CKNW Editorial
for April 19, 2001

Yesterday's interview with Maxine Davis, Executive Director of the Dr Peter Foundation and board member and physician Dr Fraser Norrie spoke volumes about the high cost of medical care. To keep a patient in acute care costs $1000 per day. To keep an AIDS patient in the Dr Peter Home costs less than $300. But it isn't only AIDS patients we're talking about here. No one can say but there are hundreds of patients who ought to be in Long Term Care but are in acute care because of the lack of LTC facilities. Suppose for sake of argument you pegged the figure at 500 - that's an increased cost of $350,000 per day to the system or something in the order of $125 million per year. That is, admittedly just a guess on my part but the point is simple - when we are looking at ways to avoid having to get private capital into the health care system we must surely first of all look at how we can save money. And what is now simply a bad situation will reach catastrophic proportions when the baby boomers hit the system with a crunch.

Now saving doesn't come without a cost. Facilities have to be built. But so do hospitals and if we're building acute care hospitals to house long term care patients that's an absurdity. A good chunk of that money needs to be re-directed.

But why, one asks, hasn't this been done long ago? It's not a new problem and we’ve known for a long time that with that aging baby boomer population surely it will soon be critical unto catastrophic.

The reasons are, in my opinion, largely a matter of mindsets and
stubbornness. The stubbornness comes from doctors and other caregivers who find it convenient to have patients in acute care hospital wards where they can be seen on regular rounds. I don't suggest that doctors deliberately have their patients stay in acute care - I just say that they are human beings (despite their occasional notions to the contrary) and may not be as fast to reclassify their patients as they might be.

The public mindset is perhaps a bigger roadblock to a huge increase in Long Term Care funding. We grew up with the notion that health care meant big acute care hospitals. That was the yardstick by which we judged health care. This was fueled, starting in the 1950s and continuing until the 80s, by federal funds paying 50 cents out of each dollar spent on acute care facilities. We built far more acute care beds than we needed and almost no LTC beds. This led to the absurdity to where we have too many acute care beds but were short of acute care beds.

This mindset manifested itself in interesting and highly damaging ways.
Politicians, playing on the prejudices of their constituents, measured the efficacy of health care by the number of acute care beds in their constituency and said so loudly and often. The political debate over health care had as its constant currency the number of acute care beds. Woe betide a Health minister who tried to readjust the system by reducing the number of acute care beds … the opposition screamed like stuck pigs. And sometimes that was reasonable because while the minister was trying to reduce the acute care beds he wasn't building the replacement LTC beds.

Ministers of Finance, used to seeing health care measured by the number of acute care beds, and used to the Hospital Construction item in the Health Budget, were reluctant to put money into Long Term Care the full effect of which would not be seen for perhaps a year or two. It’s traditionally very hard to convince finance ministers to look beyond the current budget year.

A more subtle prejudice occurred - prominent citizens, always willing to serve on hospital boards, didn't see the other care facilities as prestigious enough for them. Accordingly, Long Term Care facilities did not get the publicity the general hospital did. And the big public debates were always about hospitals – Cat scanners, MRIs, dialysis machines, cancer clinics and the like. No one paid much attention to what we often thought of as the "old folks home".

It is not an easy question. There are lots of marginal cases that will be used in arguments as to who should be in acute care and who should not. The fact remains, however, that we don't have a shortage of acute care beds, we have an excess of patients we have nowhere else for. A good part of the cause of surgery lineups are the result although admittedly there are other contributing factors there. Whatever way you look at it, the absence of proper care facilities like the Dr Peter Center provides has a huge and very costly impact on the system.

It's a multi branched nettle - but it must be grasped before the baby boomers really hit the system which is within the next decade at most.