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From hospital to home care: Yukon’s health department now offering more service hours

‘A lot of evidence does show that people do better in their home environment’
The Yukon’s health department is now offering more service hours to select clients as a way of getting them out of the crowded Whitehorse General Hospital. (Ian Stewart/Yukon News file)

As Whitehorse’s hospital beds continue to fill up — in part because of patients who should be cared for somewhere else — the number of Yukoners getting home care is also climbing.

“We’ve been seeing increasing complexity of people’s needs over the years … and of course there’s just more,” said Amy Riske, the Department of Health and Social Services’ director of care and community.

According to the department, this fiscal year the average number of clients receiving home care in Yukon every month is 614. There were 636 clients in October.

That’s compared to a monthly average of 585 clients last fiscal year and 602 the year before that.

In the Yukon, home care can range from getting help once a week with groceries, to more frequent medical care like cleaning wounds.

“A lot of evidence does show that people do better in their home environment, or they can,” Riske said.

Most clients are allowed a maximum of 20 hours a week, said Riske, though a handful do qualify for more.

Home First

The Whitehorse General Hospital made news this year because of its struggle with overcrowding.

The hospital’s acute care beds were often over capacity which lead to patients being moved to the communities with or without the consent of them or their families.

Many of the Whitehorse hospital beds — up to 40 per cent officials have said — are filled with patients who should be cared for somewhere else, often continuing care.

In an effort to get some of those long-term care patients out of hospital, the home care branch launched a new program this summer.

Dubbed Home First, it offers clients more attention than is usually available as a way of getting them home from the hospital and keeping them there.

The program started in late August with the goal of getting two patients out of a hospital bed a month.

By the end of September seven people had been discharged though one did end up going back in the hospital, Riske said.

By the end of October, 10 patients had been discharged.

Riske said most Home First clients are getting more than the 20 hours a week allotted for standard clients, though some get more frequent visits as opposed to more overall hours.

She didn’t have specific data on how many hours Home First clients get. The program is too new, she said.

From August to November Riske estimates moving clients out of the hospital has freed up 400 days when those clients would have been in a hospital bed.

“What other places have seen is that sometimes when you put quite high (levels) service for the first two to three months, that sometimes people get a bit better in their home,” she said.

“They’re at home, they can do way more at home and their services can actually decrease.”

Staffing and wait times

The number of staff working in home care has gone up. Five and a half new positions were filled using money that was announced last year.

More recently the department hired four more home support workers and a half-time occupational therapist specifically for the Home First program, Riske said. The department also expanded the hours of a physiotherapist on staff and is looking for a new social worker.

All of the new positions are term jobs, she said. They’re slated to end in September 2018 when the first phase of the new 150-bed Whistle Bend continuing care facility is scheduled to open.

“The demand and the pressures will continue to grow but we need to be adaptive as well and look at alternative measures, meeting people’s needs where they reside,” said health minister Pauline Frost.

Frost said home care was given an extra $771,000 in the most recent budget compared to last year. That’s on top of a base budget of $6.8 million.

“We have sufficient resources,” Frost said.

The government insists there is no wait list for people wanting home care. But while most might begin the intake process almost immediately, the department doesn’t track overall numbers for how long it actually takes to receive care.

Frost said those numbers are tracked on individual records but there are no averages or overall statistics.

When a person is referred to home care in Whitehorse it can take about two days for them to begin the intake process, she said.

“If there’s an imminent requirement or an imminent request then that would clearly have to be adjusted in terms of where they are on the list … we have to deal with individuals as they come forward with requests to meet the demand.”

Frost said the department “works extremely hard to be responsive and deliver the best services possible.”

Home care in the communities

In rural Yukon, the average monthly number of people getting home care this fiscal year is 235.

Last fiscal year that number was 221. It was 238 the year before that.

A co-ordinator out of Whitehorse manages support workers in each of the rural communities, Riske said.

There are also home care nurses in Watson Lake, Haines Junction, and Dawson City.

Again, the department doesn’t have a breakdown of the time it takes to get support in the communities.

For about the last two years staff with the Yukon’s Emergency Medical Services have been used to help Whitehorse home care clients by coming into their homes to offer non-emergency care.

“We’d be doing such things as medical assessments, checking blood pressure, ensuring they’re compliant with their medication, checking on them when home care is not available which is nights and weekends,” said Cameron Sinclair, manager of Whitehorse operations.

The program only has “about a handful” of clients, he said. EMS visit during a set window of time so they’re always flexible and can leave in case of an emergency.

“The main goal is to improve their health and a factor of that is less visits to the emergency (room), less visits to the hospital and really just better healthcare for them in general.”

Hospital bed usage still high

Ideally Whitehorse General Hospital would be at about 75 per cent bed capacity. Last year, beds were filled at an average of 96 per cent capacity. More than half the time the hospital was functioning at 100 per cent or higher.

Hospital spokesperson James Low said a series of changes, like moving patients to the communities and the Home First program have contributed to reducing occupancy.

The hospital is still averaging about 85 to 95 per cent capacity, he said.

Preventing people from staying in the hospital too long when they don’t need to is about more than freeing up beds Riske said. She said the Home First program will also hopefully help people maintain their confidence and stay more independent.

“It is for addressing bed pressures but it’s also for addressing people at home. There’s also a quality piece that goes along with this.”

Contact Ashley Joannou at