bed block – Michmutters
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Australia

James’s partner, Venita, suffered a stroke. Two months on, she can’t leave hospital because they can’t find a place to live

A 39-year-old stroke victim is unable to leave hospital because she and her partner have been living in an industrial shed in southern Tasmania.

Venita Brown has been told she may end up in an aged care facility or a women’s shelter if she and her partner, James Paul, cannot find a suitable place to live.

“She’s constantly depressed,” Mr Paul said. “She pretty much thinks she is stuck in hospital because she’s got nowhere to go. They’re saying I am not allowed to bring her back here.

“It’s actually put her mental health at risk, very badly.”

Ms Brown suffered a stroke about two months ago. A month prior to that, she and 42-year-old Mr Paul moved into the shed.

Venita Brown and partner James Paul.
Ms Brown and Mr Paul struggled to find somewhere to live.(Supplied)

They could not find a rental they could afford on a combined disability pension and carers allowance of around $1,300 a fortnight.

“Most two bedrooms are $300 to $400 a week and you’ve got to be able to feed yourself and pay the power bill and everything else,” he said.

The couple moved into the shed as a temporary measure. They have put together a makeshift kitchen and there is an outdoor toilet and shower.

“I had no options, so what do you do?” said Mr Paul.

A man looks at the camera.
Mr Paul said they would move anywhere to secure a place to live.(ABC News: Luke Bowden)

But the shed has no windows, the roof leaks and, with very high ceilings, it is hard to heat. The entrance is a small door that cannot be accessed without crouching down.

“They can’t stay here,” said Alex Carter, the partner of Ms Brown’s daughter, Kaitlyn.

He said the shed was a stop-gap and was never meant to be lived in permanently.

James Paul and Alex Carter inside a glorious shed.
Mr Carter said government safety nets were failing.(ABC News: Luke Bowden)

“There’s no bales right next to the bed. There is stacked-up wood everywhere,” he said.

“Item [is]some would say, a health hazard, but more through summer they’ll be at risk of if we have a fire, there’s [only] one way in [and] one way out.

“If you want to go to the toilet, or you want to have a shower, you pretty much risk getting hypothermia.”

Shower arrangement at a shed.
The shower arrangement inside the shed.(ABC News: Luke Bowden)

Mr Paul said Ms Brown had been on the waiting list for public housing for two years before suffering a stroke.

The couple said they would move anywhere in the state in order to secure a suitable home.

“They don’t care where, they just need a house,” Mr Carter said.

Alex Carter sitting in front of a caravan.
Mr Carter said the RHH was “jam-packed”.(ABC News: Luke Bowden)

Mr Carter believes government safety nets are failing.

“There’s hundreds of other people that are in the same situation and it’s just ongoing and it’s getting worse,” he said.

The situation is becoming increasingly desperate, with Ms Brown due to be discharged from the Royal Hobart Hospital (RHH) in a matter of weeks.

“Hobart Royal is already jam-packed, they’re already screaming, saying, ‘We don’t have room’ … yet, what are we doing?” Mr Carter said.

“Keeping people in beds because they’ve got nowhere else to go … is that the reason why the hospital is so full and services are being stretched to the limit?

“The housing crisis has gotten to a point where people are actually homeless… the hospitals aren’t able to release them due to a duty of care.”

Dr Saul sits next to his desk, looking seriously at the camera.
Dr John Saul from the AMA said the situation was “incredibly frustrating” from a doctor’s point of view.(ABC News: Luke Bowden)

Doctors said the housing crisis was contributing to a shortage of hospital beds across the country.

“We have to practice good patient care and we cannot release someone from hospital unless they go to a safe environment,” the Australian Medical Association’s John Saul said

Dr Saul said a shortage of aged care placements and securing NDIS support for patients was making it increasingly harder to discharge patients.

“It’s contributing to back pressure down into the hospitals and, ultimately, that goes to the ED departments, that then goes to the ambulances,” he said.

“It’s a domino effect that’s traveling all through our systems. How does this feel from a doctor’s point of view? Incredibly frustrating.

“Some of these things are absolutely soul-destroying for our hard-working staff. We’re seeing it in homelessness with mental health issues as well.

“If a mental health patient, for example, goes back on the streets, it is unsafe, they will only present back to ED earlier if they haven’t got safe and appropriate housing.”

Jeremy Rockliff looking down while speaking at a lecture.
Mr Rockliff said the federal government could fund sub-acute beds in private hospitals.(ABC News: Jordan Young)

The Tasmanian government is calling on the federal government to fund transitional beds for long-term NDIS and aged care patients.

Premier Jeremy Rockliff said the number of patients unable to leave hospital because they were waiting for aged care accommodation or an NDIS package equaled to two wards at the Royal Hobart Hospital.

“These numbers have a large impact for a small state that is doing its best to manage significant COVID workloads,” Mr Rockliff said.

He said the Commonwealth could fund sub-acute beds in private hospitals “while we work together to look at longer-term solutions around accommodation to speed up the safe transfer of the medically-ready to aged care and NDIS supported living arrangements”.

Kathrine Morgan Wicks
Kathrine Morgan-Wicks said as of August 6, there were 46 patients ready for discharge who could not leave.(ABCNews)

In a statement, Department of Health Secretary Kathrine Morgan-Wicks said that, as of August 6, there were 29 aged care patients and 17 disability care patients medically ready for discharge from their acute bed but unable to leave due to waiting for aged care accommodation or an NDIS package.

There are around 4,400 people on the waitlist for public housing in Tasmania.

Tasmanian Housing Minister Guy Barnett said a tight housing market was impacting the most vulnerable.

“Communities Tasmania regularly works with the Department of Health in situations where people are leaving medical care to find the most-appropriate accommodation options to best suit people with a range of unique requirements,” he said.

“For example, our rapid rehousing program is specifically designed as transitional accommodation for eligible people to support them into long-term housing.”

Accommodation inside a shed.
The shed leaks and is hard to heat.(ABC News: Luke Bowden)

The Tasmanian government is working on a plan to lift housing stock by 10,000 new homes over the next decade.

“One thousand, five hundred new homes [are] to be delivered this financial year alone,” Mr Barnett said.

After the ABC visited Mr Paul at the shed, wild weather and nearby flooding forced him to shelter at a family member’s home.

It is not clear when he will be able to return.

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Categories
Australia

Fixing weekend discharge key to improving capacity at South Australia’s hospitals

A senior doctor at Adelaide’s biggest hospital says the health system is under “siege” and pinpoints Mondays as the busiest day.

SA’s struggling health system was again in focus this week due to the death of a 47-year-old man while he waited for an ambulance in suburban Adelaide on Monday.

Problems around ramped ambulances, overcrowded emergency departments and full inpatient hospital beds, trouble doctors and nurses on any day of the week.

But each Monday a perfect storm of complications aligns, cranking up pressure on health staff and patients.

So, what makes Monday the busiest day in SA’s hospitals, and what can be done about it?

Headshot of Dr Peter Subramaniam at an Adelaide hospital
Dr Peter Subramaniam says having fewer doctors working and community services unavailable on weekends leads to lower discharge rates.(ABC News: Ethan Rix)

A weekend hangover

As medical lead of the surgery program at the Royal Adelaide Hospital and chair of the Australian Medical Association Council, Peter Subramaniam knows South Australia’s health system well.

He says it is under “siege”.

“The system is under pressure and there is a significant demand and our capacity to meet that demand is not working,” Dr Subramaniam said.

The qualified vascular surgeon pinpointed Mondays as the busiest days for hospitals.

“You can see from the data we have that ours are lower on the weekend compared to weekdays,” he discharge said.

“So that contributes to the log jam that occurs on a Monday.”

A masked nurse adjusts their blue plastic glove in an operation room.
Experts say more resources are needed every day of the week, including weekends.(Rawpixel: Chanikarn Thongsupa)

Dr Subramaniam said fewer doctors working to patients over the weekend had an impact discharge.

“Most acute care hospitals operate on reduced staffing,” he said.

But that’s not the only thing bringing down discharge numbers.

“We rely heavily on community services to be available and accessible over weekends and often that’s difficult to organize,” Dr Subramaniam said.

“You might need a rehab bed or a step-down bed or a community nursing service to be able to manage the patient once they’re discharged.

“Once we’ve discharged the patients, they need to go somewhere.”

Elizabeth Dabars stands outside a hospital in Adelaide
Elizabeth Dabars says a criteria-led discharge policy was never fully implemented.(ABC News: Michael Clements)

monday blues

Chief executive of the Australian Nursing and Midwifery Association’s SA branch Elizabeth Dabars said the “absence of senior clinicians” on the weekend was driving up ramping times.

Professor Dabars wants to see nurses, allied health professionals and junior doctors able to discharge more acute patients under something called criteria-led discharge (CLD).

“It’s a win for the people wanting to go home and it’s a win for the broader community who would have better access to hospital beds,” the qualified nurse said.

CLD has been hotly debated for decades and was a policy directive issued by SA Health in 2019.

A car drives past an emergency department building
The state’s emergency departments have been under extreme pressure.(ABCNews)

Professor Dabars said it was never fully implemented.

“That has not really seriously been put in place and that is a blocker to people being discharged,” she said.

“It doesn’t actually make sense for it not to be enabled.”

But the former president of the South Australian Salaried Medical Officers Association, Dr David Pope, said the number of patients that would fit the CLD criteria was small.

“Item [CLD] works quite well in some areas but I defy anyone to go around and find patients sitting around in the hospital for want of a doctor to come in on a Monday morning,” Dr Pope said.

“That just doesn’t happen.”

Headshot of Doctor David Pope
David Pope says elective surgery admissions make Mondays busier than other days.(ABC News: Ethan Rix)

He said a crowded start to the week was a side effect of elective surgery.

“That worse effect on a Monday is purely a function of when elective surgery patients arrive,” he said.

The doctor said the idea that senior clinicians were unwilling to provide care on weekends was damaging to an already stretched workforce.

“Doctors are in the hospitals 24/7, so if there’s a need for a doctor to be in the hospital they will be there if they exist,” he said.

What will change?

The state government said it was looking to make criteria-led discharge “a regular part of hospital operations.”

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