The North Simcoe Muskoka Local Health Integration Network (LHIN) is in the process of regionalizing complex continuing care (CCC) hospital beds in its area, in order to give all patients equal access to the spaces, said LHIN CEO Jean Trimnell.

However, some local physicians are still concerned about the implementation of the program causing gridlock in area hospitals.

At the March 19 LHIN board of directors meeting, a decision was passed to regionalize the beds and co-ordinate access to them through the North Simcoe Muskoka Community Care Access Centre (CCAC).

“As it stands today there are a couple of areas in the LHIN that don’t have this level of service and an example would be Collingwood,” said Trimnell. “They’ve never had complex continuing care as a service they provide in their hospital. So now once this is up and fully running, regardless of what hospital you’re in across the LHIN you’ll have equal access to the service.”

A CCC patient is someone who is in need of specialized medical attention over a longer period of time, explained Dr. David Mathies, chief of staff for Muskoka Algonquin Healthcare (MAHC).

This can include patients who have had a stroke or hip replacement, for example, who need rehab therapy before going home or to a long-term care facility.

“The average length of stay in an acute care hospital bed is about four or five days. Here we’re talking 90 (days, so) it’s a total different class of patient, but it's not a permanent patient,” he said.

Currently in Muskoka there are 34 complex continuing care beds, 10 at Huntsville District Memorial Hospital (HDMH) and 24 at South Muskoka Memorial Hospital (SMMH) in Bracebridge.

Under the LHIN’s regionalization plan, Muskoka’s numbers will stay the same.

Penetanguishene General Hospital will have 36 beds and Orillia Soldiers’ Memorial Hospital will have 48.

Royal Victoria Hospital (RVH) in Barrie will transition out of complex continuing care entirely.

Trimnell explained that currently each hospital with CCC beds determines who is admitted to them and how they are run.

Under the new program, admission to the beds would be standardized and co-ordinated by the CCAC.

“The CCAC (currently) co-ordinates access to all of the long-term care beds. They have case managers who do assessment of people already in hospitals who are waiting to go to long-term care. This was an opportunity to expand that assessment function,” she said.

Because MAHC will have 34 of the 118 CCC beds servicing the entire LHIN, patients from other areas may be transferred to Muskoka if space is available here.

Mathies said currently about half of the local beds are being used for complex continuing care, while the other half are taken up by patients from other areas where there is no more space, such as acute care.

He said local physicians remain concerned about three aspects of implementing the program: keeping patients in the closest hospital to their home for treatment; having proper rehab resources in place before outside patients are accepted; and the possibility that hospital gridlock will occur when those outside patients start to fill local CCC beds.

“The odd patient might have to come here from outside our catchment area, and when we’re already full that means they’ll be bumping an acute care patient, which bumps back into the emergency room, which clogs our beds, which then bumps back into the operating room and we can’t operate,” he said, adding that an influx of patients from outside the area could “exacerbate our already overcrowded situation.”

Mathies did say that as part of the regionalization program, SMMH will be getting six new beds likely to be used for acute care to help offset any pressure felt from outside CCC patients start coming in.

“A better, more focused, complex continuing care program is good for people who have the problems it will address. There’s no doubt about that. It’s just we have concerns about its implementation,” he said.

Trimnell said that although the program was slated to begin at the end of May, it has been pushed back so that hospitals have the proper resources before they accept any outside patients.

“A couple of the sites are still getting on board the nurse practitioners and physicians they need to be able to actually accept patients from other hospitals across the LHIN. . . (and) as soon as they are ready from a human resource perspective then we’ll be moving forward,” she said. Although she could not say when the program will begin, she added it would be “hopefully very soon.”

The idea of regionalizing CCC beds began when the Royal Victoria Hospital in Barrie approached the LHIN about concerns it had about continuing to offer the service.

“Because of the tremendous growth in that area, (they) needed to stop being a provider of complex continuing care, so that provided the opportunity to look at how we might best make that service available to everyone across the (LHIN),” she said.

In addition to creating a standard for admission to CCC beds, “the other part of the work that we’re moving forward with now is to ensure that at every site that provides the service the standard of becomes the same. So we’ll be looking at what’s best practice for this level of service (complex continuing care) and make that equitable across the LHIN over time as well,” added Trimnell.