Community can bed in to ease weight of expectation on KEMH
The recently repeated issues surrounding bed shortages at King Edward VII Memorial Hospital have served as a reminder that a larger problem is at play, one that must be addressed head-on. This can best be resolved by input and participation from the broader community.
It is important to understand the mandate of KEMH as a hospital is to provide medical treatment and services to those in need. The recent additions were for the purpose of adding a new wing, and not creating a new hospital. The primary rationale was to replace the ageing medical and surgical infrastructure, not to create new beds and rooms for those who are not in need of hospital care.
This is where the problem lies. As I have said recently in both the media and House of Assembly, the predominant cause for the bed shortages is because the hospital is being used for purposes that it was not, and should not be, intended for.
While the patients in the hospital are first rightly admitted for acute care needs, once KEMH has treated their health issue, they are fit for discharge. At that point, there exists no medical reason for their continued stay at KEMH. However, beds continue to be occupied by such persons, resulting in a shortage for new admissions and the repeated delay of surgical procedures for other patients.
If we have not personally undergone surgery, we have a friend or family member who has. These surgeries are not always immediately life-saving, but they can be life-altering; they can relieve chronic pain, produce diagnoses and improve quality of life. Yet the travesty is those patients repeatedly are being pushed back on the waiting list because there simply is “no room at the inn” — and the burden on the Government, which is funded by the taxpayer, is increased.
This is where the community comes in. While those needing procedures that only the hospital exclusively provides on the island are turned away, their beds are mostly being occupied by persons who can live mostly independently or with some minor assistance. Such assistance does not require around-the-clock skilled nursing care, which is what is on offer at KEMH. In other words, these patients no longer require hospitalisation.
The services these patients need are services that the community is better suited to provide: the provision of community resident homes for the elderly. The Progressive Labour Party believes the Government has the responsibility to ensure that its senior population is cared for. We would develop incentives for persons willing to operate safe and secure facilities for our ageing population and to spur the private sector to construct residential communities, providing seniors with greater options and alleviating stress on families and the hospital. Further, a PLP government would examine how best to facilitate the provision of home-care options.
The bed shortages are a manifestation of a larger issue that must be addressed urgently. We are all part of an ageing population. By the year 2030, more than half of all Bermudian-born residents will be over the age of 65. Having the conversation with our families and educating ourselves about the issues surrounding living a long life is crucial. It is also of equal importance to establish a long-term care plan, considering items such as:
1, Outfitting your home: Most of us would like to “age in place” so we should start thinking about how we could make our homes more accessible and senior-friendly
A PLP government would assist our senior population who wish to remain in their homes. We would consider further tax incentives and other benefits to homeowners who outfit their homes for the purposes of making them accessible for themselves and their ageing family members. Many elderly people who live alone, or with working relatives, do not need to be institutionalised; they just need more domiciliary care.
We would extend the support provided to elderly persons who are living on their own and who need help in their home. There would be an individual assessment of their needs and those needs would be provided. This would enable people who can live independently to do so for as long as they can and wish to do so.
2, Consider where you will live if you are no longer able to reside at home. As we all are fully aware, the cost associated with assisted living or nursing homes is very expensive
As I have raised in the House of Assembly, our PLP government would explore the benefits of the introduction of a long-term care insurance scheme to be offered for Bermudians.
As we live longer, and can do more for ourselves, the PLP believes that it makes sense to develop more housing for our elderly population. Non-profit organisations such as the Bermuda Housing Trust play an extremely crucial role in our community by providing quality and affordable rental accommodations for Bermuda's seniors. The trust has an extremely long waiting list, which is a clear indication that we need more commitments from other such organisations to assist.
With the abundance of vacated buildings owned by the Government and people of Bermuda, a PLP Government would commence a programme, such as what commenced in 2012 between the PLP government and the Salvation Army whereby the Bishop Spencer school was to be transferred to the Army for its exclusive use for a much needed homeless shelter. This programme can be extended to other community and civic groups for them to transform — and own and operate — vacant government properties into housing units for our senior population.
One option to address this challenge, which at first glance appears controversial, is the examination of the filial laws, which would require family members who are more than financially and physically capable of caring for their elderly relatives to take such responsibility in doing so. This does not mean a family member is expected to make considerable sacrifices; a PLP government would, as detailed earlier, provide assistance to make this a feasible and acceptable reality.
The vast majority of Bermudians do accept that responsibility willingly and with grace. However, we must acknowledge that there are many persons residing at KEMH with little or no medical issues to speak of, which is compounded by some patients' family members providing unnecessary obstacles to their discharge. These include refusing to accept offered placements at nursing homes for their family member because of preference of choice, personal inconvenience owing to location, or wanting to avoid placement altogether, but still considering the hospital a valid alternative. These family members often will not engage in dialogue with social workers to reach an agreeable solution. Quite the opposite, sadly they make every effort to avoid the discussion.
This is what I mean when I say that these family members are not prepared to take the responsibility that most of us would and do take. Family relationships can be challenging.
These laws do not seek to exacerbate them, but to provide workable solutions to this existing problem, which is burdening hospitals, fellow patients and the taxpayer.
The cases for which the filial laws are designed are those such families who have the financial and human resources, and housing resources — along with all of the other essentials necessary to care for their elderly family members outside of the hospital setting — but have decided that it is the “state's” responsibility. Those families with little or no inhibitors to caring for their elderly family members, save for the absence of a “will” to do so. That is what is meant by family members “capable” of caring for their elderly relatives.
We must also acknowledge that there are obstacles entirely out of the family's control. For example, awaiting Department of Financial Assistance decisions, no available nursing home beds, or those that do have available beds not being willing to accept patients with minor issues such as diabetes.
There are hard decisions to be made and important discussions to be had. The important part is to maintain open dialogue and work together as a community to find solutions to this crisis.
• Kim Wilson is the Shadow Minister of Health and the MP for Sandys South Central (Constituency 34)