Hospital officials seeking to head off soaring health costs report “mixed success” in getting long-term elderly patients taken home — often because their families can’t afford to look after them.“The problem is, and has been for as long as I can remember being here, that there are substantial numbers of people that we find very, very difficult to discharge for a number of reasons,” said Bermuda Hospitals Board head of Geriatric Care David Harries.King Edward VII Memorial has four wards — and the equivalent of up to one full ward is occupied by “long stayers” whose families cannot take them home.Dr Harries’ interview was part of an ongoing series on healthcare costs.Around 30 extended care patients at any particular time are proving a challenge to get discharged from KEMH, he said.“The majority are seniors, but not all by any means. However the elderly population on the Island is increasing dramatically. Ten years ago it was about 10 percent and now it’s about 14 percent. We’re facing a tidal wave of elderly people, and it’s the elderly who are the highest consumers of healthcare dollars. That’s one of the most significant things driving up healthcare costs.”He added: “The family can’t look after them, and there is a tremendous shortage on the Island of nursing home places. There is precious little community support, and it’s very expensive.”As healthcare costs continue to climb, BHB is working to encourage long-term patients out of the hospital.“The recession has brought it home, big time,” Dr Harries said. “People have been forced to find much more efficient ways of providing healthcare, and the hospital is no exception to that.”BHB hopes for its new hospital wing to free up existing clinical space — but for now, cutting down on long term patients has been a matter of changing their accommodation.Said Dr Harries: “There are four wards containing a mix of all sorts of patients. The extreme long stayers were in all four; what we’ve done now is concentrate them all in one ward, Gordon Ward, and the very fact of that is allowing discharge planning to become more streamlined.”He stressed that patients in continuing care at KEMH are not only seniors.However, the most common long-term patients are older people with “medical and mental frailty”.“We just see the tip of the iceberg,” Dr Harries added. “There are probably about 1,000 people on the Island with dementia of varying degrees of severity, and as the population ages it’s going to be a bigger problem for us.”Ultimately, changing the Island’s model of healthcare isn’t BHB’s responsibility, he said.“While the thrust everywhere else is toward private care in the community, we can’t influence that. We can only suggest it. It has to come from Government.”The hospital currently provides for about 120 patients on extended care.“If community care was in place, we could safely discharge at least a quarter of the patients that we have in the continuing care unit,” said Dr Harries.In the meantime, the hospital’s best resort is to use existing resources more efficiently.BHB chief of staff Michael Weitekamp said: “Being concentrated in one ward allows for more efficient discharge planning. Most health systems through the world are developing what we term post-acute phases of care. Really, the hospital should be the short part of somebody’s stay.”However, he added: “Bermuda has an Island-wide problem with healthcare costs. BHB accounts for 44 percent of costs, so there is another 56 percent of cost outside of our control. We could all work for free starting tomorrow, and it would not solve the problem.”