Com­mu­nity steps in to help fix over­crowded hos­pi­tals

Ag­ing pop­u­la­tion puts un­prece­dented de­mand on health care and so­cial ser­vices

The Hamilton Spectator - - LOCAL - JOANNA FRKETICH

Health and so­cial ser­vice providers are com­ing to­gether to im­prove care as Hamil­ton’s hos­pi­tals strug­gle with sig­nif­i­cant over­crowd­ing.

“We spend buck­ets of money on health care and rel­a­tively speak­ing we’re not get­ting very good out­comes,” said Terry Cooke, pres­i­dent of the Hamil­ton Com­mu­nity Foun­da­tion and co-chair of the new col­lab­o­ra­tion. “We’ve got all of the sig­nif­i­cant play­ers around the ta­ble and they ac­knowl­edge that these are not prob­lems they can solve within their in­sti­tu­tions. It will in­evitably take a higher level of co-op­er­a­tion, a greater seam­less­ness and a greater fo­cus on early in­ter­ven­tion and pre­ven­tion.”

A small group of health and com­mu­nity lead­ers have been meet­ing twice a month since Novem­ber to dis­cuss what needs to be done to break down bar­ri­ers be­tween dozens of providers in Hamil­ton. The idea came from Hamil­ton Health Sciences CEO Rob MacIsaac.

HHS and St. Joseph’s Health­care are stretched thin, with more pa­tients than beds since the fall. Hamil­ton Para­medic Ser­vice raised alarm in its an­nual re­port May 18 that Hamil­ton hospi­tal over­crowd­ing is in­creas­ingly leav­ing the city with too few am­bu­lances on the road to re­spond to emer­gen­cies.

The con­sen­sus is that the sys­tem has to change be­fore hos­pi­tals reach their break­ing point and the ag­ing pop­u­la­tion puts un­prece­dented de­mand on health care and so­cial ser­vices.

“You’ve got an ac­knowl­edge­ment by the hos­pi­tals that they’ve got huge pres­sure points,” said Dr. David Price, co-chair of the col­lab­o­ra­tion and head of fam­ily medicine at McMaster Univer­sity and HHS.

“They’ve cre­ated as many ef­fi­cien­cies as they could … Now they are start­ing to say, ‘What else can we do? We can’t cut any­thing more. There is noth­ing to trim’ … Maybe we need to look at how we do things and do it dif­fer­ently.”

The col­lab­o­ra­tion met with roughly 70 health and so­cial ser­vice providers at the be­gin­ning of May and came up with a pro­posal to the prov­ince.

It will ask the Min­istry of Health for an un­de­ter­mined amount of cash to or­ga­nize, over­see and an­a­lyze a va­ri­ety of changes in how providers in­ter­act with one an­other start­ing in three dis­tinct neigh­bour­hoods: Sti­p­ley in east Hamil­ton; Rolston on the west Mountain; and Dun­das.

The plan is to add more neigh­bour­hoods in years to come.

“If we could start to un­der­stand what are the pres­sure points and what are the bar­ri­ers to re­ally good col­lab­o­ra­tion, maybe we can start to im­prove how we de­liver health care,” said Price.

“Is it cre­at­ing a clinic? No. It’s start­ing to think about how we are go­ing to work bet­ter to­gether. How do we have a shared af­ter-hours ser­vices for our ci­ti­zens? How do we have a cen­tral­ized re­fer­ral process? How do we un­der­stand what the needs are in each neigh­bour­hood?”

Price points to the ex­am­ple of a pa­tient who was go­ing to the emer­gency depart­ment about three times a week.

“One of our high­est users of health care in this com­mu­nity was some­body who had re­cur­rent emer­gency room vis­its,” he said. “It turns out they were ac­tu­ally see­ing them be­cause of itch­i­ness and dis­com­fort be­cause of bed­bugs. What is the treat­ment? It isn’t an an­tipru­ritic cream. It’s fix the bed­bugs in their house.”

Cur­rently it’s dif­fi­cult for so­cial ser­vices to re­fer clients to health­care providers and vice versa.

But the need for the two to work to­gether is ap­par­ent in The Spec­ta­tor’s on­go­ing Code Red project. Started in 2010 by in­ves­tiga­tive re­porter Steve Buist, the se­ries ex­am­ines the im­pact that so­cial de­ter­mi­nants of health have on peo­ple in Hamil­ton in­clud­ing link­ing poverty and a shorter life ex­pectancy.

“The Code Red work over a decade has shaped the con­ver­sa­tion,” said Cooke. “How is it that we have a 21-year life ex­pectancy gap be­tween rich and poor neigh­bour­hoods? Clearly that is not a prob­lem that is go­ing to be solved at the emer­gency room door.”

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