Lack of rehabilitation clogs hospitals

Chantal Leblanc, 83, lifts two small weights of half a kilo each. Sitting on a chair, unplugged from her oxygen tank, she participates in a group exercise session led by a physiotherapist at Mount Sinai Hospital in Montreal. A hard workout.

“When you’re out of breath, it’s hard to exert yourself,” said the petite woman with gray-white hair, dressed in sweatpants and walking shoes.

Chantal Leblanc suffers from chronic obstructive pulmonary disease. Almost a month ago, she thought she was going to die. “I couldn’t breathe,” she says.

Hospitalized at the Montreal University Hospital Center (CHUM), she was transferred to Mount Sinai Hospital to perform pulmonary rehabilitation therapy. “I waited three or four days at the CHUM to get a place here,” she says.

And this is one of the problems of the Quebec health network. Due to the lack of available rehabilitation beds, patients remain stuck in hospitals, contributing in spite of themselves to overcrowding emergency rooms and hospitals.

According to the Ministry of Health and Social Services (MSSS), 13.47% of hospitalized patients in Quebec no longer required acute care, as of September 9. Among them, 41% were waiting for a place in residential care (CHSLD, intermediate or family-type resources) and 16% for a rehabilitation bed.

“There is a shortage of rehabilitation beds everywhere in Quebec,” points out Francine Dupuis, deputy president and executive director of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, which notably manages the Mont-Sinaï hospital.

In the metropolis, rehabilitation beds are closed because there are not enough doctors to take care of patients, indicates the D^D Nathalie Zan, medical coordinator for accommodation and responsible for managing rehabilitation beds at the CIUSSS de l’Est-de-l’Île-de-Montréal.

“With us, we have 35 closed beds out of 113”, she cites as an example.

At the CIUSSS Centre-Ouest-de-l’Île-de-Montréal, the Mont-Sinaï hospital is operating at 80 or 85% of its capacity, “due to the COVID-19 pandemic”, according to the director of rehabilitation and Multidisciplinary Services, Mary Lattas.

However, the needs are increasing, notes the occupational therapist by training. Many seniors have been deconditioned for two years. “We’ve had a lot of elderly people’s fractures lately in the emergency room. [de l’Hôpital général juif] “, reports Mary Lattas.

At the Ministry of Health and Social Services (MSSS), it is confirmed that “some” CIUSSS and CISSS have had to close rehabilitation beds due to the lack of doctors and caregivers. “This shortage makes it difficult to open beds at this time,” an email wrote.

Patients pay the price, deplores the D^D Zane. The average waiting time to obtain a place in rehabilitation was almost seven days in August at the CIUSSS de l’Est-de-l’Île-de-Montréal, she notes.

“Lost” time, according to the family doctor. Patients move less in the hospital and risk complications (eg a wound) or deconditioning. “When they arrive in rehabilitation, it can be longer”, underlines the D^D Zane.

Chantal Leblanc is on her second stay at Mount Sinai Hospital. She already knows that she will not be able to return to her apartment located at a 3^e floor, where she lives alone. “There are 72 steps. But they are arranging accommodation for me at 1^er stage. I’ve lived there for 33 years,” she says, pausing to catch her breath.

The Montrealer wants to finish her rehabilitation as soon as possible. ” I want to go [de Mont-Sinaï] because there are four of us in the room! she blurts into the exercise room, her walker by her side. The roommate drives her “crazy”. “I was a bit already! “, she adds to the joke.

A “future” sector

The rehabilitation sector is one of “the future”, believes Francine Dupuis. It frees up hospital beds and postpones stays in CHSLDs. “There are a lot of elderly people who can do rehabilitation and, after that, go home,” she thinks. If you rehabilitate them enough, they may be able to do two or three more years at home. »

Their condition is “often” even better than “two, three or four years” before, according to D^D Suzanne Levitz, head of the in-house rehabilitation program at Mount Sinai Hospital. “Patients understand their disease a little better, how to manage shortness of breath, how to walk and breathe at the same time,” she explains.

Users who are more fit and skilled with technologies can carry out their therapy sessions at home, thanks to telerehabilitation. When passing the To have to at Mont-Sinaï hospital, a kinesiologist, installed in front of a camera, was doing breathing exercises with 16 patients in their residence in Montreal, Lanaudière or Outaouais.

There are a lot of older people who can do rehabilitation and then go home. If you rehabilitate them enough, they may be able to do two or three more years at home.

This outpatient respiratory rehabilitation program is expanding this year. According to Mary Lattas, approximately 250 users will be able to take part, that is to say a hundred more than last year. In neurology, the number of telerehabilitation places will increase from 50 to 80 this year.

The MSSS relies on intensive home rehabilitation to free up hospital beds. He says he is working with healthcare institutions to put in place such “solutions that do not require medical coverage”.

Still, more needs to be done to recruit family physicians to intensive rehabilitation centers, judge Francine Dupuis. “In my opinion, we will have to give them the same good conditions as doctors who go to CHSLDs,” she specifies. Since 2018, the latter have benefited from improved pricing.

Few doctors do this practice, but they have a huge impact. They are enthusiasts.

According to the D.^D Levitz, the practice of intensive rehabilitation is more demanding than thirty years ago. Patients are discharged from hospital faster and are less stable upon arrival at the centres. “They are much sicker,” she said. It’s a lot more work. “To combine such a task, with the care of patients in the office and a practice in the emergency room, seems “very difficult” to “many family doctors”, she adds.

Yet it is a rewarding practice, believes the D^D Zane. “Few doctors do this practice, but they have a huge impact,” she says. They are enthusiasts. »

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