herald

Thursday 19 October 2017

Priscilla Lynch: 'Bed blockers' are not to blame... a creaking system is

The scene in Beaumount
The scene in Beaumount
Beaumount Hospital

We are hearing a lot lately about bed blockers clogging up our hospital system and denying those poor patients on trolleys a bed.

While it might sound snappy, bed blockers is ultimately a derogatory term for delayed discharges – those patients who are medically fit to be discharged from an acute hospital but who have nowhere to go.

They are most commonly elderly and frail patients who are in need of a nursing home bed, a place in a rehabilitation or step down facility, or a home care package.

As Age Action Ireland spokesman Eamon Timmins puts it: “A better description is prisoners of the State – unable to either go home, to the nursing home or rehabilitation care they need due to lack of funding.”

As trolley numbers to continue to hover over the 500 mark and hit a record 600 recently, delayed discharges also hit record numbers at 800. At any one time an estimated 10pc of acute hospital beds are filled with delayed discharges.

It is a predictable issue: during the winter months more people attend emergency departments (EDs), particularly elderly people. They need follow on care when they have recovered. Many are now too sick to remain at home any longer.

Yet despite knowing we are now living longer, with more complex health needs and an increasing elderly population with less family support, we simply do not have enough public community and rehabilitation beds. Where we do, the red tape to access them is ridiculous.

A new HSE report on delayed discharges found nearly half of patients who should be discharged from hospital to a nursing home are caught up in a lack of funding or bureaucracy in the Fair Deal scheme.

A significant amount of these patients were still waiting for their application to be processed while many had been approved but the money had not been released, while many others had not filled out the forms.

It was recently confirmed that processing times were taking over four months for Fair Deal applicants.

The HSE report also revealed how many patients who could go back to their own homes are prevented in doing so by the HSE delays in giving financial support for a home care package or basics such as grab-rails or appliances.

These delays defy all common and economic sense. Acute hospital beds are the most expensive type of care for these patients and are not suitable for their medical and physical needs or indeed their mental health.

The situation also means that patients in urgent need of a bed coming through EDs are being forced to endure unacceptable delays and unsafe and undignified care in many cases.

In recent years, the Fair Deal scheme was capped and had its budget reduced despite growing demand and huge pressure on acute hospital care.

In addition, home care packages and supports have also been cut as the HSE budget shrank. We are now witnessing the ramifications of these cuts, as was warned by those who work in this area.

Health Minister Leo Varadkar is aware of the extent of the problem and set up the ED task force in late December. He also managed to get millions in extra funding to release new nursing home beds.

Yet this funding has had little real impact as trolley numbers this week remain about 500.

Long term solutions are needed. While extra money for more nursing and rehabilitation beds and home care packages are key, some solutions do not cost anything or could save money in the long run.

For example, as Age Action has suggested, extra support is needed for people in filling out the forms to access a Fair Deal, particularly those without facilities to help them.

Also, many elderly people are being denied the chance to remain at home because the support they need, through some modifications of their home and some regular home care is denied to them.

Last, but certainly not least, cutting down waiting times to access Fair Deal beds must be a priority.

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