Give hospitalized seniors improved access to physio, advocate urges
Retired MD says services on weekends, holidays should be same as on weekdays
When an elderly patient doesn’t get up and moving immediately after a hospital procedure, “things go to hell,” says a retired Windsor surgeon who is pleading with officials to provide more physiotherapy on weekends and holidays.
“Ideally, a hospital should run seven days a week. Unfortunately on weekends, things slow down,” Dr. David Wonham said of the current situation in area hospitals, where he claims patients may miss therapy because of reduced weekend and holiday staffing.
He said a couple of years ago when he had surgery for a hip fracture, he went three days without physio over a long weekend. Fortunately, he knew the importance of becoming quickly mobile and did the exercises himself. But he fears for other older people.
Without getting up and active, people who stay in bed can quickly become deconditioned, he said. They get muscle weakness, joint stiffness, lung problems that can lead to pneumonia and a slowing of circulation that can lead to lifethreatening blood clots. These people stay in hospital longer, and in many cases they never go back home, ending up in long-term care.
The problem is only going to get worse as the population ages, said Wonham, 80. He said if hospitals devoted more staff to weekends and holidays, it would end up being cost-neutral because patient stays would be shorter.
“Unless we start to tackle these things at this time, then everything is going to be backed up and it will be very difficult to provide acute services (urgent medical care like surgeries),” he said. “It will be like a traffic jam.”
Windsor Regional Hospital CEO David Musyj said occupational therapy and physiotherapy are available at both campuses “to take care of patients who need ambulation (helping with mobility) on the weekend.” But he added there’s always room to improve.
“Is it as high as it is Monday through Friday? No, there is not one hospital in Ontario that has that,” he said, estimating that weekend occupational therapy and physiotherapy staffing is between 60 and 70 per cent of what it is on weekdays.
Wonham made his case last week to the board of the Erie St. Clair Local Health Integration Network, the health authority that plans and funds health care in the Windsor-Chatham-Sarnia region. The board ordered a comprehensive report on the issue, said chairman Martin Girash, who said that generally, the same level of service should be available seven days a week, 365 days a year.
“We, meaning the health system, need to start thinking about and acting on the thought that services like physiotherapy are no longer peripheral,” Girash said. “They’re central to good health.”
He said in the last century, there was a division between acute care — emergency department and operating room — and other services that weren’t deemed as important. But that thinking has to change, he said.
“We have had people in the past who were functioning well at home, they go to the hospital for acute care, stay in the hospital for recuperation, and they can’t go home,” Girash said.
“They can’t function again like they did before they went in the hospital because they were so weak.”
He said Wonham’s presentation was “very important” because it brings public attention to this issue. The LHIN has assigned a staffer to rethink how rehab and restorative services are delivered. He noted that hospitals are one of the only health services open around the clock seven days a week.
“We need to think in terms of this same level of activity on a weekend, if a person needs it, as during the week.”
We, meaning the health system, need to start thinking about and acting on the thought that services like physiotherapy are no longer peripheral.