How a new program frees up beds by helping inpatients find care elsewhere

Maria Manalo spent more than four years in a hospital room at the Center for Addiction and Mental Health (CAMH), although she did not need hospital care for almost a year and a half.

Today, she lives in a private room inside a CAMH facility that was transformed into an assisted living facility after the hospital moved its emergency department last year.

Manalo says living in the hospital was lonely and stuffy. But now she’s forging new relationships and found a greater sense of independence as one of 37 vulnerable Alternate Level of Care (ALC) patients discharged from hospital for transitional housing under of a new program called The Path Home.

“At the hospital, I was more alone, mostly because I don’t have family here to visit me,” Manalo said outside the downtown Toronto facility. “Customers and staff [here] are nice to me because i am nice to them. I have a lot of friends.”

The program was started by CAMH and LOFT Community Services, a nonprofit that provides support to people with mental and physical health issues, during the COVID-19 pandemic. It helps clear hospital capacity and provide care and housing for low-income ANS inpatients with complex mental health and addiction needs.

Those who run The Path Home estimate they will eventually be able to discharge more than 100 people from the hospital this year.

Maria Manalo is pictured in her private bedroom. She says she eats and sleeps better in her new home than when she lived in the hospital. (LOFT Community Services)

Patients are designated ANS when they occupy a hospital bed, but do not require hospital-level care. They wait to be placed in an appropriate environment such as a long-term care home or a rehabilitation center.

In recent years, the number of ANS patients has increased in Ontario, but their impact, especially on hospital capacity, has come to light more publicly during the COVID-19 pandemic as hospitals desperately try to create space when a barrage of COVID-19 -19 patients threatened the system with collapse. Although hundreds of people have been displaced during the pandemic, there are still around 4,000 ANS patients in Ontario hospitals and health experts say more needs to be put in place to provide them with proper care .

In 2019, ANS patient care cost the province about $ 500 per day per patient, according to the Ontario Hospital Association.

“We are constantly looking for what can be done,” said Marnie Escaf, clinical vice president of the University Health Network (UHN). “In some cases, this may require adding capacity in the system. So it’s a very active program, a very collaborative program, but it’s not an easy problem to solve.

The average hospital wait time for an ANS patient in Ontario is around five months, but some patients with more complex cases, like Manalo, stay much longer.

Ontario’s hospital system was under immense pressure even before COVID-19 with “hallway medicine” becomes the norm in some hospitals, a problem Premier Doug Ford has promised to end.

From hospital bed to karaoke

Manalo was first hospitalized with seizures, depression, anxiety and high blood pressure. With the help of the staff, she is now able to do daily chores like laundry and making her own bed, things she couldn’t do in the hospital.

She says she is thrilled to finally have her own walker and enjoys the activities on offer, especially the karaoke dancing.

“I am very independent here [compared] at the hospital, ”Manalo said. “I can sleep better, I can eat better.

Maria Manalo is pictured outside the Center for Addiction and Mental Health facility where she now resides. She says there are a lot of activities to participate in and that she especially enjoys dancing karaoke. (Evan Mitsui / CBC)

The Ontario Hospital Association says during the pandemic, the number of ANS patients peaked at “historic highs” of 5,300 patients on two occasions during the pandemic: once in mid-June 2020 and again in mid-February 2021. At that time, they represented between 16.5 to 18 percent of beds.

Ontario Health says the GTA Alternate Level of Care Intervention Table was established during the pandemic to help identify pressures on hospitals’ capacity, to make recommendations on where and how patients ANS and post-acute should be transferred and work with community providers who accept ANS patients.

During the pandemic, long-term care homes were invited to make room for ANS patients and in April, the Ontario government issued an emergency order allowing hospitals to transfer ANS patients to long-term care homes without their consent.

The Ontario Hospital Association says that since the guideline was put in place, approximately 3,400 ANS patients have been transferred out of hospitals in Ontario, but it is not known which ones have been moved under the emergency order.

Ontario Health says that thanks to ongoing work, rates of ANS patients have remained stable throughout the pandemic. It indicates that between April 2019 and March 2020, ANS patients represented 16.2% of patients in Ontario hospitals, while this number increased slightly to 16.7% during the same period of the year. last.

Improvements in hospital capacity, but still need space

As COVID-19 hospitalizations continue to decline and elective procedures gradually resume, Ontario hospitals are now facing a massive backlog of nearly 16 million medical procedures and Escaf hope that continuing to move ANS patients will help.

“We’re really focused now on how to fix the backlog,” she said.

So far, three UHN patients have been transferred out of the hospital as part of The Path Home, according to Escaf. She says the program is particularly useful because it allows ANS patients with complex needs, including behavioral issues, to receive care in an environment that suits them better than a hospital.

“It would be a win-win situation for the hospital environment as well as for the patients in terms of respect and dignity to have these patients placed elsewhere,” she said.

Healthcare workers move into the intensive care unit at Centenary Hospital at the Scarborough Health Network in northeast Toronto on April 8, 2021. (Evan Mitsui / CBC)

The program has also eased pressure on CAMH; At its peak, ANS patients made up a quarter of patients there, but since the program began in March, that number has fallen to 15 percent, according to its president and CEO.

Catherine Zahn says that at this point in the pandemic, people are waiting longer to access CAMH’s emergency department, which means the admission rate is higher than usual and more space must be available.

“They wait as long as they can and arrive at the hospital in a more serious condition,” she said.

“We have a number of people who need care, who are in crisis, who need crisis and critical care, and being able to free up space in the hospital to accommodate those who are seriously ill is a contribution. to the overall mental health care system, ”she said.

Expedited program due to COVID-19

LOFT has been transferring ANS patients from 22 Toronto-area hospitals for years and plans to move 400 people in 2021 alone. The Path Home is its newest program and has started accepting patients earlier than expected due to the pandemic and the need to free up hospital beds.

An empty space at CAMH’s College Street location was quickly renovated to accommodate patients with an accessible washroom, dining room and common area.

“COVID has shed light on a lot of things and one of those things is hospital capacity and the need to create innovative and creative options for people to use hospitals for what they are designed for – crisis care, needs. acute care, ”LOFT said CEO Heather McDonald.

The program is specially designed for ANS inpatients who have nowhere to go and who have complex needs, including mental health, substance abuse, behavioral issues and other psychosocial barriers. Some face homelessness and have mental and physical health issues.

The launch of The Path Home program was accelerated during the pandemic to help free up hospital beds. A floor inside a CAMH building on College Street in Toronto has been renovated to create living space for patients. (Evan Mitsui / CBC)

“Together, there isn’t a place designed enough to serve them,” McDonald said. “[The Path Home] is a more dignified environment for people to express their independence. “

The average wait time for program patients in hospital for an appropriate care setting is just under two years.

As is the goal of all ANS patients, The Path Home works with its clients to prepare them to live as independently as possible. After three to 12 months in the program, they will move on to either a long-term care facility, community housing, or one of LOFT’s supportive housing programs.

Manalo says she’s learning a lot about her health and how to live more independently, but, while she enjoys the program, she says she looks forward to its release.

“They help me with whatever I need until I can be independent again.”

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Linda Stewart

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