National Review

Nowhere to go

Four years ago, Hubert Rolle, now 63, was taken to Princess Margaret Hospital (PMH) in an ambulance after he suffered a stroke.

 Although he was discharged some time back, Rolle remains in bed at the hospital.

 He said he has nowhere to go if he leaves. PMH is his home now.

 In fact, Rolle told National Review he has not been outside the hospital in the last four years.

 He’s partially paralyzed.

 He said he has no family.

 “Sisters or brothers, none,” he said.

 Asked whether he likes living at the hospital, Rolle said, “I can’t do better. If I had some place to go, I can go, but I have no place to live.”

 What does he do there every day?

 “I just lie down because I can’t walk too far,” he said, adding that he leaves bed to use the bathroom, but he mostly watches the small TV on the wall and listens to the old radio on a nearby nightstand.

 We asked him where he would like to go if he could leave. He responded, “Downtown.”

 Rolle said while he can’t go anywhere, he feels “alright”.

 “The nurses are my friends,” he added.

 The only visitors he gets are “church people” who come to spread Christian charity.

 Rolle is one of 27 boarders at the hospital — 25 adults and two children, a boy, 13, and a five-month-old baby boy.

 Of the 25 adults, 19 are males and six are females. The eldest is 85.

 The 27 boarders include 19 Bahamians, four Haitians, two Jamaicans, one Cuban and one German.

 One boarder has been at the hospital since 2011; one since 2013; one since 2014; two since 2015; three since 2016; one since 2017; seven since 2018; and 11 were discharged this year and never left.

 With the exception of the children, they are housed on Male Medical II.

High cost

These 27 boarders have already cost PMH $7.5 million, according to the hospital’s Financial Controller Allington Hunter.

 A patient becomes a boarder when he or she is discharged but does not leave the hospital. Hunter explained that the calculations on the boarders’ cost to the hospital were done from the point of discharge.

 “So for the 27 that we’re referring to now, you would have had individuals here from as early as 2011, so you can imagine the cost, the time and the effort involved in caring for someone for so many years, and we’ve calculated that this group of individuals has used up close to 18,000 patient days,” Hunter said.

 “That’s bed space and when we equate that to what it ordinarily costs us on average, about $420 per day, that’s equivalent to $7.5 million for these 27 boarders.”

 But he said the cost is likely even higher when other factors are considered.

 “…If we have boarders in the accident and emergency area, it contributes to overcrowding. When there’s overcrowding in that unit we have virtual wards that are opened,” Hunter explained.

 “Those virtual wards must be manned by 100 percent overtime, so that’s a cost that’s not even attached to this that can be attributed in some way to having a boarder population, so it’s quite costly.”

 The boarder issue is a long-standing one for the nation’s premier healthcare facility.

 Writing in 2016 to Herbert Brown, then managing director of the Public Hospitals Authority (PHA), Hospital Administrator Mary Lightbourne-Walker said there was “no relief in sight” to the problem.

 “The planned redevelopment works for this fiscal period at the Princess Margaret Hospital is directly threatened by this issue of boarder patients,” Lightbourne-Walker warned.

 “We shall not be able to start works without the ability to operate revolving wards. Currently we have no revolving wards as all space is occupied. Space not occupied is directly related to our inability to convince persons to staff these spaces on an overtime basis.

“Undoubtedly, we are in crisis. The entire sectorial systematic approach is required to solve this dilemma. Princess Margaret Hospital needs help now. We must be creative. We have proven within our sector that public private partnerships can work and are viable options.

“Home based care options with those partnerships in mind can and is a viable option that must be explored as we seek to improve healthcare efficiency, quality outcomes and a healthy nation.”

Lightbourne-Walker observed in that correspondence that there were 16 to 23 residents within the hospital occupying acute care beds on any given day.

When the hospital’s executive team sat down with National Review during a recent visit at PMH, Acting Hospital Administrator Sonia Bastian Rose said, “I’m inclined to say that perhaps it’s trending up, but generally it’s no more than 20 on average, children as well.”


How does one become a boarder?

“I believe that they would have been admitted for some level of care, the treatment would have certainly occurred and they would have been discharged. Nursing homes would deliver their patients to us and you can understand why perhaps that would happen, but sometimes they don’t leave,” Bastian Rose explained.

“They refuse to take them back. We have organizations that you would consider to be partners to some extent, they would have been treating or caring for individuals in their homes and they come into hospital for an acute episode; we expect that they would be treated and returned to the home and there is a refusal to take them.

“At the end of the day it is anticipated that PMH is the catch-all for everything that happens in the country. There are implications, of course, because on the other hand the thought is that we are supposed to have beds readily available for everyone when there is a need for acute care.”

 Hospital officials say boarders are placing a strain on PMH.

“Where there are individuals in a bed that no longer require the medical care or treatment and they remain at PMH…if it’s deemed to be a boarder, physicians don’t generally [see] them, but if there is a demand for medical intervention then of course we will call someone in to do the assessment, but there is always a call for nurses to be available in an environment where there is a significant shortage of nurses,” Bastian Rose said.

“We don’t always require registered nurses to be involved, but it certainly detracts or subtracts from their ability to provide services to those persons that are in real need of medical care because they’re in an acute state.”

This is because the nurses also care for boarders.

The situation makes life particularly difficult in the Accident and Emergency Department.

“This is not comfortable because it’s an acute area where patients are in and out. You alluded to the trauma; sometimes we have to lock the department down. It’s a very busy place, not a comfortable place to be as an admitted person, but they are receiving all the care they need,” said Medical Chief of Staff Dr. Caroline Burnett-Garraway.

“We have boarders in the emergency department as well and they take up a bed then we have our acute patients on ambulance trolleys sometimes. The ambulance then can’t go out to pick up acute patients, they’re backed up and it puts a big strain on the nursing team as well because we’re used to acute care, in and out, you’re admitted, you’re discharged.

“But they have to feed, bathe, turn, give medication to the boarders and that definitely adds to the stress in the emergency department.”

A PMH issue

There is a general sense that this is a PMH issue, Bastian Rose said, but it is not solely a PMH issue.

 “My expectation is that if there is a long stay patient in the hospital who is just here, they’ve moved beyond the point where they require acute services, there should be another institution, entity available where there is collaboration in terms of discharges,” she said.

“We don’t generally have that. The patient comes into PMH and the expectation is that ‘it’s your problem; we’re not taking them; we can’t provide support’.

“I don’t believe that we get the level of collaboration from other national organizations to assist us with managing the problem. If it’s social services, well, they’re readily on the ground, but generally speaking, it’s our problem; ‘they’re in your bed; you manage them’ and for me the concern generally is if you require care and we say to you a bed is not available, it’s another crisis and also PMH’s problem.

“So from where I sit, I believe that if we have foreign nationals in the institution, and we do, how do we get them back home for instance? We’ve made some efforts, some attempts to have conversations externally to PMH and the question generally is, ‘Well, do you have the person’s passport?’ I can understand why that question would be raised, but are we also supposed to go out and look for it?”

In June, Minister of Health Dr. Duane Sands said the number of boarders at the hospital is “reflective of the social challenges that we have in the country”.

“As a healthcare facility, what do we do?” he asked.

“Put the person on the road? We can’t do that. So, this has to be dealt with through other agencies and the creation of alternatives because if you look at some of the long-term facilities they are not going to do it for free. So, the question is now, who is going to pay for it?”


Each boarder has a different story.

Some have been abandoned by their families.

The youngest boarder, the five-month-old, came from “another home, not from parents or family”, but that home indicated that it is not prepared to take the baby back, according to Principal Nursing Officer Valerie Pratt-Miller.

Pratt-Miller said the 13-year-old is not mentally fit to attend regular school, but children boarders at PMH have in the past left the hospital to attend school.

Teachers from the Ministry of Education also teach at the hospital, she pointed out, “so children who are able to go to school, whether they are boarders or otherwise, they can go to school and keep up with their curriculum”.

Burnett-Garraway said boarders are at the hospital because of all kinds of issues.

She said some of them come from private assisted living homes and their families can no longer afford to pay for them to return. Other boarders come from homes that are in disarray, which are not fit for them to return to.

“There really are some very sad stories,” she said.

Not all boarders expect to spend the rest of their lives in PMH.

A 59-year-old man, who did not want his name used, said he has been at the hospital for the past eight months.

He explained that he used to live with his sister, but she is currently in hospital in the United States dealing with a serious illness.

 The boarder, who appeared to be in good spirits, said he is waiting for her to get better so he has a home to return to.

The man told us he has relatives who visit him at PMH, but he stays at the hospital “abiding by rules and regulations”.

 He said he’s there because he has “no other choice” and said he is well cared for by the nurses.

“I sit down, relax and keep a focused mind,” the man said when asked how he spends his days.

“If I had a chance to leave now I would go. I wish I could get out of here. I have no intention to be in here for the rest of my life. I still have more in me left to do.”

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Candia Dames

Candia Dames is the executive editor of The Nassau Guardian.

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