More long-stay beds no solution

Press, 15 January 1985, Page 7

More long-stay beds no solution

More long-stay geriatric hospital beds are not the answer to the problem of elderly patients taking up beds in acute hospitals, according to the Canterbury Hospital Board’s regional geriatrician, Dr Richard Sainsbury. Overcrowding in medical wards at Christchurch Hospital and The Princess Margaret Hospital has been blamed recently on the shortage of long-stay geriatric beds which has left many elderly people taking up urgently needed beds.

Dr Sainsbury said he had five reasons for disagreeing with any suggestions that more long-stay beds were needed.

First, he said that the geriatric bed guidelines produced by the Health Department which showed that Canterbury had more longstay geriatric beds than it

needed, also showed that the province had not enough assessment and rehabilitation beds and day hospital places for the elderly. The 1981 guidelines indicated that Canterbury needed 679 long-stay beds, while it already had 999, Dr Sainsbury said. The guidelines also said that the province needed 151 geriatric and 38 psychogeriatric assessment and rehabilitation beds, and these figures correspond with 66 and 30 actual beds, respectively. The province also needed 75 day hospital places, but had only 25, Dr Sainsbury said.

“My second point is that because of the severe financial situation of the board it was necessary to close 12 of the assessment and rehabilitation beds anyway, reducing the actual figure from 66 to 54 in mid-November last year," he said.

This means Canterbury has about a third of the Health Department’s recommended number of beds for that category. The Princess Margaret Hospital, which was able to provide only a third of the day hospital places recommended by the department, had to close the entire day hospital programme for three weeks over Christmas because of staffing difficulties, Dr Sainsbury said. His third point was that other parts of New Zealand were nearer the Health Department guidelines and had shorter waiting lists for continuing-care beds. Canterbury, however, had more long stay beds and longer waiting lists. “This suggests it is not so much a matter of bed numbers but bed usage,” Dr Sainsbury said. The fourth point was the fact that in other areas it

was possible for all elderly people to be assessed, so they got the appropriate care.

Until 1982 there was only one geriatrician to assess all the elderly people in Canterbury, Dr Sainsbury said. Now there was the equivalent of three full-time geriatricians. A 1982 Health Planning and Research Unit study had shown that 38 per cent of elderly long-stay patients had had contact with an assessment unit, but a much greater percentage was being assessed now. The board was now assessing all elderly people already receiving a subsidy and in long-stay accommodation. “My fifth point is the effect of the populationbased funding formula on the board.

“The daily bed subsidy (different from the geriatric subsidy) paid to private hos-

pitals is deducted from the local hospital board’s funding,” Dr Sainsbury said.

He said it meant that for each private hospital bed built, the hospital board lost $10,402 from its annual budget. This deduction came from a board already deemed by the Health Department to be over-funded, Dr Sainsbury said. “The nursing budget is short because the over-all funding to the Hospital Board has been reduced.

“A survey done last year showed that up to one-third of elderly people admitted acutely would have been admitted more appropriately to the rehabilitation and assessment ward had the facilities been available,” Dr Sainsbury said.

He said it had also been shown that appropriate rehabilitation and assessment facilities plus community

support services caused the demand for long-stay care for the elderly to drop markedly.

In the last nine or 10 years the Dunedin waiting list for long-stay care had dropped to about one month in spite of the area having a lower ratio of long-stay beds per person. Canterbury has a seven-month waiting list.

Dr Sainsbury said his hope was that rehabilitation and assessment services could be improved by increased staffing by modifying the Hospital Board's funding formula.

Changes he would suggest included greater funding for elderly people in the Canterbury area and a change in the way private hospital funding was taken away from board funding. No progress could be expected unless funding improved, Dr Sainsbury said.