Madam, - Eithne Donnellan's report in your edition of May 16th, "Call to charge families who block discharge of patients", raises a number of issues.
Having studied the discharge profile of 1,240 older patients from one acute hospital in Cork city over a two-year period, we have found that delays in discharge are caused by many factors. Ninety patients had a delay in discharge, resulting in 2,436 lost bed days over the two years. the main reasons were lack of community supports and appropriate long-term care facilities. We specifically found that delays in discharge of older patients were not attributable to their relatives "blocking" discharge. Most relatives rightly seek appropriate facilities for those whom they represent.The decision to discharge must take account of a patient's individual needs, including medical, nursing and social supports.
Access to long-term care facilities entails lengthy bureaucratic procedures, not least the subvention process. Legislation governing subvention is unclear. The process is not transparent and varies widely from one region to another.
We agree that there is a lack of community facilities for older patients who are vulnerable because of multiple illnesses, high levels of dependency and changing social structures. However, blaming relatives is simply another attempt to shift the focus from the lack of essential resources. The use of the term "bed-blocking" in the context of elderly people who are ill and vulnerable through no fault of their own is clearly distasteful. - Yours, etc,
Dr PAUL GALLAGHER, Specialist Registrar in Geriatric Medicine, Cork University Hospital, Wilton, Cork.