Sunday, 12 January 2014

False expectations.

In the last few days several newspapers in Canada have carried stories of Hospitals apparently sending home patients, to find that they died a few hours later. Their condition was worse than what the doctors in Emergency service thought or the Nurses in charge of discharging patients followed established procedures sending patients on their way not realizing that the patient was alone and had no one to care for them at home.

The practice of clearing beds is not a new policy, it is one which was implemented in many Canadian Hospitals in the mid 1990's as Provincial health budgets were slashed by politicians in a drive to be seen as business minded, bringing the concept that a health care facility could be run like a factory producing widgets, ''Be efficient and Work Smart'' was and still is the philosophy behind it all.

Our politicians in Canada understood that our current health care system instituted in the 1960's needed reforming to control costs. Many a Province  spend a very large part of their operational budget on health costs. But how to reform a system seen by most Canadians as a Sacred Cow without committing political suicide, this is the crux of a complicated question.

It is Winter in Canada and this winter 2013-2104 has seen the effects of dramatic climate change, the temperature in much of Canada has been severe and this brings a host of problems not encountered often before.  So people are more vulnerable in many ways and if you are not in good health or elderly then you are more at risk, sometimes as the news stories show, at a far greater risk than one would expect. What as also changed in the last 25 years or since 1990 is the way government services are provided, in this case hospital care.  Politicians in an effort to please the public have been slashing budgets and services, what we knew or came to expect in terms of services before 1990 and what is done today is totally different.  With cuts there are a lot less services and people are expected now to look after themselves or make private arrangements. This means, making sure the hospital room is cleaned properly, that meals are served and follow diet, that medication is dispensed and bed sheet are changed for clean ones. In some Provinces a small tip or favour to hospital staff can ensure better service.

Last year  I was invited to a business dinner with various people who had in common that they worked in providing social services to the population in general. Next to me on my left was a big Hospital administrator from Northern Ontario and on my right was the head of the Soup Kitchen in the National Capital region. The Hospital Administrator was explaining that the Government of Ontario to get more mileage out of its budgets in order to provide more efficient health services, I love the buzz word ''efficient'' what ever that means, he had to ensure that people do not spend any more time than absolutely necessary at the hospital and doctors and nurses where asked to work as a team to ensure that the patient be looked after, treated and then released quickly.

What happened next was to ask the individual to continue his or her convalescence at home and let families look after the relative in need. This way with a minimum of beds available much more people could be processed, again a word I love, it has that mechanical ring to it. This in turn would lower cost, it is all about money and little else.

I told him that this was a fine in theory but the public at large was not aware of this plan or if they are it is at a very superficial level, not believing that this might apply to them or their loved ones. At any rate this is the here and now and this is the way it works.

But in Canada many a politician has made his or her career by claiming that financial disaster is at hand due to difficult times, they never explain what they actually mean by that. So the easiest thing to do is to portray yourself to the electorate as a pro-business and cost cutting kind of politician who will solve all problems by downsizing and cutting or slashing budgets, making the government so small in can fit in your bathroom. This is called ''thinking outside the box'' and is suppose to look smart.

The politician being careful of course to NOT ever mention or explain that you are also getting rid of services in the process. The latest is to require all to have a computer and be online in order to access Government Services. You are not online too bad we do not want to hear from you, you do not exist, but we fully expect you to vote for me at the next election.

Again in this cynical political approach the over 65 crowd which represent a very important segment of our society in Canada are pushed to the margin.

In recent weeks more stories have come forward about how hospitals have sent home often in the middle of the night elderly patients without enquiring if this person had anyone to take care of them.

In one case at the Grace Hospital in Winnipeg  on New Year's Eve when it was -40C, an elderly man was put in a taxi, wearing slippers and his pyjamas and sent home. He did tell the staff at the Hospital that he had no one at home and he did not feel well, nonetheless the procedures are the procedures. He was found frozen to death in a snow bank in front of his house the next morning by his care giver. He died of a heart attack and hypothermia did the rest. He had gone to the hospital complaining of symptoms like heart trouble, vomiting, fever etc. The staff obviously did not think much of it or where too short staffed to be able to care for him during the Holiday period.

Being short staffed to provide any kind of government service is also the common trend nowadays, it is called ''greater efficiencies'' by senior bureaucrats, one person is called upon to do 3 to 4 jobs. The other problem is that at night or after 6pm in any hospital, the staff is usually junior or new, fully trained but not as experienced as the Monday to Friday 7am to 6pm medical crowd, mistake can happen and often as we see today in the service sector, the new younger generation is too self-absorbed to notice anything outside of their zone of knowledge. A few days later the CBC reported that Grace Hospital is now involved in a second case resulting in the death of a patient.

This is only Winnipeg cases, similar cases of elderly persons being mistreated, neglected and dying happen in other parts of Canada each week, this is truly shameful and unacceptable.  In all cases, the politicians promise to look into the matter and change the procedures, all the while they are looking for a politically expedient answer.

One wonders, when the big management types in the different Provincial Ministry of Health came up with these procedures, did they think of all possibilities or were they just being ''efficient or cost effective'' in order to please their Minister with quick solutions.

I am willing to bet based on my own Government experience, that expediency took over from common sense. Not to forget the promised of a big bonus for anyone who finds politically easy solutions to difficult problems.

All these changes in the way services are provided never seem to take into account that in Canada, people in general do not live with their family and it is very common to see elderly people on their own without any close relatives to help them out. Often they live in another part of the country and cannot come rapidly in case of need. Care givers are very expensive and not for every budget. What drives all this is the politics of cutting taxes, smaller government and trying to make government function as if it was Walmart.

The lesson in all this for all of us is to be prepared and have a plan in case you fall ill or need assistance, do not count on the Government to help you out. The governments at all levels are far too enamoured of processes and procedures and providing a service is simply not part of the equations. As they say ''As long as the public believe we are providing a service that is all that matters''.

Being a senior, over 60 years of age in Canada is not a pretty picture, unless you are financially well off.  Another disturbing statistics in Canada, the number of suicides is the highest amongst Seniors over 80 years of age, this does not attract much attention, because most are male and end their lives violently. What a sad situation.


1 comment:

  1. Well, it's not a lot better here, even if we should be glad we still have a National Health of sorts. My ma was sent home far too early after a hip op, wouldn't let me stay the night because she had a neighbour on call and a set up which was supposed to send people on the evening she was back and the next morning. They didn't show and she panicked trying to get up and sort her own pills - blood pressure plummeted and both she, her goddaughter and the neighbour who were there thought she was going to die. They called the paramedics who looked after her for two hours and an ambulance came to take her back to hospital. But the copious notes the paramedics had made weren't transferred to the hospital.

    As for her time in there - nearly a month all told - there were good and bad nurses, but no co-ordination, abuse of patients with demential (nearly everyone else) and a list of things that went wrong which I've written down and must now write up to file a report. A real eye-opener. Anyway, she's been incredibly spirited and - as one nurse put it - 'vocal' about what she needed.