the creation of a transition team to help expedite the discharge of those with complex conditions to make sure they didn’t end up back in hospital with unnecessary complications.
But it is not clear if such a team was ever implemented. Trillium Health Partners did not respond to the CBC’s queries on this subject.
‘Nobody took any responsibility’
For its part, the seniors’ advocacy group CARP says the health-care system is too fragmented, causing vulnerable patients like the elderly to fall through the cracks as they transfer from hospitals to other points of care.
It wants to see navigators created to help guide patients through the often complicated health system. But, Eng notes, that might not be necessary if those in the system communicated properly with each other to begin with.
““What kind of hospital system requires you to have a monitor, a chaperone to help you get through it safely?” she asks.
“Nobody took any responsibility to make sure this man was safe at home. It’s paying attention and caring enough that somebody doesn’t get left like this.”
Patient advocate Donna Davis agrees that the Czubak situation “isn’t just a one-off.” But she says it is more than just hospitals systems that are too complex. So too are the machines used to diagnose patients, the multitude of drugs prescribed and the mixture of conditions being treated.
The Saskatchewan nurse and co-chair of Patients for Patient Safety Canada suggests hospitals need to establish a family point-person, someone who must always be alerted by the hospital when an elderly or otherwise vulnerable person is in the system, and especially when they are discharged.
“This is certainly one case where we in health care obviously need to learn from and put something in place so it doesn’t happen again,” said Davis.
Some critics have suggested the larger issue is the shortage of beds and the rush by hospitals to discharge so-called “bed blockers,” meaning patients, often elderly ones, no longer in need of acute care.
But Glouberman, for one, doesn’t buy that notion, and says the Czubak situation is more indicative of a larger problem with a health-care system that spends money primarily on hospitals rather than community care, where patients should be recovering and rehabilitating.
“The issue isn’t the hospital, it’s what’s not outside the hospital,” said Glouberman.