To relieve overloaded hospitals, a growing number of health establishments in Quebec are opening these days “non-traditional sites”, such as hotels, to accommodate patients no longer requiring acute care, but who are waiting for a place in CHSLD. or be able to return to their seniors’ residence.
In the Chaudière-Appalaches region, the Convent of the Sisters of Charity of Saint-Louis de Lévis has been welcoming since Monday 13 of these patients called in the jargon as “alternative level of care (NSA)”. These patients may, for example, be waiting for a place in a CHSLD. Or be positive for COVID-19 and not be able to return to their retirement home (RPA) right away.
WIKICOMMONS PHOTO
Convent of the Sisters of Charity of Saint-Louis de Lévis
The spokesperson for the CISSS de Chaudière-Appalaches, Mireille Gaudreau, underlines that the number of NSA patients has “experienced a very significant increase in the last hours”.
Sylvie Turcotte’s father is one of these patients. The 85-year-old man entered St. Mary’s Hospital in Montreal on December 29 with a pulmonary embolism. He contracted COVID-19 in hospital while sharing a room with a patient who tested positive. However, he did not show any symptoms.
Even though he no longer required hospital care, the retirement home he lives in refused to take him back because he was positive for COVID-19. Mme Turcotte recounts that his father was therefore hospitalized in a small room, with another patient, on a red floor.
He was confined to his room. He no longer needed to be in the hospital. He had to move to avoid getting another clot. But it was too small.
Sylvie Turcotte
Mme Turcotte therefore decided to welcome her father into her home by isolating him in his basement.
On Saturday, Press revealed that the growing increase in these patients at the end of acute care is creating enormous pressure on hospitals, already overwhelmed by the number of patients positive for COVID-19.
Faced with this increase in the number of NSA patients, several health establishments are reluctant to return them to CHSLDs or RPAs, for fear of contaminating these environments as was the case during the first wave. President of the users’ committee of the CHSLD Alfred-Desrochers of the University Institute of Geriatrics of Montreal (IUGM), Anne Kettelbeil fears these transfers to CHSLDs. “Already, the CHSLDs are understaffed,” she said. And several workers are absent because they are infected with COVID. If we add residents who are positive or at risk of being so, that adds even more to the load. ” For meme Kettelbeil, “these transfers cannot be done in a ‘safe way’, neither for the patient nor for the nursing staff”.
Co-chair of the Community of Practice of Physicians in CHSLDs (CPMC), the DD Sophie Zhang believes for her part that, “under the right conditions”, patient transfers to CHSLDs can be “acceptable and even desirable”. For her, it is clear that the situation in CHSLDs is no longer the same as in the first wave. There is no longer a lack of personal protective equipment. The majority of residents are vaccinated. “But there is a lack of staff, as everywhere in the network”, indicates the DD Zhang.
“Thus, condition no 1 for a transfer, in my opinion, it is the absence of service breakdown at the staff level in the receiving CHSLD, wrote by email the DD Zhang. No one knows how to care for a vulnerable older person better than we do. You just have to be careful not to treat CHSLDs as a valve for the hospital. ”
“Bring the problem elsewhere”
At the end of the week on Twitter, the geriatrician David Lussier, of the IUGM, wrote that, “in a context of lack of hospital beds, these patients (NSA) must be transferred out of hospital”. The Dr Lussier specifies that the opening of non-traditional sites such as hotels requires “dedicated staff, therefore relieved of other activities”. A situation which is difficult in the face of a major staff shortage, adds the doctor.
In Lévis, for example, the staff who will work at the Couvent des Sœurs de la charité de Saint-Louis come from family medicine groups in the sector and patient attendants, “CHSLDs and other relieved sectors such as outpatient clinics. », Says Mme Gaudreau.
For the geriatrician and epidemiologist Quoc Dinh Nguyen, Quebec has few resources for convalescence.
Once again, this is a sign that our network is built a lot around hospitals. If home care, CHSLDs and rehabilitation sites were more solid, we would not have the problem we currently have.
The Dr Quoc Dinh Nguyen, geriatrician and epidemiologist
The Dr Nguyen maintains that the transfer of patients to CHSLDs must be done in the “least disruptive way possible for all settings”, in particular by avoiding transferring infected people. “The problem is not always the lack of places. It is also the lack of personnel. Sometimes I wonder if we don’t just bring the problem somewhere else. ”
“Caution is in order”
The CIUSSS de la Capitale-Nationale will also soon open a non-traditional site to accommodate 29 NSA patients positive for COVID-19 in the Concorde building. About sixty healthcare workers will be needed for this site. In Laval, NSA patients positive for COVID-19 have been received in a former residence for the elderly in the territory, the RPA du Vieux Moulin since December 14, explains spokesperson Judith Goudreault.
At the CIUSSS de l’Estrie, CHUS, a “temporary CHSLD” with 54 beds, is fully utilized. The region currently has 134 NSA patients. CIUSSS spokesperson Geneviève Lemay explains that “the issue” preventing the establishment from opening a new non-traditional site “is not one of space, but of the availability of human resources”.
President of the Regroupement québécois des residences pour seniors, Marc Fortin believes that these non-traditional sites can be a good solution for NSA patients. He says that in recent days, several seniors’ residences have come under pressure from their CISSS to take back NSA patients positive for COVID-19 or who have not yet received a negative test. However, Quebec’s directives are clear, recalls Mr. Fortin. “It takes a negative test to take a patient back,” he says.
Mr. Fortin recognizes that the pressure is strong on hospitals now and that having all these patients in beds is not optimal. But according to him, it would be dangerous to return them too quickly to RPA. “For autonomous people, we are able to confine them to their room. But for patients with cognitive impairment, it’s more difficult, ”he says.
Even though the majority of RPA residents are all tripled vaccinated and that protective equipment is now available, Mr. Fortin emphasizes that the residents are part of “the most vulnerable population” and therefore that “caution is required”.