Home care a piece of the health puzzle

What if you could fix one of the biggest issues in our overstressed health system, and do it for a mere $1 billion?

All right, a billion is not a “mere” in the minds of most Hamiltonians, or Ontarians. It’s a mountain of money. But in terms of government spending on public and social infrastructure, which includes health care, it’s relatively cheap. Consider that capital and construction costs for Hamilton’s LRT line add up to $3 billion. The annual budget for Hamilton Health Sciences is more than a billion. The City of Hamilton’s 2022 operating budget was just under a billion.

The provincial government is sitting on a surplus of $2.1 billion thanks to inflation and strong economic performance. And according to the Financial Accountability Office, budget surpluses will continue to grow and will reach $8.5 billion in 2027-28.

All this is intended to provide context for that initial $1 billion. It’s a lot, but not compared to the numbers that jump around in the government sector.

Back to health care. Unless you’ve been getting all your news from social media, you already know that one of the ongoing and most challenging issues facing hospitals and the system in general is that of acute care beds being taken up by patients who really shouldn’t be in an acute care setting.

It’s a very safe bet that they’re not there because they want to be. These folks, who are referred to as alternate level of care patients, can’t be discharged because there is no appropriate place for them to go. As Spec health journalist Joanna Frketich reports, they are on waiting lists for long-term care, home care, complex continuing care, rehabilitation and mental-health care.

All those community health sectors are under the same sort of stress as hospitals to one degree or another. Hence, this seemingly intractable problem. The acute care beds are badly needed for people who truly need acute care, but they are in a bottleneck created in large part by other bottlenecks in the system.

As Frketich reports this week, there is something we can do about this. Hamilton-based Home Care Ontario, which advocates for improving the home-care system, says it could make a big dent in the problem if the province invested more in home care. That’s where the billion comes from.

In 2022, the province committed to that investment, but plans on doling it out over three years. So this isn’t new money, it’s money already committed but that could be invested sooner, and with greater impact, if it was invested now rather than two years from now.

After all, the health/hospitals crisis isn’t getting incrementally worse year over year. It’s already a near disaster, and will only get worse with our aging population and other factors, such as the next pandemic.

Making its case, Home Care Ontario uses some Hamilton examples.

The number of ALC patients at Hamilton Health Sciences is at a record high. HCO says adequate home care investment could get as many as 270 of them out of hospital and into more appropriate, and affordable, forms of care. This in a single health-care system where one in five acute care beds is taken up by people who don’t really need one.

The ALC crisis at HHS and St. Joseph’s Health Care is so bad the systems opened space at the former Crowne Plaza Hotel, which has housed ALC patients since it opened in fall of 2020. All 150 beds in that facility are taken up, and that doesn’t nearly house all the ALC patients in the two hospital systems.

An immediate investment of the size sought by HCO would add 2.72 million hours of home care in a sector where there is a waiting list of 15,000. ALC in hospitals, the most expensive health-care setting, can cost $730 per day. A similar patient in home care would cost more like $103 daily.

Today we hear a lot of experts acknowledging that money alone will not fix what is wrong with Canada’s ailing health systems. That’s true. Innovation that respects universality and timely, equitable access to care is essential.

But in some cases, investment makes good sense and is good value. This seems like one.