New obstacles to residential care

Issue: BCMJ, Vol. 59, No. 9, November 2017, page(s) 444 Editorials
David R. Richardson, MD

“I’m sorry, Bessie, but you have to leave. We caught you sleeping, so you obviously don’t need 24-hour care and can’t stay here at the home anymore.”

In September I received an e-mail with the subject: Optimizing Fraser Health’s Residential Care Services.

Currently individuals are screened for residential care in their respective community by an interdisciplinary team that includes physiotherapists, occupational therapists, social workers, home health liaisons, and more. With family input this team decides if the patient is failing at home despite maximal support services, and will wait-list the patient for the next available residential bed. The e-mail I received outlined a new, second level of screening by a Collaborative Review Panel made up of local and regional leaders that will jointly determine client eligibility and how best to use community beds. This information was followed by a statement, which wasn’t referenced, that said, “caring for clients in the community results in better health outcomes.” I am not aware of any randomized double blind study comparing health outcomes of matched clients at home versus in residential care.

Personally, in over 20 years of practice, I have never had a patient end up in an intermediate or extended care home if they didn’t need to be there. In fact, these individuals are often maintained at home much longer than I thought possible by overworked and burned-out family members. When these families are at the end of their rope, and their loved ones end up in hospital, they are frequently made to feel guilty and are coerced into taking Granny home for one last try. Without this group of tireless, unpaid health care workers toiling at all hours, these patients would not last in the community. Now after jumping through all the hoops and having everyone agree that their loved one is ready for residential care (which is no easy decision or process) the patient must also be evaluated by some faceless panel. What isn’t clear is what happens if the panel disagrees with the local community’s recommendation. My fear is that the exhausted families will relent once more and accept another try at the cost of both the patient’s and their own health. Another level of bureaucracy isn’t the answer to the real problem of limited residential care beds in the face of a large, aging ailing demographic cohort.