Quebec’s emergency rooms are operating at 139 to 174 percent capacity. A man over 70 waited 16 hours without seeing a doctor, went home, and died. Nurses are leaving the public system in large numbers. The province faces one of the most significant healthcare staffing crises in its history. The government’s solution is to send patients home earlier and monitor them through a screen. This is called hospital at home. It is a priority initiative of the Ministère de la Santé et des Services sociaux. The government committed to deploying it across all regions of Quebec by 2026. $40 million has been allocated to the project. The CHUM is among the first hospitals implementing it. The announcement described it as a more humane and efficient healthcare network. What Hospital at Home Actually Is Connected medical devices and teleconsultation are an integral part of home hospitalization. This fast-growing service is an alternative to conventional hospitalization. Which means patients who would previously remain in hospital beds are discharged earlier and monitored remotely through devices and virtual appointments. A nurse or physician connects with the patient through a screen. The patient’s vitals may be tracked through connected equipment at home. The government’s stated rationale includes reducing emergency room congestion. Eliminating infection risks associated with hospital stays. Improving patient quality of life by allowing recovery at home. These are legitimate benefits in specific contexts. A patient recovering from a planned surgical procedure in stable condition who prefers home recovery with virtual follow-up is a reasonable candidate for this model. The question is whether this program is being designed for those patients. Or whether it is being designed to solve a capacity problem the government created and does not want to fund its way out of. The Specific Problem With the Timing Quebec announced hospital at home as a priority initiative while its emergency rooms are at 139 to 174 percent capacity and the government has been unable to retain the nurses required to operate at designed capacity. When she unveiled the project in May 2023, Quebec’s minister responsible for seniors anticipated implementation of eight such programs by 2024. Radio-Canada learned only four had been launched so far. Which is the standard Quebec institutional delivery pattern. Announce the program. Commit the funding. Deliver at roughly half the promised pace. Request patience while the cultural change takes hold. Meanwhile the emergency rooms that the program is supposed to relieve continue operating at over 100 percent capacity with nursing shortages that the program does not address. What the Program Does Not Solve Hospital at home does not create nurses. It redistributes the existing nursing shortage across a different geography. Dr. Michaël Bensoussan, head of Charles Lemoyne Hospital’s gastroenterology unit, has concerns about how Quebec may go about delivering the changes. Whether a patient needs a bandage change or physiotherapy, the province will need to find nurses and other health-care workers to tend to the patients. Which is the specific gap the announcement does not address. A patient monitored remotely still requires physical care. Wound care. Medication administration. Physical assessment. Which requires a nurse or other healthcare worker to travel to the patient’s home. Which requires nurses the system does not have. The initiative frees up about seven nurses a day that can be reassigned to intensive care or the emergency room according to one hospital administrator. Seven nurses. In a system with a shortage measured in thousands. Which is not a solution to the nursing shortage. It is a redistribution that helps specific units at the cost of the home care capacity the program claims to build. What $40 Million Buys About $40 million is to be invested in the hospital at home project by 2026. Quebec’s emergency rooms are at 139 to 174 percent capacity today. The nursing shortage is measured in tens of thousands of unfilled positions. The province is paying premium private agency rates for nurses it drove away with poor working conditions. $40 million invested in retaining nurses through competitive compensation and improved working conditions would produce measurable results in the emergency rooms that are killing people through wait times. $40 million invested in teleconsultation infrastructure and connected home monitoring devices produces a program that has launched at half its promised pace, requires nurses the system does not have, and addresses the symptom of overcrowding rather than its cause. The symptom is too many patients in emergency rooms. The cause is not enough staff and not enough beds to treat them adequately. Sending patients home with a screen does not add staff. It does not add beds. It moves the inadequacy from the hospital to the patient’s living room and calls it innovation. The Honest Assessment Hospital at home is not without merit as a healthcare model. In properly resourced systems with adequate staffing and genuine community care infrastructure it produces real benefits for appropriate patients. Quebec is not implementing it in a properly resourced system. It is implementing it in a system with a critical nursing shortage, emergency rooms at 174 percent capacity, and a documented history of announcing programs at twice the pace it can deliver them. The patient who waits 16 hours in an emergency room and goes home to die does not need a teleconsultation platform. They need a doctor to see them before 16 hours pass. Which requires staffing. Which requires investment in the conditions that retain the professionals the system needs. The government chose the screen over the staffing. Which is what $40 million for virtual care infrastructure while nurses leave for private agencies tells you about who is making decisions and what they are optimizing for. It is not the patient on the stretcher. SIIIOCULI — Intelligence. Sovereignty. Awareness. siiioculi.lilxbrxaker.com