Every morning at 10:00 a.m. a van arrives at West Park Hospital in Toronto and disgorges its human cargo destined for the day hospital. Among the patients heading for six hours of rehabilitative therapy is ruddy-faced George Mainprize, 78, a former rock driller, now stricken with a severe bronchial disease and dependent on a portable oxygen tank. “I’d rather be fishing,” he says, but admits he’s pleased he’s not a permanent inpatient.
Not only are the costs of chronic care rising to as much as $165 a day, but hospitals are hard pressed to free up the country’s shortage of chronic-care beds. As a result, in the past two years 22 hospitals across Canada have initiated dayhospital programs to treat long-term illnesses that range from asthma to stroke. “Without these facilities,” states Dr. Allen Johnson, head of West Park’s program, “most of these  patients would be institutionalized.” Unlike the traditional outpatient clinic, the day hospital employs a team of doctors, nurses, therapists and social workers to map out treatment plans tailored to each long-term case. “Our objective is to postpone or avoid admissions,” explains Dr. Duncan Robertson, founder of the day-hospital program at Saskatoon’s University Hospital.
Most patients attend a day hospital twice a week for periods varying from six months to two years. Stroke victims relearn how to cook for and bathe themselves, while patients with respiratory ailments practise chest exercises. Currently, most hospitals aim their day programs at geriatric cases. But Vancouver’s Lions Gate Hospital’s program has recently expanded to include sessions for diabetics, the obese and people suffering from chronic back and knee problems. Lions Gate’s director, John Borthwick, notes with pride that several mild cardiac patients have sidestepped the inpatient beds altogether and have been placed immediately in the day hospital.
Day programs have often instilled a greater feeling of independence in their patients. “We’ve seen tremendous psychological improvements in them,” notes West Park’s executive director, Margaret Hagerman. “Learning to make the bed again or getting in and out of the bath means the person can stay at home.” While studies of the program’s
benefits are still in progress, Hagerman feels day-hospital clients recover more quickly than inpatients.
Despite their apparent successes, many day-hospital programs—which cost two-thirds less than inpatient treatment—have had problems securing extra funding from their provincial governments. “We were told if we wanted a day hospital, it would have to come out of our existing budget,” says Saskatoon’s Robertson. Because the day hospital isn’t a setting for dramatic life-and-death struggles, he suspects some health ministries were initially
reluctant to loosen the purse strings. Health administrators, however, now believe day programs are worthy of more money because they could drastically alter the pattern of hospital care for the elderly and the chronically ill. “Much of the work of hospitals involves treating acute episodes in long-term illnesses,” explains Borthwick. “If we can lessen those incidents, the hospital can operate more efficiently.” But the patients have the most to gain. Says Mainprize, without flinching: “If it weren’t for this place, the undertaker would have me.” -CATHERINE RODD
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