Health Rationing

On radio this week, Dr. Brian Goldman talked about health rationing—it is important to listen to what he says Rationing Coming Soon To A Hospital Near You.

It is important to talk about life and death issues with your family and your values and wishes so that they don’t know what you would want and have to make those decisions in an emergency room.

The other issue that Dr. Goldman did not discuss is that rehabilitation and home care are currently being rationed.

Rationing of Rehabilitation Services

Rehabilitation and homecare don’t have the same press coverage as emergency wait times and patients waiting in hospital corridors, but both homecare and rehabilitation can significantly improve your quality of life.


Currently, after a stroke 40% of people are discharged directly home from emergency. They receive little or no rehabilitation.  For those admitted to rehabilitation, rehabilitation is very successful. Stroke survivors spend less time in hospital and much more likely to be discharged to homes in the community. However, the survivors being admitted to rehabilitation in 2007-08 are significantly less disabled than in 2003-04. This suggests that people who have larger strokes may not be admitted to rehabilitation.  These statistics are from Ontario.

• The median length of stay decreased by four days, and the total discharge FIM® score remained the same between 2003/04 and 2007/08. Patients displayed the same functional improvements in less time (a median length of stay of 33 days in 2003/04 vs. 29 days in 2007/08).
• Despite the average functional status on discharge remaining unchanged from 2003/04 to 2007/08, there was a 2.5% relative increase in the number of stroke patients discharged to the community following inpatient rehabilitation (80% in 2003/04 vs. 82% in 2007/08) and an associated 31% relative decrease in the number of stroke patients discharged to long-term care (13% in 2003/04 vs. 9% in 2007/08).
• Conclusions and recommendations:  There were positive trends in length of stay, discharge to the community and long-term care. 
• A high provincial admission FIM® score (median 78, average 76) suggests that a notable proportion of patients with more severe disability in the target group (i.e., an admission FIM® score for inpatient stroke rehabilitation of 40–80) were not getting access.  This may reflect a lack of community/outpatient services requiring admission of persons with milder levels of disability and/or pressures on rehabilitation centres to reduce length of stay (as reflected in the reduction in length of stay by four days) and/or referring sites’ familiarity with best practices for rehabilitation. This requires further investigation and validation. This requires further investigation and validation. Outpatient facilities should be surveyed to identify available therapy. (page 44 SEAC, 2010)

Rationing of Hospital Cleaning

CBC marketplace revealed rationing of hospital cleaning in their report -- Poor hospital cleaning revealed as major problem.  Time and again, hospital insiders told Marketplace that cleaners were being asked to do more with less. "We used to have one person to one wing of a hospital to clean," one cleaner said. "Now, we have three floors to clean." See Marketplace -- Dirty Hospitals.

What Services and Supports are Available to Help Stroke Survivors and their Families?

There are a wide variety of services and supports that might help you after stroke.

Federal Government:

• Services Canada
• Guide to Government of Canada Services for People with Disabilities and their Families (2006)

Alberta Government:

• Resources for Persons with Disabilities
• Resources for Caregivers.  Resources for persons or organizations who care for individuals who need support due to age, or physical or mental illness or disability.
• Find a Health Care Professional.  This page provides information for the wide variety of health professionals in Alberta – doctors, nurses, ambulance operators, and many others who provide services for the maintenance and improvement of health.