It would take very little for Muskoka Algonquin Healthcare (MAHC) to become seriously overwhelmed with COVID inpatients should serious infections rise and require hospitalization.
Both the Bracebridge and Huntsville hospital sites are already often at or over capacity. According to Vickie Kaminski, interim MAHC president and CEO, on January 27 Huntsville hospital was at 98 per cent capacity while the Bracebridge hospital site was at 104 per cent capacity.
People are not only living longer, said Kaminski, but the services they require are not readily available which means many—10 to 20 patients at each hospital site—will take up acute care beds until the service they require becomes available.
“Some of it is related to the services that are needed in the community that would facilitate either keeping people in their own homes longer or being able to transfer them home sooner, or sometimes it’s [a shortage of]long-term care beds. So we have a number of alternate care patients and those I’m sure you know are people that no longer need acute care but they need some form of care that prevents them from just being able to go home independently. So, they’re waiting for that kind of service. It could be a long-term care bed; it could be homemaking services in their home. It could be assisted living. It could be rehabilitation services that are in pretty high demand—so it could be any one of a number of things,” she explained.
“That means then that patients waiting to be admitted into those acute care beds get backed up into emerg and they can sit for a day or so waiting for a bed and that puts or occupancy rate over the 100 per cent,” she added.
Both hospital sites serve a total population of approximately 60,000 residents in Muskoka and East Parry Sound, not including seasonal influx. Yet between both hospital sites, MAHC has just 101 inpatient beds. The province, due to the pandemic, allowed MAHC to open an additional 15 beds bringing its inpatient bed count to 116.
“So they’ve allowed us to open 15 additional beds as [COVID] surge beds. So as long as we can staff [them]we can add [them]… our normal bed complement sits at 101 inpatient beds. So we can actually go up to 116 and we’re able to do that so that’s part and parcel of how we manage with that capacity,” she explained. “The other thing that the province is doing is they’ve made a really concerted effort across the province to use all of the community care and all of the long-term care resources so some communities have more of that available, and what they’re saying to us now is they’re going to help us move patients to the resource so that we can free up beds inside systems sort of log jammed as well.”
On occasion, according to Kaminski, MAHC has accessed inpatient beds at the regional Pandemic Response Unit (PRU) in Barrie. The field hospital was approved for 70 beds to act as a regional resource should area hospitals face crippling capacity challenges.
“I don’t think they’ve ever fully opened all those beds because they couldn’t find staffing for them but we have been able to access PRU beds over the last year or so, on occasion,” she explained, adding that patients have also been transferred to other facilities outside of the immediate community like St. John’s Rehab Hospital in Toronto.
“Orillia has been working very closely with us as well. They were able to do some work with their assisted living providers and so they got additional beds opened up and staffed and so we’ve been able to move… a handful of patients,” said Kiminski, who did not have exact numbers.
In the meantime, attempts to free up hospital resources through the reintroduction of provincial mandates such as halting all non-urgent and non-emergent surgery procedures and diagnostic imaging has created a backlog. “We knew that that would add to the backlog. So, we’re making sure that we get urgent and emergent [procedures]done and we’re just crossing our fingers that we’ll be able to get back into regular procedures soon,” said Kaminski. “Certainly, the province has indicated that we’d be in this position at least until the end of January so we’re waiting to hear where we go from here. But the backlog does grow when you do that, so we are keeping an eye on it and we’re looking at ways and means if there are any available to us, that we’ll be able to take a bite out of that backlog once we get back into doing regular procedures.”
As per the provincial mandates being directed across Ontario in all hospital communities, rather than just those significantly impacted by COVID, and whether hospital CEOs have agreed with those directives, Kaminiski had this to say: “We have had conversations as CEOs about the ability to do procedures. So lots of ours are outpatients. I mean really and truly the diagnostic imaging and the surgery that we do here doesn’t necessarily take up inpatient beds so conceivably we could’ve done a few of those things during this round.”
But Kaminski noted that being able to move people around the system would require that all the different parts work in unison. “So it was meant to level the playing field and to say we’re all going to be disadvantaged and we will work as a system to recover once we’re out of this current phase.”
On January 27, 2022 both hospital sites had 14 COVID-positive patients (seven at each hospital site). Just one of those patients was in the ICU in Bracebridge. “So it is a very different look this time around. So patients are sick, they’re not requiring ICU but they do require hospitalization and they’re getting better faster so they’re not here as long as they were in the first three phases [of COVID],” said Kaminski.
Asked what her biggest concern is moving forward during this pandemic, Kaminski said staff.
“I guess it’s keeping staff motivated and just giving them that light at the end of the tunnel because they’ve been with us all through this and it has been tough. I mean they’re working differently now. When I came to do this contract, I found out I had to wear a mask when I come in the hospital. I should’ve thought of that but I’ve never had to wear a mask for long periods of time… not a seven-hour, 12-hour shift. You can imagine our staff who are in protective equipment and wearing masks, they’re doing an extra shift because we’re short-staffed. I worry about the staff, that’s my biggest concern. I’m afraid we’re going to see an exodus of people as this starts to ease off they might think ‘I’m getting out of here before it happens again,’” said Kaminski. And the exodus may get worse as a vaccination mandate for MAHC hospital workers comes into effect in March. Leaving is their choice, noted Kaminski.
As for staff in general, “how do we keep them motivated?” she questioned. “They’ve been great. They are great and we want to keep them around.”
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