Thursday, July 31, 2008

Pressing hard, or hardly pressing, for more Niagara long-term care beds

Tiffany Mayer wrote in “Death report seen as lobbying ‘tool’”, (St. Catharines Standard, Dec.1, 2007):

“It's the kind of information that can be used to lobby governments to invest in health care in Niagara.
And that's how the site chief for St. Catharines General Hospital plans to use a report that says the hospital has one of the highest death rates in Canada.
"What I think is important for us to do is ... to try to look at the release of this data generally - not as a specific number to fixate on but as a tool for us to potentially advocate for more resources in the community that will help us both in the hospital and as Niagara to ... optimize care as best we can," Dr. Jeff Cranford said.
On Thursday, the Canadian Institute for Health Information (CIHI) released standardized mortality ratios in a watershed study of 85 larger acute-care hospitals and 42 health regions throughout Canada (excluding Quebec).
Based on an average of mortality rates, including palliative care, from the past three years, St. Catharines General tied with Scarborough General Hospital as having the third highest death rate. St. Catharines General was 29 points above the national average, established in the study as 100.
Some of the key factors identified by the Niagara Health System that influenced the study results include:
° A regionwide shortage of 90 family physicians and nursing staff.
° The lack of beds available at long-term-care and rehabilitation facilities.
° Outdated infrastructure. Parts of St. Catharines General are more than 100 years old.
° A shortage of hospice and palliative care in the region.
Add to that a population with a high prevalence of chronic heart disease, cancer and kidney disease, and the poor socio-economic status of the region, and the odds are stacked against the General and the Niagara Health System, which as a whole was 22 points above the average national death rate.
"Health care really is a system and the hospital is only one part of that, albeit an important one," Cranford said. "Even the people who created the number acknowledge that - that the other factors in the system play a great role in this."
Fixing all that ails health care in Niagara would inevitably lower the death rate, but better numbers aren't the hospital's main goal, Cranford said. Improving care is the priority, and the two don't necessarily coincide.
A CIHI release said the numbers can be used as one measure of the quality of care. But the ratio is best used as a trend, not a target.
"We don't want to focus on the number. We want to focus on improving the quality of care," Cranford said.
That doesn't mean the hospital or Niagara Health System are waiting for government help. Improvements to care have been made while others are in the works, Cranford said.
The most important, he said, has been ensuring there are physicians at each of the three major NHS hospitals to care for patients who don't have a family doctor.
The other measure is streamlining care in the intensive care unit at the General by having one physician oversee all patients.
Reviews of death charts at all NHS hospitals are also done to determine care deficiencies, Cranford said.
"That review is ongoing, but I'm comfortable in saying we're very comfortable in the level of care and diligence that's been given to patients," he said.
St. Catharines Mayor Brian McMullan echoed Cranford that the CIHI study could help convince elected officials that health care in Niagara needs some TLC - and should have gotten it years ago.
"It does point to the need for a new hospital and we can't afford to wait and probably as a community we should not have had to wait this long," McMullan said. "We need that hospital desperately. We need that now."
City planner Paul Chapman was appointed as an expediter to facilitate building a new hospital in west St. Catharines by 2011.
The city's partnership with McMaster University to establish a clinic here to train medical residents as general practitioners could also help alleviate the family doctor shortage, McMullan said.
But more is needed, he noted.
"People who should be in a long-term-care facility are not there," McMullan said. "They're in a hospital and sadly, in some cases, passing away while they're there. That's not the appropriate place for them to be at that stage of their life, so we're going to continue to press the provincial government hard for additional long-term-care beds here in the city of St. Catharines."
St. Catharines MPP Jim Bradley noted the region had the chance to add 200 long-term-care beds in 2001. Local decision-makers at the time felt they weren't needed, Bradley said.
"I think we're seeing now that we need them," he said. "It would be nice to have them there now, but that was the past. We have to look to the future.... Our needs are obviously very great needs."
But, he added, as requests are put forward for more beds and programs, "we'll see them approved."
The province has also increased funding for home care and assisted living, which will help free up beds in hospitals and long-term-care facilities, Bradley said.

How study was conducted.

The Canadian Institute for Health Information released a report this week comparing hospital death rates. Using the hospital standardized mortality ratio, or HSMR, the 2004-2007 report compares death rates at 85 larger acute-care hospitals and 42 health regions in Canada, outside Quebec. Each hospital was rated against the Canadian average, which was assigned an HSMR of 100. A hospital or region with an HSMR greater than 100 has a mortality rate exceeding the national average; less than 100 means an institution's death rate is lower than average. The rating was adjusted for a number of factors, including age and sex of the patient and health status upon admission.”


In the above article, St. Catharines Mayor Brian McMullan says the city will “continue to press the provincial government hard for additional long-term beds here in the city of St. Catharines.”

So then, since Dec.1, 2007, when the above article was written, what has the city of St. Catharines actually done on McMullan’s pledge? Can McMullan provide any letters from the city to Jim Bradley demonstrating that the city truly was ‘pressing hard’ for more long-term beds?

Did the city receive any answers from Jim Bradley, or from the Ministry of Health? How hard did anyone press this issue? Have requests "been put forward for more beds" to Bradley, and has Bradley had "them approved", as intimated in the article?

Apparently, the City of St. Catharines now has millions to wield in expropriating lands for some proposed cultural palace, yet, is this really a priority, considering the health crisis Niagara Region is in? McMullan talked about the the NHS getting more "TLC" - was the recent NHS HIP report, closing and consolidating facilities, "TLC" enough for McMullan?

Shouldn’t McMullan's first priority for these millions of dollars be towards the health care system, in particular, getting those long-term care beds built and funded?

The St. Catharines Standard on July 30, 2008, wrote "OHA ( Ontario Hospital Association) president, Tom Closson's nine-minute video is posted on the health system's website at In it , Closson discusses constraints in funding and human resources facing hospitals across the province, including the NHS."

Funding constraints??

Wasn't funding their health monopoly the responsibility of Jim Bradley's Liberal government?

The Liberals denied that there was any link between their funding model and the problems at the NHS!! And the Liberals have prevented the Ombudsman from investigating the NHS, to ascertain whether the Liberal's claim could be substantiated.

In Hospital death-rate in Liberal Jim Bradley's St. Catharines: third-worst in Canada I wrote:

"The Toronto Star reported Jan.7, 2008, that Smitherman, talking of Brampton , "dismisses bids to link patient care troubles to funding model". Yet in Niagara, exactly a month ago, the St. Catharines Standard (Dec. 7, 2007) reported: "Laurel Ostfield, a spokeswoman for Smitherman, said the spectre of a review of operations at the NHS isn't a direct response to high death rates at St. Catharines General Hospital, which made national headlines last week."

So: 'patient care troubles' are not related to funding - at least in Brampton, and as already predetermined by the person running the system, Smitherman! Are we just supposed to take this Liberal's word that this is true?!

And, what about the 'patient care troubles' in St. Catharines?

There, Smitherman's staff were also denying any link between the CIHI report and the subsequent Liberal NHS 'organizational review' .

You would think that the Liberals would show concern about the high death rates and launch, not a simple organizational review, but a full-fledged inquiry.

But no, in St. Catharines they didn't even acknowledge any link between the 'funding model' , the high death rates, and their so-called review.

The Liberals also ignored that "The NHS has consistently maintained it doesn't receive enough funding from the provincial government to properly care for a population with a large mix of seniors and residents on the lower end of the socio-economic scale. "If a review brings in the results we need to get the funding we need, then we're all for it," [Betty-Lou Souter, chairwoman of the health system's board of trustees] said. "The bottom line is, we need to have more money to carry out the programs we're doing."" (St. Catharines Standard, Dec.7, 2007).

So why doesn't Jim Bradley explain why his Liberals are not sufficiently funding the health monopoly which they cherish so? Where's the money?"

It's been eight months since the death-rate report came out, yet, no one is now mentioning any link between the mortality-rate, the Liberal's (under)funding model, and this drastic July 2008 HIP proposal.

How seriously are Bradley and McMullan really taking this crisis?

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