Alberta Premier pitches ‘discharge’ ward in unused space at Edmonton hospital

Alberta Premier Danielle Smith says two empty floors at an Edmonton-area hospital could be transformed into a “discharge” ward, freeing up acute-care beds that are being used by patients waiting for continuing care or long-term care spaces to open up.

But some experts warn that these transitional spaces could exacerbate issues in the health care system if they are not appropriately staffed and managed.

Speaking to The Globe and Mail editorial board last Thursday, Ms. Smith said two unused floors at the University of Alberta Hospital have been sitting idle for more than a decade and could be converted into dedicated spaces for patients awaiting long-term care placements or home-care support.

“What I think we’ll likely do is create a floor in that hospital that becomes the discharge floors,” Ms. Smith said. “We need to make sure that there is a space in a hospital that gives them all the range of care that they’re going to need until such time as we find an appropriate place for them to go.”

Ms. Smith’s proposal would become part of the government’s plan to overhaul the health care system, which includes breaking up the province’s single health authority, Alberta Health Services (AHS), into four departments and introducing new legislation to reform continuing care. But discharge wards are a new wrinkle, raising questions about how exactly they would work and whether they are a viable solution.

In March, Ms. Smith said during a budget announcement that there were 1,500 “alternative level of care” (ALC) patients filling 18 per cent of acute-care beds. Over the next fiscal year, the province wants to build or replace 1,600 continuing care spaces while creating an additional 1,050 transitional beds by 2025.

The empty floors Ms. Smith has suggested using for her proposed discharge ward are only roughed-in and would not be suitable for patients without a significant capital investment.

At the same March budget announcement, Ms. Smith and Minister of Health Adriana LaGrange said evaluations on how best to fill unused spaces must be conducted on a “facility-by-facility basis.”

AHS would not confirm any plans to renovate the empty floors, instead reiterating its continuing work creating an inventory of all unoccupied spaces in its facilities.

“Alongside Mental Health and Addictions and Seniors, Communities and Social Services, we are going to consider how to best use this space, which may include development of health care infrastructure that could be used for patients that have been discharged from hospital,” said Andrea Smith, the press secretary to the Health Minister in an e-mailed statement last Thursday.

Some experts are skeptical that creating separate discharge spaces would help reduce pressure on acute-care facilities while addressing the shortage of long-term care and supportive living beds.

University of Manitoba assistant professor Christine Kelly, who researches the politics of home-based care, said the problem isn’t about creating space, but staffing it.

“That would be something to highlight, is who would staff it,” she said. “It’s not just a conveyor belt of care. We want to do it well.”

Retaining and expanding the health care work force is something Ms. Smith has listed as a priority, but Ms. Kelly said opening up more spaces in hospitals already short on staff could create a “worst of both worlds” scenario leading to an “ad hoc style of care.”

Instead, she said, the focus should be on strengthening existing home-care supports and long-term care facilities, rather than pouring money into new buildings or expansions that could become obsolete as the situation improves.

“It actually is this bubble that we have to get through,” Ms. Kelly said. “What do we do in 20, 40 years when the bubble’s passed?”

Janice Keefe, chair of family studies and gerontology at Mount Saint Vincent University in Halifax, said Ms. Smith’s idea for transitional care isn’t uncommon, explaining how Nova Scotia Health partnered with a private company to build a designated transitional care facility for patients who no longer require acute care but still need support.

She said what concerns her about a discharge ward is the quality of care patients would receive.

“Is the alternative just out of sight, out of mind, or is it providing the right type of care for that older individual to improve?”

She also wonders if a discharge floor could adequately provide rehabilitation services for older patients and suggests that reinforcing home and long-term care is better for patients overall.

“Being in a hospital is not the best place for a very old or much older person if they are stabilized.”