– He can’t get out of the room if the door is closed. Then he needs help. He uses a walker to walk, but needs help to get up, says Tore Ellefsen. He describes the situation as very burdensome for the next of kin, and has sent a notice to the State Administrator in Troms and Finnmark. The 89-year-old father has been diagnosed with dementia and Parkinson’s, and sleeps alone in a ten square meter room at the University Hospital of Northern Norway (UNN) in Harstad. – If he falls on the floor, he won’t get up himself. So, for example, when he is lying on the mattress, he does not have the opportunity to go to the toilet. In that case he has to choose to crawl there, there are no other options, says Ellefsen. The son Tore Ellefsen says that it has been two tough months for the relatives. Photo: Private According to the son, the father sleeps on a mattress on the floor, because he is not going to fall out of a bed and hit himself. – But he often rolls out of the mattress, and ends up sleeping on pure concrete. Ellefsen’s father has been ready for discharge for over 70 days. He is far from the only one waiting to leave hospital in northern Norway. – It is demanding to give them offers that are good At the start of week 16, the University Hospital of Northern Norway has over 40 patients ready for discharge. Several of these are at UNN Harstad. – These are patients who have extensive nursing and care needs. They need protection and services that are difficult for us to provide in a busy hospital ward, says Gina Johansen, operations manager at UNN Harstad. She refers to special activities and other types of adaptations that are important for the patient group, which can be difficult to provide because they are an emergency hospital. – Then it goes without saying that when patients stay in bed for a long time, it is demanding for us to provide the offer that is adequate and that is good for them, says Johansen. – We are an emergency hospital. The medical department in particular, which has had many of these patients, is an emergency department where 90 per cent of admissions are urgent, says the operations manager at the hospital. Photo: Trygve Grønning / news Ellefsen understands that the hospital does not have the capacity to give the father the care he needs. He believes the responsibility lies with Harstad municipality. The hospital has also sent several reports of concern to the State Administrator. 5 degrees in the room In the notice from the next of kin it is stated, among other things, that the father is in a room where the temperature is regulated automatically. The temperature can be as low as five degrees, based on the time of day, as the temperature is adjusted according to a time schedule. The son writes that the temperature can be adjusted manually, but that it is not something the father is capable of and therefore someone from the next of kin has to follow up. The operations manager at the hospital tells news that there is not a radiator in the room, as there is in most rooms. She says that it should not be like this and that they will immediately follow it up, so that the desired living temperature is maintained. The father has several cuts on his body, which his sons believe are the result of his frequent falls. Photo: Privat Works with measures Toril Skår, municipal manager in Harstad municipality, says that she does not want to comment on individual cases. But she also says that she is not satisfied with patients spending up to 70 days in hospital. – That is what we are working on now, to see if we can get measures in place that enable us to take them back to the municipality. Whether it is short-term accommodation, long-term accommodation or back to your own home, says the municipal manager. – We are doing what we can to look at measures that we believe can have an effect on reducing the number of days ready for discharge, says municipal manager Toril Skår in Harstad municipality. Photo: Arendal municipality Some of the measures Skår points to is that they will establish nine short-term places at the new health center in the municipality. But there the municipality is experiencing challenges with few applicants for the vacant positions. Now the municipality is looking at whether they can entice with North Sea rotations, in order to be able to recruit more. The new health center will soon be ready, with 150 new care places per day. – We can get nine places up quite quickly. Then we have to gain experience from that and see what it means in terms of the number of days ready for discharge. The goal is for us to go down significantly. We will see the result when we have started operations. They have also decided to use a staffing agency to get the first nine places up and running as quickly as possible, and hope they will get it done during May. The municipality has paid the University Hospital of Northern Norway between 20 and 25 million in the last two years, because they have not been able to receive patients ready for discharge. – It’s actually money we don’t have that we use. We have not set aside much to pay for patients ready for discharge. County physician concerned County physician in Troms and Finnmark, Anne Grethe Olsen, says she cannot comment on the case in question because it is being processed. But she nevertheless expresses concern that several municipalities are unable to accept patients ready for discharge from the hospitals. – We now see that several municipalities have not developed their nursing and care services to a sufficient extent to look after patients ready for discharge, who need a higher level of care after discharge, she says. – It is a municipal responsibility to ensure proper planning and dimensioning of the services for these patients. When a municipality does not accept a patient ready for discharge, this is a breach of the Health and Care Services Act. The state administrator in Troms and Finnmark carried out an inspection of Tromsø municipality and UNN in 2022. – After that, the municipality has worked systematically and well to implement planned measures. We now see that the measures are working, says the county doctor. – We will also carry out a supervisory follow-up of Harstad municipality, says the county doctor. County doctor Anne Grethe Olsen says they will supervise Harstad municipality. Photo: Marius Fiskum / State administrator in Troms and Finnmark – No “quick fix” In 2022, the University Hospital of Northern Norway had 21,105 inpatient days for patients ready to be discharged. Director of Cooperation at UNN, Glenn-Helge Hattmann, informs news that so far this year they have had even more than they had at the start of 2022. But in Tromsø municipality, they have had a gradual decrease in the number of patients ready for discharge. It has not come by itself. The municipality has worked to enable more people to move home, made 24 new municipal places available, worked on the way they recruit, made the rotations more attractive and offered more pay or other benefits. – There is no “quick fix”, because it is a complex picture. Money is an important factor in this, but the main challenge for both Tromsø and other municipalities is the personnel situation, says department director for health and care in Tromsø municipality, Magne Nicolaisen. Department director for health and care in Tromsø municipality, Magne Nicolaisen, believes the future will be challenging. Photo: Håkon Iversen Despite the fact that the municipality has slowly but surely reduced the problem of patients ready for discharge, he is worried about the future. – Patients ready for discharge have become a national problem. In the coming years, we will also very quickly have an increasing number of elderly people, while at the same time there will be fewer people of working age, says Nicolaisen. – So we will have to rethink how we organize and plan the services. – Having dark thoughts Back in Harstad, Ellefsen hopes for change, and a better offer from the municipality. – It has been two tough months for all relatives, he says. Ellefsen says his father doesn’t want to be where he is either. – What is perhaps the worst for both us and him is that he is very ready when he is ready. He knows why he is there when he has the lucid moments, and thus he gets dark thoughts. – I hope that no one has to experience the same as we have experienced, says Ellefsen.
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Increase in patients ready for discharge – relatives and hospitals despair – news Troms and Finnmark
