Too many non-acute patients are stuck in hospitals. A converted hotel aims to change that
Hamilton Health Sciences using novel approach to care for patients awaiting physical rehab, long-term care
There's a jacuzzi tub next to the nurses station at the Satellite Health Facility in Hamilton, Ont.
Dr. Craig Shott, medical director for the Hamilton Health Sciences (HHS) centre, calls it a "remnant" of its former life.
Before it housed patients, the building on Main St. in downtown Hamilton was the Crowne Plaza Hotel.
"The purpose of it initially was to deburden the hospitals with the COVID-19 epidemic coming up," Shott told White Coat, Black Art host Dr. Brian Goldman. "But now it's used by Hamilton Health Sciences as a decanting facility due to our overwhelmed hospital system."
Run by both Hamilton Health Sciences and St. Joseph's Hospital Hamilton, the Satellite Health Facility is designated for patients requiring an alternate level of care (ALC) — that is, those who don't require acute care in hospital but are unable to return home for a number of reasons.
The centre employs 15 physicians and more than 100 nurses. It also offers physical therapy and provides access to a number of specialists, including speech pathologists and social workers.
Some patients are waiting to be placed in long-term care or to access in-home care. Others, like 62-year-old Cindy Mark, are receiving physical rehabilitation before they return home.
"It feels like a hospital-type thing without the IV poles and, you know, all that business," said Mark, who is receiving care for a broken upper arm. "They look after you."
'People are literally stuck in our hospitals'
Approximately 15 per cent of acute-care hospital beds across Canada are filled by patients designated as ALC, says Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto.
That means one in nearly seven hospital beds are occupied by patients who don't need to be there but have nowhere else to go.
"People are literally stuck in our hospitals," said Sinha, who is also director of health policy research at the National Institute on Ageing in Toronto.
"That's why we're seeing a proliferation of these models where we have creative solutions to create more space and more beds."
By moving patients from acute-care hospitals to a retrofitted hotel, the two hospitals running the site are creating a transitional space for those who cannot return home.
The Satellite Health Facility doesn't look like your typical health centre.
The former hotel's original check-in area remains intact, offering a friendly welcome to those entering the facility. The rooms also offer a warmth that is often missed in the sterile environment of a hospital, officials say.
Many of the rooms retained the hotel's original furniture, including beds and "big TVs."
"All the patients love the large TV in the rooms, so it's not the standard hospital small TV," said Shott. "That's a selling point for sure."
But converting a hotel to a health centre comes with challenges.
Carpet in the rooms had to be removed in order to meet infection control practices. Washrooms also needed to be retrofitted — contractors replaced showers and tubs and moved toilets and sinks.
Amanda Weatherston, a nurse-turned-project manager who oversaw the renovations, says the revamped Crowne Plaza is an example of health-care ingenuity during the pandemic.
"There was definitely a buzz in something new, exciting and inventive, because we were asked to think outside the box for the pandemic, and I think this was a huge example of that," Weatherston told Goldman.
More solutions needed for ALC patients
Even so, Sinha says moving patients into a converted hotel doesn't address the underlying issues that have led to a backup of ALC patients in Canadian hospitals.
"If we appropriately funded the home and community care and long-term care services that an aging population needs, we wouldn't have the ALC crisis that we do have right now," he said.
Michael Carter, an expert on health-care system resource planning, says adding capacity through something like a converted hotel is a "Band-Aid" on the larger problem of inadequate home and long-term care.
"The simple solution is … supply and demand — like, they just have to match," he said. "And if it doesn't match, you're going to get bottlenecks."
One way to reduce those bottlenecks, Carter says, is to focus on what he calls discharge planning the moment a patient ends up in hospital.
That requires asking questions like, "How long are you going to be here? Where are you going to go? What can we do in advance to set up that long-term care home and get it approved and find a space?" said Carter, a professor of industrial engineering at the University of Toronto.
"The old way was you waited until the doctor said to discharge, and then you start looking for a place."
Sinha sees increasing home-care options for those needing long-term care as a key solution to reducing the burden of ALC patients on Canadian hospitals.
Home care, he argues, can offer substantial savings to the government, as caring for people in their own homes is more cost effective.
"You don't have to be a mathematician or rocket scientist to say, 'Wait a minute, if we invest in more home and community care and other long-term care services that are often cheaper to organize and administer, we probably don't need to have as many people waiting in hospital,'" he said.
'Health-care workers will bend over backwards'
Kelly O'Halloran, director of community and population health services at Hamilton Health Sciences, acknowledges that while the Satellite Health Facility provides one solution, it points to larger capacity issues within the system.
Hamilton Health Sciences says that home is where patients should be — but their ability to discharge patients is limited right now.
"There's lots of work going on in the home-care setting so that people can go home. People that want to go home should go home," said O'Halloran. "We're all struggling with staffing shortages, including the community."
The Satellite Health Facility has funding from the Ontario government to operate until March 2024. But staff at the centre believe it will continue beyond that date.
"When push comes to shove, [health-care workers] come together … we put in the hours because we all got into health care for a reason, and it's to care for patients," said Weatherston.
"This shows, across the board, health-care workers will bend over backwards [and] think creatively."
Produced by Jeff Goodes
