Why some patients are waiting months in N.W.T. hospitals for long-term care beds

The N.W.T.'s medical director says turning the former Stanton hospital building into a long-term care facility is "an important part of the solution" to address the wait for long-term care beds in Yellowknife.

However, Dr. Claudia Kraft, the territory's medical director,alsorecognizes that "it doesn't solve all of the demand challenges because there may still be people who are looking for sites in other communities."

As the territory's population grows older, the demand for long-term care and extended care services is also likely to increase; some residents are already waiting months in hospital for a space to open up.

No alternative

In March 2017, Sandra Lester says her mom, Betty Ann Patterson, suffered "an incident," which she believes was a minor stroke.

"She was delirious and acting really strange," said Lester. "She was incoherent and this wasn't like her at all. She was completely coherent all the time."

She rushed her mom to Hay River's emergency department. Lester said the episode passed and doctors ultimately discharged her.

The next day, Lester says she received a call from one of her mom's friends, telling her that her mother was banging into walls with her walker.

Lester brought her mom back to the emergency department. This time Patterson never left it was clear she could no longer take care of herself. She'd now have to wait for a space in the town's extended care facility.

Lester said her mom waited in the hospital about three months before finally being assigned a room.

This kind of situation is known as an "alternative level of care" (ALC) stay within the health care system: when a patient does not need full inpatient care, but is still in an acute care bed in the hospital.

"These patients cannot be released from the hospital because there is no alternative care available," reads the health department's annual report.

In 2022-2023, the median length of ALC stays in N.W.T. hospitals was 40 days. That means half of ALC patients stayed for longer than 40 days, and the other half stayed for less. That figure droppedcompared to 2021-2022, when the median length of stay was 71 daysthe longest in at least 15 years. From 2019 to 2022, 22 per cent of stays were longer than six months.

Wanting to stay close to home

Dr. Kraft said there are several individual factors that determine how many people are waiting for long-term care at any given time, and how long their wait is. One common factor, though, is whether there is a space available close to home.

In the N.W.T., patients can choose which facility they go to.

Lester said her mom was offered a room in Fort Smith.

"I said, 'Are you out of your mind?Her whole family is in Hay River and you're gonna send her to Fort Smith?'"

Kraft said these kinds of reactions are not out of the ordinary.

"It is very common that people are willing to wait quite a long time until they can get the appropriate placement," she said.

In other jurisdictions, she added, patients can lose their spot on the waitlist if they refuse the space they're offered. But that doesn't work in the territory, where residents are spread far apart.

"It's considerably more complicated in a setting such as ours where travel costs and flight routes can make that kind of connection to a community that also has appropriate cultural and community connections much more difficult to access," said Kraft.

But even if they stay in hospital, Kraft said patients may not have all the supports they need especially the opportunity to participate in communal activities.

Lester said she saw that with her mom.

"She was a very social person, so all she would do is sit in this walker halfway in her room and halfway staring down the hall because she was lonesome when we weren't there," she said.

Costs and capacity

Alternative level of care stays strain the health care system both in terms of cost and capacity.

These patients are not staying in emergency room, ICU or operation recovery rooms. However, they are still considered acute care and are in inpatient care beds,which are some of the most expensive beds to operate.

CBCNews has asked the Department of Health and Social Services how much ALC stays cost but has not yet had a response.

"There's not a lot of different places where we have clear levers that we can pull to change the number of beds that are needed on any given day across the system," said Kraft.

"People who require admission because they've got a serious infection or need an urgent surgery will keep coming and needing those services. There's no way for us to turn them away."

One of the few levers the system has, she added, is elective surgeries. Essentially, residents that need non-emergency surgeries may have the procedure delayed until a bed opens for them.

Part of the territory's solution to these issues is turning the old Stanton hospital building in Yellowknife into a long-term care facility. Now known as wegat (the traditional name for Frame Lake in Wldeh), the facility will also house outpatient rehabilitation services and pre-scheduled primary care appointments.

The territory has said the rehab and primary care services are now scheduled to open early next year with the long-term care and extended care units following "shortly after."

Kraft said the long-term care portion will have a phased opening, with 17 beds opening at the start and ultimately growing to 74 in total, anadditional 16 extended care beds.

"There will be quite a bit of flexibility initially and then as the phases progress for further capacity opening up at that facility that will be adding net new capacity for long term care within the territory," Kraft said.

Lester hopes the territory opens other facilities outside of the capital.

Erin Griffiths, CEO of the Hay River Health and Social Services Authority, said there are 25 long-term care beds in town at the Woodland Manor.

She added that the authority is working to expand its homecare program to keep residents in their homes for longer.