On any given day, a cohort of patients large enough to occupy all the beds in St Vincent’s hospital remains stuck in hospitals across the State, despite being well enough to be discharged.
The 550-600 “delayed discharges of care”, as these patients are known, regularly outnumber the daily trolley figures. It is tempting, though over-optimistic, to think trolleys might disappear if the problem of delayed discharges could be solved.
This is a clear lose-lose situation. The patients suffer by being forced to remain in hospital, with all the attendant privations this involves, while the health system is unable to use their beds for other patients requiring admission.
As the Irish Gerontological Association pointed out in 2018: “A proportion of delayed patients may experience physical ‘deconditioning’ due to being subject of processes of hospital care that they no longer need which may restrict usual levels of physical activity, impair their sleep, increase the risk of hospital-acquired infections, iatrogenic events and/or negatively impact upon their psychological wellbeing. The feeling of being a ‘bed-blocker’ can often add stigma to a situation that is no fault of their own.”
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The problem of delayed discharges is a long-standing one. It was the subject of an independent expert review in 2018, yet still numbers continued to climb.
Then the pandemic hit. Extreme measures were taken to suit the emergency circumstances. Hospitals were emptied to prepare for the expected wave of Covid-19 infections. The perils of over-rapid discharge were demonstrated when some of those sent to nursing homes were found to be positive for Covid.
Later in the pandemic, the health service attempted to return to normal service. Hospitals managed their beds more efficiently, discharged processes were tightened up and new investment beefed up services in the community. The number of delayed discharges recorded each day halved and it seemed the problem was on the way to being solved.
Alas, this is not the case. Numbers are back up to pre-pandemic levels once again, even if the underlying reasons for delaying the discharge of patients have changed somewhat. Meanwhile, hospital emergency departments are busier than ever, particularly with older, frailer patients, so the pressure on beds is higher than ever.
A lack of home care staff has emerged as one of the biggest single reasons why patients’ discharge is delayed. More than 1,000 patients approved for home support had their discharge from hospital delayed this year due to a shortage of carers, figures obtained by The Irish Times show.
So while much of the debate around health services focuses on shortages of consultants, its highest-paid staff, shortages of low-paid care staff are having an equally deleterious effect.
The same challenges are cropping up in the UK and many other countries, as the population of older people with multiple medical conditions continues to swell.
HSE figures show problems around the nursing home support scheme (NHSS or Fair Deal) are also contributing to delays. A further 375 patients who were approved for funding for Fair Deal had their discharge delayed due to having to wait to secure a place. A total of 1,144 people had their discharge delayed by various lengths of time, because of delays in completing or submitting Fair Deal applications.
Last month, an advisory group on home carers published a report recommending measures to make the job a viable career option. It suggested home carers should be paid travel expenses and for time spent travelling between service users’ homes. It also recommended carers receive the national minimum wage as a minimum, and said their entitlements to State benefits should not suffer if they work part-time.
None of these recommendations look likely to resolve issues in the short term.