How Bayshore HealthCare helps free up hospital beds

Stuart Cottrelle, President of Bayshore HeathCareHandout

Doctors, nurses and virtually everyone else involved in Canada's health care system are sounding the alarm about hospital capacity issues and ER wait times. Between funding, legislation and an aging population, the cause is multifactorial, and solutions are contentious and few on the ground. Four years ago, Bayshore HealthCare, a Mississauga-based provider of home and community health services, launched an innovative program that's already helped increase Ontario's hospital capacity—and unexpectedly, even diverted patients from the province's notoriously overextended long-term care homes.

The program came about in 2019, around the time hallway medicine—the practice of treating hospital patients in hallways when rooms aren't available—was making its rounds in the media. A portion of hospital beds routinely filled up are designated "alternate level of care" (ALC), which is when a patient isn't sick enough to need acute care but not quite well enough to go home without medical support. Patients in this condition tend to linger in ALC beds with no timely, medically efficacious route to return home and free up space for those in acute need.

Responding to this problem, Bayshore introduced @home—a roughly 16-week transitional program that gives patients an individualized home care plan delivered by an interdisciplinary team of nurses, PSWs, therapists and their local community health care services. It's funded by the government at no out-of-pocket cost to the patient, and in the four years since its inception, it's admitted more than 3,000 patients and saved Ontario hospitals 240,000 ALC bed days.

A recurring criticism of Canadian health care is its fragmented delivery model. Siloed practitioners and medical records mean patients can be left to self-advocate, undergo redundant rounds of testing, and play broken telephone between various specialists. A true team-based approach is hard to come by, and that gap is exactly what Bayshore's program is meant to address, all while targeting persistent hospital capacity woes. The interdisciplinary-team approach was expected to save ALC bed days, but it also accomplished something no one planned for.

More than 10% of @home patients who would otherwise end up in long-term care homes—which themselves suffer from major capacity and staffing issues—ended up staying at their own homes instead. "It's an unintended consequence, and that's wonderful for the system. We think part of the reason is bi-directional communication between patients’ families and their care teams," says Karen Fisher, director of community partnerships. Rather than a top-down prescriptive approach, these teams consistently communicate with patients and their families, ramping care up and down as needed.

"We are proud to partner with Ontario hospitals in the @home programs to relieve our overburdened hospital sector and allow for more patients to receive the high-quality, personalized care they deserve in the comfort of their homes," says Bayshore's president, Stuart Cottrelle. "We listened to families, found out what missing from the current system, and designed a care pathway around that." Actively listening to the communities it serves and leveraging its talent base accordingly is Bayshore's secret sauce—and a major part of the reason it's been in Canada's Best Managed Companies program for 16 consecutive years.

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