Its all about clearing beds. I was a manager of clinical operations at LHSC for a few years before I retired and came back as a staff RN. Part of my responsibilities after regular hours was to oversee bed access and flow..basically who got beds, who got sent home. The hospital needs between 200 and 300 discharges daily to account for planned surgical admissions, clinic admissions, emerg admissions, interhospital transfers, repatriations from outlying hospitals, traumas, Drs offices, etc. The hospital is one big conveyer belt that never stops..ever. Not to defend the system, but even a hospital as large as LHSC has a limit to its resources..physical beds, staff to look after those beds, etc.
Your initial 8 hrs on a stretcher in the ER is unfortunately standard issue..up to 24hrs for non-trauma is common. If you can talk, are conscious, have a clear ECG, then you wait. Even things like broken arms, chest pain, etc go to chairs.
After the ER assessment, only the sickest of the sick get admitted..ie..if you can be seen later in the community by your care provider, have a home to go to, can be referred to out-patient services(which can take months) the you're discharged. At any point in time, the hospital is likely at around 100-115% capacity..meaning all beds are spoken for, and other admissions are overflow..in hallways on stretchers, in storage rooms, or in ER beds. The problem with ER beds is..they aren't nursing care beds, they are assessment beds. The ER isn't an admission unit, so when people are admitted to hospital and there are no beds to go to, the ER gets backed up, and cant assess people who need to be seen...thus the 8, 10, 24 hr waits. It can get so backed up people are waiting in the parking lot in ambulances for 24 hrs not even being able to be offloaded as there are no Nurses to accept them. I've seen it where every ambulance except 2 in the entire London Middlesex area were tied up waiting in ER parking lots...only 1 or 2 ambulances left on the road to go to calls. Its a disaster.
Someone like your mother should be admitted to a short term care/rehab facility like Parkwood before going home..and they should have made that referral. The hospital doesn't want to admit her to a medicine unit as she doesn't really require that level of care, and it blocks a bed for an acute medicine patient..however the reality in the hospital is a large percent of medicine beds..and other beds..are taken up with elderly waiting for placement to long term care facilities..which often have waits of 6-12 months. Ive seen upwards of 50, 60% of some units beds taken up with ALC patients (alternate level of care) not requiring an acute care bed.
So...when someone like your mom comes in to the ER with a caring family and a home to go back to, a PSW service in place, and no acute care issues (rehab isn't considered acute), eating and drinking well..she goes home. The Drs often could care less if there aren't any beds..they expect they just appear on command. Your saving grace is you have a caseworker and a meeting. My recommendation....REFUSE to take her home..you don't have to. They may categorize her as ALC and charge her a small daily rate for the hospital bed..but no-one has ever been forced to pay that. Set very firm limits with the hospital with what you and your wife are able and willing to do, and force the hospital to find her a rehab bed.
You're right, its a disaster, especially for the elderly. Best wishes to you all.
