Chaplain's Corner

Mrs. Albright had been in the hospital for a few months now.  At first she was admitted because she fell at home and broke a hip.  The hip was repaired and she spent some time on the Rehab unit with the hope that with some physiotherapy she could get back on her feet and back to her apartment. 

However, as is often the case, the broken hip and the subsequent hospitalization provided the opportunity for a number of important assessments to be made.  In the course of her time on the Rehab unit, the staff discovered some concerns that even her family were not fully aware of.    The standard cognitive assessment revealed that she was in fact experiencing moderate dementia.  It seems that up until now, her well developed coping skills had covered the onset of dementia, or it had been lovingly excused as the normal realities of her advanced years. 

The Occupational Therapist’s assessment of her ability to manage the activities of daily living further confirmed these findings.  When she was assess in regards the basic skills she needed to care for herself at home, it became apparent that she could no longer safely carry out the basic functions of living on her own.  After a couple of months, the Rehab staff decided that a family meeting was in order.  In the meeting Mrs. Albright’s physician and the Rehab staff shared their findings and recommended that she be paneled for a personal care home.

Mrs. Albright and her children had been concerned about some of the difficulties she was having even before the fall and broken hip.  Now with the hard evidence from the Rehab assessments before them, they realized that changes would be required.  They had hoped that a Personal Care Home wouldn’t have to be the next step, but when all the options were explored.  It clearly was the direction things needed to go.  Mrs. Albright was paneled and shortly after she was transferred from Bethesda Hospital to Vita to await placement at Bethesda Place.

It was hard enough to accept the need to be paneled for a personal care home, but the family was incensed when they were told that their Mom would have to await placement in Vita.  They were angry because their Mom had lived in Steinbach the past 40 years, three of the four children lived with their families in Steinbach and the fourth lived in Winnipeg.  Not only did they feel it was wrong to take their Mom out of her community, but they were offended that now they would have to drive out to Vita to support Mom, a wrinkle in their schedules that was going to be very inconvenient.

So why in the world was Mrs. Albright moved?  That’s a good question and not always an easy one to understand, even for those of us who work in the hospital here in Steinbach. The reality is that the policy to move people from a busy hospital bed to another less busy outlying hospital or another PCH, such as the one in St. Adolphe has to do with bed allocation, using valuable, well staffed and resourced hospital beds for those who need them most.

Bed allocation has become one of the most challenging tasks of our hospital administrators in recent years.  As you all know the population in our region is growing faster than any other part of the Province.  As well, the birth rate in the South Eastern part of the province is also higher than in any other part of the Province.  Population growth means that our health care facilities, especially Bethesda Hospital, will be stretched for as you may be aware, as our population has grown, the number of beds in our hospital has not.  This is why there is the growing pressure to discharge patients or to move folks like those paneled for personal care homes to facilities where the beds are not in demand.  There are always others that need the services of the Bethesda Hospital. 

Now at the moment when the call is made sharing the information that an elderly patient is being moved to another facility, it seems so unfair and from our limited point of view it seems so arbitrary.  But we need to remember that at that moment we have a limited point of view.  We don’t realize that many a day, over 50% of our surgical beds at Bethesda are filled with medical patients, overflow from the first floor medical unit.  You may think, well, so what?  Well, when this happens, where are the surgical patients going to be cared for after their surgery?  Sometimes elective surgeries have to be postponed because the surgical beds are not available.  

We also forget that the hospital administration needs to always keep in mind the reality of admissions from the Emergency Department.  Many of the admissions come through the Emergency Department, now busier than ever.  The family that is told that Mom is being moved while she awaits placement, often doesn’t think about the importance of insuring that a bed will be available when the EMS rolls into the hospital ER with accident victims or some one who just suffered a heart attach or stroke. 

A few years ago the hospital allowed ten, sometimes even more, paneled patients to remain at Bethesda Hospital while they awaited placement in the personal care home of their choice, but that was a luxury that we can no longer afford.  I wonder if we have ever tried to put ourselves in the shoes of the hospital administrators. Our andministrators are competent, caring people who are not untouched by the realities that their decisions impact.  Yet their responsibilities will not allow them to be guided purely by emotion.  They must make decisions thinking not so much about this individual situation or that individual situation, but by their responsibility to do everything within their power to insure that when the services of the hospital are needed by the people of our region, that they are available.

Don’t think for a moment that they do not hear the stories of individuals who are upset by the policies they are responsible to administer. Don’t think for a moment that they are untouched by some of the heart rending reasons presented as they are asked to forgoing the application of a policy in individual situations.  They hear the stories and are touched by the stories.  The application of the policies that guide the allocations of beds at Bethesda is not carried out with a “who care” attitude.  They care!  But they are responsible to care on a much larger level than you may be when you get the call that Mom is being moved to Vita or St. Adolphe.  They have to care not only about the current reality in the hospital but what this evening and tomorrow might bring through the doors of the hospital.

As the chaplain at Bethesda, I sometimes feel the tension between your frustration and the frustration of our administrators.  Both grow out of the stress of caring: yours out of the stress of caring for your Mom or Dad, your husband or wide; theirs grows out of their care that to the best of their ability this hospital will be prepared when any one of the 60,000 that live in the South Eastman region walk or are carried through the doors of our hospital in need of care.

There are many days that I go home grateful that I am the chaplain of the facility and not the facility manager or the manager of one of the departments of the hospital.  I have no aspirations for that kind of responsibility.  It is a very big job and I for one believe everything would run a bit smoother if we spent a bit more time praying for wisdom for our administration, and praying that we would have a greater capacity to understand that we can not always have things the way we would like, than being frustrated that they can not accommodate our personal needs and desires.  The truth is, in a system with limited resources, where the needs are always greater that our capacity to meet the needs, we will always have to accept the fact that the best we could do is not what any of us would ideally like to do.