Delays in discharging patients exacerbating trolley crisis

Nursing home owners say a “disconnect” between hospitals and private nursing homes, arising from delays moving patients out of hospital, is contributing to the trolley crisis.

While upwards of 600 patients remain on trolleys in hospitals this week, nursing home beds remain empty due to delays in discharging well patients,they say.

Albert Connaughton, owner of Belmont House nursing home in Dublin, said there is a “disconnect” and “lag” between when elderly patients are ready to leave hospitals, and when they get discharged to step-down facilities, such as nursing homes.

Staff from the facility will assess patients to see if the nursing home can provide appropriate care, but following an assessment it can take more than a week before the patient is discharged and moves in.

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“There is a lag, no doubt about it . . . Within that timeframe of a delay you’re worrying that that person is going to pick up a bug, or an illness and be delayed further,” Mr Connaughton said.

There are a lot of players between the patient, the family, the hospital, nursing home, transitional care team, and the Fair Deal office, who “could be more joined up”, he said.

The Fair Deal scheme offers financial assistance towards nursing home fees, and takes into account what personal contribution people can make, and assets such as their house.

Less overcrowding

The fewer patients delayed leaving hospitals, the more beds free for people coming in, and less overcrowding in emergency departments or on trolleys, Tadhg Daly, chief executive of Nursing Homes Ireland, said.

Close to two-thirds of patients waiting to leave hospitals, or “delayed discharges”, move into long-term residential care, such as a nursing home. Currently there are around 500 delayed discharges from hospitals each week.

There was a build-up of delayed discharges during Storm Emma, which led to fewer available beds across the system.

When the private sector aren't involved in the emergency planning, how can we be part of the solution?

Mr Connaughton said on Monday that an elderly man was due to be admitted to Belmont House, but it was held up over a delay confirming his admission from the health service transitional care team.

“That bed is available, we don’t know if he’s coming in today or not, that could go on for a week, and that happens regularly,” he said.

Mr Connaughton said the private and voluntary nursing home sector was out of the loop when it came to plans to tackle hospital overcrowding.

“When the private sector aren’t involved in the emergency planning, how can we be part of the solution?” he said.

The Health Service Executive said the number of delayed discharges per week has been reduced in recent years, due to investment in transitional care units and more short-stay "step down" beds.