Alternate level of care (ALC) patients are often the scapegoats to what ails the healthcare system. They are accused of being overly expensive bed blockers who use up more resources than they need and prevent somebody who needs a higher level care from accessing those services.
I would argue that the system does not adequately understand the issue of alternate level of care patients, that alternate level of care patients might not use as many resources as they are accused of using, and that if the system addressed the problem of ALC it does not follow that access to healthcare, and in particular a reduction in wait times to care would follow.
First, the system does not adequately understand the issue of alternate level of care patients. It should be noted that all patients who are not "acute care" patients are "alternate level of care" patients. This would include patients who are admitted and waiting for a procedure (pre-procedure ALC), as well as patients who are "well enough" to be discharged but cannot be discharged because of inadequate post-discharge care environments. The problem of pre-procedure ALC is not the same as the problem of post-procedure ALC but rarely are the two kinds of ALC looked at separately. Typically, when people think of "bed blockers", they are thinking of patients who are adequately recovered from their illness or surgery to be discharged but cannot be discharged because they still require some level of care, or their home environment is inappropriate. Some of these patients will not need a permanent placement in a long-term care home, but rather need a place where they can recover further before returning home or are waiting for home care or informal care providers to be available to provide for their needs. At any rate, the needs and reasons that those patients are ALC needs to be better understood before leaping to the conclusion that building more long-term care facilities is the solution to the problem.
Second, on the issue of cost it is erroneous to assume that the "average cost" of a hospital day is the appropriate cost to attribute to an ALC patient. The average cost of a hospital day is an aggregate number that reflects the costs of "high needs" patients and "low needs" patients - it is all of the costs of hospitals divided by all of the hospital days. The mere existence of a patient in a hospital does not attract spending on that patient. It is absolutely ridiculous to think that an ALC patient is as resource intense as a patient who is within the first 48 hours post-surgery, or who is acutely ill, yet - declaring that an ALC patient costs the same as these other patients is often what happens in the hand-wringing over ALC. If it takes 5 nurses to care for 20 acutely ill patients, those same 5 nurses might be able to care for 50 "alternate level of care" patients, or perhaps nurse aides are adequate to address their needs. Further, it may be desirable to have some "less resource" intensive patients in the mix as it provides for a bit of a break. Do we really want a system where nurses are working at the limits of their capacity, all the time? What might that mean for rates of medical error? What might that mean for rates of nurse burnout? What might that mean for rates of occupational injuries among nurses? It is even imaginable that having these patients in hospital might be the most efficient way to address their needs under some circumstances. In short - do not expect resolving the ALC problem to save as much money as is often estimated. If the ALC problem were adequately addressed we would see the average cost per patient day increase, not decrease.
Lastly, because governments set health budgets, even if the beds were available in hospital - it is a heroic assumption to think that the number of procedures performed would increase by any substantial amount. To the extent that money is actually saved and could be reallocated to provide access to care, some additional surgeries might be performed. However, the increase in access is likely to be far less than what is often imagined - just because a bed or an OR is available in the public system does not mean that it will be used. Unless governments are willing to spend more on healthcare, they will simply reduce the number of beds "staffed and in operation" or will close OR's to manage budgets.
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