Social care shortfall adversely affecting hospital beds

One in ten hospital beds in Portugal are being occupied by patients who are unable to leave due to a lack of social care provisions, costing the country €180 million and adversely affecting the running of hospitals and the health of the patients who have nowhere else to go.

More than 1,500 beds in public hospitals are being occupied by people who have already been discharged, but who remain hospitalised due to lack of social care response.
According to data from the Portuguese Association of Hospital Administrators (APAH), of a total of 17,826 hospitalisations registered on 18 February, 1,551 were considered to be “inappropriate hospitalisations”, up by 722 (87 percent more) compared to the previous edition of the Barómetro de Internamentos Sociais.
The total number of days of social care hospitalisation was 119,971, with 77.4 days being the average national delay for inappropriate hospitalisation, 21 percent less than in the previous edition of the barometer.
Lisbon and Vale do Tejo are the regions with the highest number of social care admissions, representing 81 percent of the total, says the study, which adds that of these admissions, some 80 percent of these patients are over 65-years-old.
Speaking to Lusa agency, the president of APAH, Alexandre Lourenço, said that the study covered 40 entities from the SNS and the Regional Health Service of the Azores, seven more compared to the previous edition, and “had coverage of about 90 percent of the total of beds ”, 9.6 percent more than monitored in the last study.

For Alexandre Lourenço, the number of social care admissions (8.7 percent, an increase of 4 percent more than in the previous year) is “very overwhelming”.
“About one in ten hospitalisations are unnecessary and we could be providing more appropriate care outside these institutions to these patients,” he said.
“The associated financial value, which exceeds €180 million, is also very striking”, he stressed, considering that it ends up being “a waste” because it could be applied in the development of the National Network of Continuing Care or in the development of social care responses across the country.
“The funding could be put to much better use, which would also result in better care and general health for patients who should not be hospitalised simply because of a lack of social care response”, said Alexandre Lourenço.
While there has been an increase in the number of unnecessary hospital admissions in the latest study one of the reasons behind this has been the increased coverage of the barometer compared to previous studies, which while allowing for a more complete picture of the situation has also effected the numbers.
The survey found that of the patients who had already been discharged from hospital but were forced to remain there, the majority (57 percent) had to stay in hospital because they were waiting for support from the National Continuing Care Network, 16 percent of the patients had to remain in hospital due to incapacity within the family to provide support and care and a further nine percent were waiting for a vacancy in a nursing home.
Alexandre Loureço warned that because they are in hospital unnecessarily for usually “more than two months” these patients are subject to a series of problems, including the increased risk of hospital infections and a general loss of autonomy and functionality.
“Every extra day a person is unnecessarily in hospital will see the patient lose further functionality which then in turn makes it even more difficult for the family to be able to offer suitable care at home as patients end up having physical limitations that then require rehabilitation care.”
At a time when the number of beds available in hospitals has become crucial due to the Covid-19 pandemic, being able to release patients into the care system has become even more of an issue but one that can only be resolved with a substantial increase in social care funding.