Dear Colleagues, 

Last night Global TV aired a story in which I appeared – briefly – to discuss our approach to managing the hospital's resources and how we work to discharge patients from the acute phase of their illness to a variety of options – rehabilitation, home care, a nursing home- to name three locations. The television story prompted this Straight Talk because I am passionate about the sustainability of our health care system and know that the future of our system requires that the right care is given to the right patient at the right time in the right place.

As leader of this organization, I work with all of you to balance the resources we have to meet the needs of all of the people who come to us for care. Each one of you works with patients and their families to provide the care needed, with a view to having them leave hospital and, in the vast majority of cases, return home. We start planning for a patient's discharge before the moment they enter hospital because we know that acute care has risks, and that people do not actually want to stay in hospital a moment longer than they require.

In a very small number of cases, patients and their families struggle with leaving the hospital for a variety of reasons including fear of the next phase, inability to come together as a family to make decisions, or sometimes a waiting list at a preferred long-term care facility. Our social workers, colleagues from the Community Care Access Centre, and other social agencies are all available to these families and our inter-professional teams work through to resolution in virtually every situation. I admire the work that you do together and thank everyone for their care, their professionalism and their compassion for these patients and their families.

In rare circumstances, we reach an impasse where a family will not work with us on a discharge plan. In these situations we are permitted to charge a co-payment for some patients which is set at approximately $50 dollars a day -- about the rate for co-payment in a nursing home. This fee is charged while a patient is waiting for placement and has been designated as ALC – or alternate level of care. We very rarely discuss this with patients. In the rare instance when a family will not work with us we mention the co-payment issue.

Until about a year ago, we would very rarely discuss charging patients approximately $1,600 a day – the cost of an acute care bed for a day – for patients who were discharged or ready for discharge who refused to leave and/or refused to take part in discharge planning. These conversations were uncommon and difficult situations for everyone – the patient, their family, and members of our care teams and no one wants this to happen. But, we also have to think about the patients waiting downstairs in Emergency who have a greater need – that of an acute care bed with highly trained professionals who can help them through an acute episode of severe illness.

We stopped talking about charging $1,600 per day earlier this year. Today in the rare circumstance where patients and families refuse to work with us we only discuss the daily co-payment rate mentioned above.

We recognize that Ontario faces a fiscal challenge and that we will have a major role as healthcare leaders and providers in finding solutions for sustainability of our publicly funded system. That is what people expect of us and it is what we will all do together. The integration of Toronto Rehab into our family is an important step towards sustainability. I believe that UHN is uniquely poised to create a health care network which looks at the journey of care as a whole and seeks to work with each patient so that they can regain maximum quantity and quality of life at the best cost to our system. I also think that the work that is being done in the CICC with projects like the Virtual Ward will help us to reduce the proportion of patients who are readmitted after hospitalization and that the next logical step in that area is working with people in their homes so that they never arrive at our Emergency Department.

I'll end this by saying that I think the Province's strategy for aging well at home is absolutely correct. If we look at our own families we know that our parents want to maintain independence for as long as possible. A health care system that supports that aim is something that we all support.

As always I am interested in your comments.

Bob Bell

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