Ensuring the right patient is in the right bed

A name change to some beds at Port Colborne Site from Acute Care to Complex Continuing Care (CCC) took place recently.

Patients at the site did not notice much of a change – in fact, historically most of the 56 inpatients have been receiving CCC or Alternate Level of Care services during their hospital stay.

CCC provides rehabilitation programs for medically-complex patients who need hospital-based services, regular assessment and active care management. The healthcare team providing this specialized care is led by a Hospitalist (hospital-based physician specialist) and a Nurse Practitioner.

CCC patients who are in a slow-paced recovery program have a treatment plan with the focus to independence and discharge home. As well, complex care units provide care to palliative patients and those awaiting transfer to an active rehab bed in the community or a long-term care home. There are also some patients who remain in hospital because their medical conditions are too complex for nursing home care. On average, CCC patients stay in hospital for 85 days at Port Colborne Site.

Also in these beds are Alternate Level of Care or ALC patients who have finished the acute care phase of their treatment and are waiting for a nursing home bed or community services at home before being discharged. The average length of stay for ALC patients in an acute care bed is 12 days.

Co-payment charges

There are two situations when patients are charged a co-payment fee. The most common is for ALC patients waiting for a bed in a long-term care home or chronic facility. Once the physician has determined that his/her patient no longer requires acute hospital-based services, the patient is deemed ALC and a co-payment maximum of $53.07 per day is charged, as set by the Ministry of Health and Long-Term Care.

This co-payment is the patient’s contribution towards accommodation and meals. It is the same rate charged to residents in nursing homes. The co-payment has been in place for many years and is changed each July.

The second situation where the fee is charged is to some CCC patients who remain in hospital because their medical conditions are too complex for nursing home care. In cases where the Complex Continuing Care unit becomes the patient’s permanent residence, the same co-payment is charged, on a scale based on income.

“It’s important to note that many low-income patients qualify for a reduction in the rate of the co-payment,” says Wendy Robb, Health Program Director for Transitional Care and Rehabilitation and Port Colborne Site. “Following Ministry guidelines, the hospital uses a sliding scale based on last year’s income tax statement. Only the patient’s income is used for this calculation – other family member’s incomes are not included.”

In both of these cases, the patient would pay the same rate as they would for a nursing home bed. To ensure fairness with other patients and residents in long-term care homes and to prevent inappropriate use of acute care resources, everyone is now charged the same rate. This allows hospitals to direct more resources to patient care, rather than accommodation.

More home-care and community-based services are being established through the Community Care Access Centre, and Niagara Health is working closely with this key partner to transition patients home.

A similar plan for Complex Continuing Care beds is being rolled out at Douglas Memorial and Niagara-on-the-Lake sites this fall. In addition, six beds at Douglas will be used for short-term acute care admissions.

Acute inpatients, such as patients with pneumonia, those recovering from surgery and patients with acute stomach conditions are now cared for at other Niagara Health locations – Greater Niagara General Site, St. Catharines General Site and Welland Site. «