Long-term care: re-sparking the debate

Staff at Joseph Brant Hospital in Burlington are asking their elderly patients to go home in order to free up hospital beds for those needing acute/emergency care. Critics of this action suggest that the hospital is really removing, rather than freeing up, these beds in order to reduce their $5.5-million deficit. What strikes me as surprising is that staff are wearing "Home First" buttons to promote this initiative. What impression does this give to patients who absolutely need hospital care? Unfortunately, in order to balance the reality of taking on more patients, especially those with acute care needs, others are left to draw the short end of the stick. This time its seniors, re-sparking debate about the need for extended home care coverage and investment in long-term care facilities. 

A few issues are at play.

There are both advantages and disadvantages to receiving care at home. At home, patients are most comfortable in a familiar setting, can move around more to improve rehabilitation, and are away from any threat posed by superbugs at hospitals. However, the sicker the patient, the more supervision they need. Supervision by health care professionals costs money and currently the province only covers 1-hour worth of services - the rest of the costs have to be shouldered by the patient and their family. Admittedly, the hospital is trying to get churches and community organizations to help out, but the absence of any suitable long-term care facilities makes alternatives difficult to consider. 

One hopes that the hospital is only releasing elderly patients when they are deemed fit to leave. This cannot be guaranteed in constrained circumstances where new patient arrivals dictate the frequency of freeing up hospital beds. Acute care needs trump chronic care needs, but a chronic care patient left unsupervised in their home can easily wind up with an acute care problem. Are they ways in which adequate home care services can prevent this from happening?

My housemate Gabe believes that technology offers a solution. Specialized monitoring systems could be set up at home to provide 24/7 visual access on the patient's whereabouts. In addition, gadgets could be attached to their bodies to provide feedback on vitals and any unusual physical movements. All this information could then be fed into a data processor where people would work around the clock to monitor the health and safety conditions of hundreds, if not thousands, of patients living at home. Could this work as a short-term solution? 

WC 

Teaching Evaluation

Period 1 Ratings   4 3 2 1 Total  Overall Evaluation of Orgo Instructor?  2  8  2  0  3.00   Was the instructor prepared for class?  3  7  2  0  3.08   Did the instructor make the class interesting?  3  7  2  0  3.08   Was the instructor on time?  11  1  0  0  3.92   Did the instructor move the class at the right pace?  5  6  1  0  3.33   Student 28, Evaluators: 13 Average 3.28   4 = Excellent; 3 = Good; 2 = Satisfactory; 1 = Poor; 0 = Unacceptable

Not bad. Wish there was qualitative feedback. 

WC

Crying Babies

Imagine this. You've been asked to supervise a male infant in one of the pediatric wards. Upon entering his room, you are relieved by the fact that he is sleeping peacefully. It's almost the end of your shift and you welcome some tranquility at last. 

As you take a seat at a nearby chair, you can't help but notice the rhythmic rising and falling of the infant's chest. You remind yourself to look out for any abnormal patterns of breathing. The boy is resting on his stomach and you wonder why he hasn't fallen asleep on his back. You remember from your developmental psychology class that it is generally safer for infants to sleep on their backs with their face to the ceiling. He seems comfortable in his resting position so you don't bother to move him. At least his head is tilted sideways so that you can watch his face while he sleeps. 

After the fascination of scrutinizing the baby subsides, your mind starts to wander. You start to think about your plans for the afternoon, for the rest of the week, and ultimately for the rest of the summer. A TV is right beside you, but you know better than to turn it on. If a parent walked in, you wouldn't want to be caught doing anything other than supervising their precious child.   

Suddenly, the infant blinks. Is he waking up or just teasing you in his sleep? He blinks again and his eyes widen. He's awake! You haven't played with an infant in a while, but you are ready to at a moment's notice. 

He starts crying. Not surprising. He probably misses his mom or dad and feels threatened by this random stranger in the room. Predictable attachment response for an infant at this age. You try to use soothing words to calm the baby, but to no avail. 

Next, you try rolling him over on his back to facilitate more open communication. Your maneuvers are clumsy and sloppy. His crying gets worse. 

You try to give him a soother. It works temporarily, but he wants none of it after a few seconds. He redoubles his crying efforts.

Out of desperation, you try to distract him with some toys. He hardly pays attention to them. By now, his wailing hurts your ears and you are emotionally crushed by the tears rolling down his cheeks. Must be a pain response to something medical in nature. 

You attempt the last trick in your books - a cuddle. You haven't done one of these in a while so you're naturally hesitant to take him out of his bed. You note several cords and lines attached to his body, which complicates getting a firm hold on his limbs and torso. Forgetting to swathe him in blankets, lowering the guard on the bed, and giving him enough neck support are only a few mistakes you make while performing this intricate move. He cries more intensely to signify your failure to attend to his needs. Frustrated, you put him back down on the bed. 

Despite years working with children and being a regular volunteer on the pediatric ward, you feel a strong uneasiness about what to do next. Besides being unable to calm the baby, you are not even certain about why he is crying. 

Feeling helpless, you're about to give up when a nurse suddenly arrives. Remarkably calm, she provides words of encouragement, explains why the baby is crying, and thanks you for supervising the child. It's her turn to take over now. You feel undeserving of her appreciation. 

As you exit the room with a hanging sense of defeat, you wonder what you would do if the nurse didn't show up.

Am I ready to respond to an emergency?

Last weekend, I did a course on Standard First Aid and CPR. If there is one thing I took away from the experience, it would be the following: saving a person's life in any emergency situation is of utmost importance. Those with adequate training have a responsibility to intervene in dire situations that call for their expertise. 

All of this seems noble and Good-Samaritan like, but I'm still left with an unsettling feeling. After a weekend of training, I hardly consider myself qualified to handle an emergency situation on my own. If I make a mistake in any step of the life-saving protocol, am I not guilty of doing more harm than good on the patient even though I act out of good faith? Despite sufficient training, making a mistake is a real possibility in the heat of the moment as you race against time to save a life. 

For example, using an automated external defibrillator (AED) can help bring a patient back to life from cardiac arrest by delivering an electrical shock. Although the AED is a reliable, user-friendly, and generally worry-free device, things can still go wrong if metallic objects are not removed from the patient's body before administering the shock. These details are all too easy to miss in the spur of the moment. If death results from this negligence, you may not be held liable due to Good Samaritan laws, but can you truly escape the blame put on yourself? Can you erase the thought that, had you not intervened, the patient would probably still be alive? In this case, fear of adverse consequences and doubt about one's competency are legitimate excuses for inaction. Wouldn't it be better if someone else assumed responsibility? 

I'm at the cusp of understanding not when and how, but if, I can provide care.