Nova Scotia

Patients stuck in hospital waiting for home care causing 'ripple effect'

A new national analysis of hospital stays and visits shows that many Canadians are stuck in hospital longer than they need to be while waiting for home care, and nearly 10 per cent of people who seek substance use and mental-health services in emergency rooms do so repeatedly.

Canadian Institute for Health Information gathered data from all provinces and territories

Across Canada, about 92 per cent of patients who need home care can be discharged on schedule but the rest have extended hospital stays due to delays lining up supports so they can resume living in their own homes. (Shutterstock)

Delays accessing home-care supports are keeping thousands of Canadians in hospital longer than required, which is creating added pressure on a hospital system already under strain from people waiting to get into long-term care facilities.

The lags in setting up supports for people's own homes are tying up beds in hospitals that are already full, said Mélanie Josée Davidson, director of health system performance with the Canadian Institute for Health Information.

"Even though a person might be waiting for home care, that might have a ripple effect all the way down to waiting for emergency department services," she said.

The Canadian Institute for Health Information compiled data from all provinces and territories related to access to home and community care, as well as mental health and addictions services in 2017-2018.

Across Canada, one in almost 12.7 people who are capable of returning to their homes with supports such as help with bathing or changing the dressing on a wound are being kept in hospital while those services are put in place.

Home-care supports may include someone to assist with buying groceries or bathing. On any given day, CIHI says there are 1,320 people in hospital who could go home if those services were in place. (Robert Short/CBC)

This amounted to 27,717 Canadians who needed the extended stays, 295 of which were Nova Scotians.

Nationally, the median length of an extended stay was one week. In Nova Scotia, it was 13 days.

The hope is the data will help paint a picture of what community and social services are needed. The numbers will be tracked for the next decade.

"We are providing this information really as a baseline to see how we're doing as a country and where we might need improvement and to help us track over time how we're improving in these services," said Davidson.

Across Canada, about 400 people are hospitalized each day due to drugs and alcohol. CIHI says this accounted for a total of two million days in hospital in 2017-2018. (Robert Short/CBC)

The CIHI report, Common Challenges, Shared Priorities, found many of the patients waiting in hospital to go home are complex cases — such as people with dementia, diabetes with complications or congestive heart failure. Half of the cases involved people older than 82 and women were more likely than men to be affected.

Davidson said there are solutions that are working in some parts of the country. She said it helps if staff look at what patients will need to carry on at home as soon as they're admitted.

"In some places, we have home-care workers in the hospitals who are there to learn about the patients and ensure that the services that they will need will be ready at the same time that they will be," she said.

Other things, such as ensuring family members or friends can transport patients home, can also cut down on delays, she said.

Drugs and alcohol use analysis

The report also analyzed why people are being hospitalizated for substance use and who is most affected.

It found 10 people every day die from issues related to drugs and alcohol while in hospital, which is in addition to people who die in their homes and communities.

For its report, the Canadian Institute for Health Information compiled data from all provinces and territories related to access to home and community care, as well as mental health and addictions services in 2017-2018. (Canadian Institute for Health Information)

"About 400 people [are] hospitalized each day because of harm caused by substance use and overall that's more than for heart attacks and stroke combined, so quite a significant number," said Davidson.

The report found alcohol contributed to 2,740 — or 70 per cent of — hospitalizations for substance use in Nova Scotia, the highest percentage of any province and well above the national average of 53 per cent.

Across Canada, a higher percentage of men sought help.

Young people land in hospital due to cannabis

However, people ages 10 to 19 broke that pattern with young people more likely to seek help for cannabis-related issues and a higher percentage of girls ending up in hospital.

The report found "cannabis hospitalizations were often related to symptoms of psychosis or distress."

"We know that alcohol and cannabis are much more acceptable and socialized in our culture and sometimes we forget that they can have negative health impacts, whether that immediate like an overdose for example, or more long term like cirrhosis," said Davidson.

Mental-health issues also frequently presented in conjunction with addictions and in 10 per cent of cases, people are considered repeat visitors, landing in hospitals four or more times a year.

The report cautions that the relationship between mental illness and addictions is complex, with some patients self-medicating and others suffering from anxiety, depression or psychosis due to chronic substance abuse. (Shutterstock)

"That really speaks to kind of a rotating through the emergency department," said Davidson.

Young people were also seeking out help for a combination of mental health and addictions issues.

"The other piece that stood out to us was that it's actually a very young cohort of people who are frequent users of the emergency department for mental health and addiction. So, half of the patients that we're seeing were under the age of 35. And that was slightly more men than women, except amongst children in youth where it is more girls than boys," said Davidson.

Next year, CIHI will also start looking at suicide and self-harm, caregivers distress and the transition between home care and long-term care.

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About the Author

Elizabeth McMillan is a journalist with CBC Nova Scotia. Over the past nine years, she has reported from the edge of the Arctic Ocean to the Atlantic Coast and loves sharing people's stories. She can be reached at elizabeth.mcmillan@cbc.ca

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