Reta, 95, is a patient at Southlake Regional Health Centre, which has been lauded for its program helping seniors be discharged quickly so they may return home with health care support.
Southlake Hospital
Hospitals in Ontario are planning to provide health care services to more seniors in their own homes and house patients who no longer need acute care in retirement residences and hotels, as they brace for a potential second wave of the coronavirus.
The pandemic has highlighted an urgent need for alternative care for seniors, say health care experts. The elderly can’t languish in acute-care hospital beds or be transferred to unsafe nursing homes.
The experts say more hospitals should copy an innovative home-care program at Southlake Regional Health Care in Newmarket, north of Toronto. The program is at once a window into how one hospital has helped seniors be discharged quickly and return home with health care support, and a stark reminder of the uneven pace of progress elsewhere.
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Reta, 95, was one of the first patients to participate in the Southlake@home program at Southlake Regional Health Centre in Newmarket, Ontario, north of Toronto.
Southlake Hospital
During the first wave of the coronavirus, hospitals cancelled most elective surgeries to clear space for a surge of critically ill COVID-19 patients that never came. Hospitals also emptied beds by discharging many patients to retirement and long-term care homes.
This time around, they have less flexibility for dealing with patients who no longer need the acute care services of a traditional hospital but are unable to live independently.
“This is about transitioning from crisis management, which we did in the spring, to living with COVID,” said David Pichora, chief executive officer of Kingston Health Sciences Centre and member of a government committee planning for the next wave of the pandemic. “Nobody wants to go back to what we were doing in April.”
Patients who no longer need acute care are filling up hospital beds once again, primarily because hospitals can no longer discharge many of them to long-term care homes, where more than 1,800 residents in Ontario died from COVID-19.
These patients, known as alternate-level-of-care (ALC), occupy just over 5,100 hospital beds, about the same number as before the pandemic when overcrowding was a chronic problem.
The homecare program at Southlake hospital in Newmarket, Ontario, pictured here on July 20, 2020, has helped the hospital dramatically reduce the number of days patients wait for appropriate services.
Galit Rodan/The Globe and Mail
The province’s Chief Medical Officer of Health, David Williams, issued a directive last month preventing long-term care homes from accepting new residents or readmitting previous residents to wards, where up to four individuals share a room. The order does not affect existing residents who live in ward rooms. Slightly less than one-third of Ontario’s 78,443 long-term care beds are in older homes with wards.
The Kingston region in southeastern Ontario is losing 300 of its 4,000 long-term care beds as a result of the new admission restrictions, Dr. Pichora said. His hospital admitted 78 patients to long-term care in June, about a third of the normal volume.
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Hospitals also will do everything possible to avoid cancelling surgeries again, said Dr. Pichora. There are no data in Canada linking cancelled surgeries to mortality rates. In the U.S., the National Cancer Institute predicts that tens of thousands of excess cancer deaths will occur over the next decade as a result of delays in treatment caused by COVID-19.
Patients like Reta, who have participated in the Southlake@home program, wait less than a day to return to their own homes once they no longer need acute care.
Southlake Hospital
Kingston Health Sciences is one of several hospitals that have found alternatives for ALC patients by leasing empty space in other buildings. It has installed 30 beds in a retirement home and is looking for more space. Queensway Carleton Hospital in Ottawa has retrofitted a floor in a hotel with 32 beds. North York General Hospital in Toronto has 20 beds in a retirement home, and is working with community groups to care for these patients.
“This close partnership between sectors has to continue after COVID,” said Joshua Tepper, CEO of North York General.
The Ontario Hospital Association is urging the government to earmark additional funding for home care and for more hospitals to lease space in hotels and retirement homes.
Administrators at Southlake hospital, picured here on July 20, 2020, are exploring the use of neighbouring retirement homes for some patients.
Galit Rodan/The Globe and Mail
A Ministry of Health spokeswoman said the government is working on a plan to help hospitals manage capacity, including looking at using hotels and other alternative sites beyond Sept. 30.
Samir Sinha, the director of geriatrics at the Mount Sinai and University Health Network hospitals in Toronto, said the pandemic is an opportunity for government to expand home care, a less expensive option. The province spends $103 a day on home care services, compared with $182 a day for residents of long-term care, government figures show.
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“If you ask anybody,” Dr. Sinha said, “they will say I want to stay in my home as long as possible.”
Several hospitals, including Kingston Health Sciences and North York General, have introduced home-care programs similar to the one at Southlake, the first of its kind in Ontario.
Patients who have participated in the 16-month-old Southlake@home program wait less than a day to return to their own homes, once they no longer need acute care, said Arden Krystal, chief executive officer of the hospital.
Judy Smith’s 95-year-old mother-in-law, Reta, was one of the first patients to participate in the Southlake program. Twelve days after Reta was rushed to hospital in March, 2019, after she fell in the dining room at her retirement home, fracturing both ankles, she was back in her own apartment.
A team of nurses, occupational therapists and personal support workers provided care to Reta for 14 weeks, until she could go to the dining room for meals on her own, using her walker.
“I had high standards for care,” said Ms. Smith, a retired geriatric nurse. “This program met those standards.”
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The program initially helped Southlake reduce the number of ALC patients, but these beds are once again filling up. Today, ALC patients occupy roughly 20 per cent of the hospital’s 525 beds. As a result, Southlake is also exploring using neighbouring retirement homes for some of these patients, Ms. Krystal said.
“Because of what happened in long-term care many families are somewhat reluctant to jump to that now,” she said. “They don’t want their loved ones to become endangered.”
Editor’s note: An earlier version of this article had an incorrect age for Judy Smith’s mother-in-law, Reta.
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
