This is the first of six articles about the complex issue of Alternate Level of Care (ALC). I will examine the work of the Sudbury ALC Steering Group, effects on the Sudbury Regional Hospital, the history of health care spending in Ontario, and recommendations for action - what we need to do to adapt to our changing reality.
I have written from the perspective of a physician – first as a family doctor in the northern community of Geraldton, then as a critical care physician at Sudbury Regional Hospital. I have seen many changes over the last 40 years – many wonderful advances in treatment. Yet the public appears increasingly dissatisfied.
Why do we hear repeated complaints about long wait times in our Emergency Department; or complaints about hospital patients placed in hallways? What is all the fuss about ALC patients? Let me explain.
What is happening in our society is unprecedented. People everywhere are living far longer than they used to. In 1900, the average life expectancy in Canada was under 50. It is now approaching 80, and still rising. Eighty, it is said, is the new 65. The age bracket that has experienced the largest growth in numbers is 100 and older.
That is surely something to be grateful for — especially since many older people these days also remain healthy, fit and active for much longer. Many people are taking charge of their own health by doing sensible things such as not smoking, not drinking, and eating in moderation and exercising regularly.
But even fairly fit older people need more health care than younger ones, and for an increasing number of years.
Growing numbers of older people will become less able to look after themselves and will need some form of help. The great bulk of that care is still provided by family and friends, the traditional source of support for the elderly. But with dual working households and youth migration, outside help is becoming increasingly important. New drugs, medical technology and innovation will demand more financial support. Thus pressures to spend more on health and long-term care can only continue to grow.
Innovation is something to be grateful for. Not that many years ago, the treatment for a heart attack was bed rest, oxygen and morphine. The treatment was cheap but not very effective. Now we have open-heart surgery and stents to open clogged blood vessels, and modern medications to prevent re-obstruction. These treatments are expensive but effective – improving quality of life dramatically.
Our health care system is facing a “perfect storm” – a growing number of people requiring increasingly complex treatment for illness in hospital, and a growing number of elderly, fragile individuals who may not be ill but are unable to live without support. As a result, we find ourselves with an untenable situation - too many people entering the health care system via the hospital and too many people unable to leave, with too few community resources to accommodate their needs.
In my next column, I will try to answer the question “what exactly is an ALC patient?”
Dr. Peter Zalan is president of the Sudbury Regional Hospital medical staff. More info.