Letter from the Editor: How the community can help tackle bed block - it's more than just a health issue

It’s a depressingly familiar sight at Wollongong Hospital’s emergency department (ED) – wall-to-wall patients in varying degrees of suffering, many frustrated and angry at the long delays they’re facing.

Outside ambulances arrive in a hurry but are far slower to depart.

If it’s any consolation to those patients, it’s a sight that also frustrates Margot Mains, the chief executive of the Illawarra Shoalhaven Local Health District (ISLHD). The difference is, the pressure is on her to try to ease the pressure in the ED.

Most people in the waiting room don’t understand why the system appears to be moving at a snail’s pace and often take their frustration out on the medical staff around them.

They are unaware that in wards above them, someone’s parent or grandparent, aunt or uncle has been “living” in a hospital bed for days, weeks or even months, ready to leave but unable to go home.

These older or disabled people initially came to hospital for treatment for one or maybe more illnesses and have since recovered to a stage where they can be discharged.

But for one reason or another, they can no longer return to their former home without support and services in place. Some may never return to their former home, their needs too great and instead require a bed in residential aged care.

However, it’s not just one parent or grandparent, or just a few, the numbers can run into the hundreds.

And while they are waiting in a hospital bed to be assessed and receive those critical services, that bed is not available for the person who’s come into the ED and needs to be admitted for treatment.

Therefore the ED remains full because patients have nowhere to go – welcome to bed block.

It’s a vicious cycle with no easy solution.

More in-home services to allow people to remain in their own homes require more funding and more staff.

Building new residential aged care facilities requires huge injections of funding – about $400,000 per bed – and more staff.

For some time now, ISLHD has been in the unenviable position of being the worst district in NSW to be afflicted by bed block.

Sadly, those “technically” homeless people are staying in hospital far, far longer than other patients – on average more than three months, compared to four and a half days.

In a bid to help the community better understand the issue, Community Industry Group has created a series of podcasts which digs deep into the problem and the potential solutions.

For the past two years, the group has been bringing key stakeholders together to develop strategies to address the issue and improve outcomes for older people, for the health system and for the broader community.

CEO Nicky Sloan this week released the first in the podcast series called Bed Block – It’s more than just a health issue.

Her first guest was Margot Mains, who pulled no punches in explaining just how critical the issue is.

“Some days start in the emergency department with 40 people waiting to get into beds,” she says.

“The department is consumed with people waiting for beds and there are still people coming in the door.

“Then you have ambulances arriving and can sometimes have difficulty bringing patients in from the ambulance to ED until we can find spaces for people.

“Reduced bed numbers means we have to cancel elective surgery.

“People staying in hospital for longer reduces the beds we’ve got available for our acute services. It’s a real concern for the whole of community.”

Margot says there are a variety of reasons why the Illawarra has been so badly hit by bed block.

Our population growth between 2016 and 2021 was seven per cent, compared to the NSW average of four per cent.

We also have a higher aged population – 5.7 per cent are aged over 80, compared to the NSW average of 4.8. People are living longer and the demand for aged care services is outstripping supply.

And the real kicker has been the loss of 600 residential aged care beds.

ISLHD has introduced a number of strategies to address the problem, including more aged care outreach services to treat people in their homes. Of the 3000 residents who were seen by multidisciplinary health teams, only 500 required hospital treatment.

A transition service with 24 beds was introduced in conjunction with Figtree Private Hospital and technology introduced during the COVID pandemic such as virtual hospital wards and health in the home is helping to keep older people at home.

Margot gives high praise to the STARS program, which Community Industry Group introduced last year. Volunteers provide experienced advice and support to older people and their families so they can access the aged care services they need.

“They are really passionate people who have considerable experience in aged care, who are connecting with people as they are making significant decisions in their lives as to where they go next,” Margot says.

“It can be a huge decision for the person, for carers and for the family.”

And this is where the community needs to step up to help ease bed block in the future.

“We all need to reflect on what we need to do to get ready for ageing,” Margot says.

“We need to start thinking about that journey and what it is. It’s not easy, it is complex and it has some very significant personal and family decisions in it.”

No-one likes to think about ageing, or our family members ageing, but planning ahead allows time to make important decisions while you, or your family members are still able.

Government and health experts all agree and acknowledge that it’s much better for people to retain their independence and live in their own homes for as long as possible.

There is help available to allow people to do just that and while the system may not be the most user-friendly system in the world, it’s getting better all the time.

Talking about plans for ageing is a bit like talking about death – it can be uncomfortable and difficult, but if the alternative is to have a loved one languish in a hospital bed for weeks or months because there is nowhere for them to go, I know what I’d much rather prefer.

So next time you’re stuck in the emergency department, or hear people complaining about their “horror” wait, do your community a favour and take the time to plan for your old age.