It is now over a year since the creation of the transition unit at St. Joseph’s Hospital.
The transition unit is a 22-bed unit on the second floor of the hospital (previously the surgical ward) that is provided for patients, mostly elderly, who are no longer in need of acute care, but not ready to be discharged. Most of these patients are awaiting placement in long-term care facilities and are designated ALC (alternate level of care).
To create this dedicated unit, the third floor of the hospital, which had previously been the medical floor, was changed to medical and surgical, in the process eliminating 18 acute-care beds.
There was a great deal of opposition from the medical staff, the nursing staff and everyone else in the hospital, as well as the community at large to the loss of acute care capacity in the hospital.
Over 8,000 people signed a petition opposing the change and the staff and community made joint appeals to VIHA (Vancouver Island Health Authority) to provide adequate residential care in the community so that acute care beds did not need to be taken away. VIHA didn’t respond.
The administration didn’t bend.
Michael Pontus, who was the CEO of St. Joseph’s at the time, was asked by a delegation of staff and community members to come to a public meeting to answer questions and explain and defend the actions of the hospital. He declined but said that he would be pleased to do so any time after November 2010, once the new unit was up and running.
It must have slipped his mind after that because no such meeting has taken place, and now he is no longer the CEO.
The justification given by the St. Joseph’s administration for cutting acute care beds was that the creation of the transitional care unit would solve the problem of having ALC patients in acute care beds. It was said that with the TCU none of the remaining beds in the hospital would be needed for ALC patients. This had to be done, the administration said, because VIHA had not fulfilled its promise of new residential beds in the community.
Losing 18 acute care beds has made a terrible situation even worse with no respite for the pressure on the emergency department and staff on the third floor run off their feet. There is still a desperate need for residential care beds in the community and now the situation in the hospital is worse.
This was what the medical staff, nurses, unions, and community predicted and it has been proven correct.
The administration “promised” that the creation of the transition unit would mean that none of the remaining acute care beds would be needed for ALC patients. That was a promise impossible to keep.
St. Joseph’s has, now, routinely, a minimum of six ALC patients, and usually many more, above and beyond those in the transition unit.
They are put in acute care beds wherever they can be found, first in the old pediatric Unit (six beds on the first floor that are, for all intents and purposes, a holding area for the TCU), on the medical-surgical third floor, in psychiatry.
On Nov. 30, for instance, the medical director and the vice-president patient services notified the medical staff that, “We are in Overcapacity Protocol Level 5. We have 5 admitted patients in the ER and 7 in ER Overflow. We have a total of 31 ALC patients” and asking, “Could all physicians please review once again their patients for discharges. Thank you for your assistance.”
This is not unusual. It is ‘normal’ for St. Joseph’s. The request and the numbers are typical.
I think that it’s time for the health care community and the community at large to stand up to VIHA, the Ministry of Health Services and the Clark government and put some fire behind the demand to increase the number of public residential care beds in our community.
It’s time the administration of St. Joseph’s Hospital did the same.
P.S. Whether, someday, we get two new hospitals or one new hospital or no new hospitals, we need the residential care beds and we need them now.