The cost of a standard hospital stay in Alberta has risen by almost 30%, an analysis of data released by the Canadian Institute for Health Information has revealed. This coincides with an increase in population for Alberta of nearly 12%.

The data shows an increase in the cost of a standard hospital stay, up by 26% between 2011-2012 and 2015-2016. Census data collected by Statistics Canada shows that Alberta’s population has increased by 11.6%—the highest of any province or territory— between the 2011 census and the most recent 2016 census.

According to John Church, a political science professor at the University of Alberta who studies health care in Canada, there are a number of reasons for this increase. The first reason is the lack of an integrated healthcare option outside of the hospital setting, which means “that everybody gets driven into the hospital setting, whether they need to be there or not.” And the hospital setting, Church said, is the most expensive setting for a patient to receive medical services.

“If you have a situation in which I don’t need to be hospitalized… then my hospital care is going to look pricier” said Dr. Raisa Deber from the University of Toronto’s Institute of Health Policy, Management and Evaluation. Deber said that it’s where and how the money is being spent as opposed to the fact that money is being spent.

It’s the issue of “what exactly am I paying for in the hospital as opposed to what am I paying for in other settings?” said Deber. She pointed to chemotherapy as an example, saying that if the drugs are delivered in a hospital, as opposed to an outpatient clinic, the cost of the drugs count towards the hospital’s budget.

The second reason that Church pointed to is the lack of a single patient record system, which can result in patients undergoing tests which other healthcare workers have already administered.

Church also pointed to the fact that wages in Alberta are typically higher than other healthcare workers across the country. A separate report from CIHI states that the average gross clinical payment to Alberta physicians was $380 000, the highest in the country.

And given Alberta’s rising population, Church says that this issue is poised to get more expensive. “More people means more people potentially needing health services” Church said. Church said that the demand on Alberta’s healthcare system will increase, both in numbers and in demand on its services, that as the population ages it will require more health services that can handle the more complex health issues inherent with age.

Church pointed out that elderly people often require the most amount of healthcare, that most people consume the most health services in terms of cost in the last few months of their lives. Deber concurred, stating that “if [the] population [is] going to be younger and healthier, then you would expect [the cost of an average hospital stay] to be smaller.”

A report from the Alberta Auditor-General has identified these three reasons for expensive healthcare in Alberta as “pervasive barriers” that prevents Albertans from “receiving the quality of care they could receive.”

“Unless there are fundamental changes… people will continue to flood to the emergency room” Church said. Church identifies timely access to healthcare outside of hospitals as necessary to alleviating this costly issue. This includes “everything from seeing your family doctor to seeing a range of service providers that provide services to seniors, [to services] that provide access to community-based mental health service [and services that are] providing sufficient access to things like home care.”

Potentially risky prescriptions are the leading cause of hospitalizations for one in two seniors across Canada, according to an analysis of data from the Canadian Institute of Health Information (CIHI) report.

More elderly persons are living longer than ever before, and the healthcare system buckles in effort to not only provide the proper care, but prevent unnecessary harm to Canada’s aging population.

“Medication errors occur all the time,” said Jennifer Jin, a pharmacist at the Queensway Carleton Hospital in Ottawa, Ontario. “The result can be clinically insignificant to fatal, depending on the medication involved.”

Between 2015 and 2016, upwards of four million seniors aged 65 and older were admitted to a Canadian hospital, according to numbers in the CIHI report. 1.9 million of them were admitted because of either wrong or potentially harmful medication.

A medication error can happen at any point before the prescription reaches the patient.

It can be as simple as an incorrectly written administration route, a wrong dosage supplied, or a prescription picked up from the wrong tray.

“There’s not one nurse that can say ‘I’ve never done a medication error,’” said Guylaine Gallant, the director of health and wellness at the Prince of Wales Manor in Barrhaven, a retirement home in Ottawa.

“It does happen,” she said. “But we try to make sure that there are no room for errors.”

Hospitalizations put a strain on the healthcare system, especially when it can be prevented.

“The hospital beds would ideally be available for patients who need care due to their medical conditions,” said Jin. “And not filled with patients who have iatrogenic illnesses from taking wrong or inappropriate medications.”

The terms ‘inappropriately prescribed’ and ‘potentially inappropriate’ have completely different meanings, she noted. The latter refers to unsafe prescriptions for the elderly population that should be avoided altogether.

The Institute for Safe Medication Practices Canada’s ‘Beers List’ compiled medication names, cases and research for potentially inappropriate medications for older persons. Listed as ‘high alert’ are: warfarin, oral antiplatelet, insulin, opioids and digoxin – all medications used for blood clotting and blood sugar regulation, narcotics or various cardiovascular problems.

In Jin’s experience, the top three prescriptions given to partients are heart medications, antidepressants and narcotics. All of which are commonly used by seniors as well.

While the Canadian Institute for Health Information report doesn’t show for which inappropriate medications are most frequently used or administered by who, healthcare professionals have systems in place to prevent risks and errors from happening.

Gallant oversees the Manor’s implementations of the College of Nurses of Ontario standards to ensure mistakes and risks are minimized. Some examples include operating their own in-house pharmacy, a self-reporting system for errors and numerous trainings and audits per year.

“It’s like CPR. You think you now it until you’re being asked at a course and think, ‘s**t, is the ratio 50 to two? Thirty to five?’” Gallant said, highlighting the importance of  accountability in her line of work. “It’s the same with medication—you get a little comfortable and you forget some stuff.”

On the other side of the counter, another problem occurs. When a patient sees multiple doctors, specialists a locations, they don’t bring their medical history slip and ends up on serious medications, this is known as ‘poli-pharmacy’.

“It’s huge. Next thing you know, this medication interacts with that one— but the physician didn’t know—  the patient is 80,” ,” Gallant said. “She can’t tell she’s already on that medication. They end up having so much medication and that’s why they’re in the hospital.”

“The aging population is getting too much,” she said, stressing the need for for better care. “I just feel the need for them is here.”

Women in Ottawa are being hospitalized for self-harm almost double the rate of men, according to an analysis of data that a national research institute uses to track hospitalizations.

Data from the Canadian Institute for Health Information shows that 462 women were hospitalized in Ottawa last year for self-inflicted injuries such as burning, cutting, overusing drugs or attempting suicide in other means, compared to 270 men. That’s around eight women for every five men.

This trend is visible consistently in Ottawa dating back from 2010, the earliest date the data provides. But according to specialists, that is only part of the story.

“Women use different methods to attempt, so they tend to stay alive,” said Renée Ouimet in an interview. She is the coordinator of the Ottawa Suicide Prevention Coalition, which is run through the Canadian Mental Health Association’s Ottawa branch. The coalition runs workshops and trains Ottawa residents on how to manage suicide attempts.

She said that the means women use, in general, tend to leave time for the person to be discovered, whereas men tend to use more violent, and faster means.

Ouimet said that it isn’t really an issue of women attempting suicide more frequently than men. She said the numbers for attempted suicide are about equal, men to women, but that men tend to ‘complete’ suicide more frequently. She also said that women seek help more often, and that mental health programs tend to be geared more towards females.

Ouimet made a point of differentiating beteen self-inflicted injuries and suicide attempts, stating they are often different things. “You can self harm and cut and burn for years and years and never attempt suicide,” said Ouimet. She did note that many who do self-harm, however, may also attempt suicide at some point.

For the purposes of having clean, unambiguous data, the health institute slots attempted suicides with self-inflicted injury leading to hospitalization into the same category.

Mark Patton, a counsellor with Family Services Ottawa, said in an email exchange that in his work he sees the trend of more women self-harming than men. He said that in his experience, however, men tend to cut less but tend to use “methods of self-harm that are more ambiguously self-harm.” If someone is driving recklessly, he said, or drinking heavily, are these methods of self-harm?

The data would say no, but it is confined to a strict definition of self-injury.

Patton said that might be a sign of bias. “When most people think about self-harm, they likely imagine a girl or woman who cuts,” he said, so other forms of subtler self-injury are not being accounted for.

The health institute stipulates that this category includes only what is clearly self-inflicted injuries requiring hospitalization, meaning only those actually admitted to the hospital, not just the emergency room. It also recognizes that many cases were likely intentional self-harm but could not be listed in that category unless the practitioners or nurses were certain it was deliberate.

That means there are even more hospitalizations for self-injury than currently visible in the data.

Even without those cases, Ottawa hospitals still see hundreds of female patients for self-inflicted injuries. This trend of women being hospitalized more for self-harm is present across the province and even across the country.

** If you are in distress or considering suicide, there are places to turn for support, including the Ontario Suicide Prevention Network at 416-670-4689. The Canadian Association for Suicide Prevention also has information about where to find help.**

When Sean Hopkins reads about a suicide in Whitehorse, he braces for the worst. “It’s highly possible that I know or have even looked after that person,” he said.

Canadians in the territories are nearly three times more likely to be hospitalized for intentionally cutting, poisoning, or harming themselves compared to those in the provinces, according to an analysis of national health data.

Hopkins has worked as a mental health counsellor in Whitehorse for the past 18 years. He’s no longer surprised by the number of self-injury hospitalizations, but he can see the effect on the community.

“It’s a difficult reality and there’s a kind of intimacy here because we’re such a small population,” he said.

Nearly all of the Yukon’s mental health services are located in Whitehorse, leaving nearly 14,000 people who live outside the city with “a poverty of services”, according to Hopkins. He said a lack of mental health supports in remote communities across the territories could help explain the high rates of self-injury.

The analysis looked at data from the Canadian Institute for Health Information (CIHI). CIHI tracks self-injury hospitalizations that are deemed intentional, reflecting suicidal behaviour.

Northwest Territories suffered the highest rate of self-injury hospitalizations in 2015-2016, with 194 hospitalizations per 100,000 people. Manitoba recorded the lowest rate at 54 per 100,000.

Despite years of experience, Hopkins struggles to understand why the numbers remain so high in the territories.

“Is it isolation? Is it hopelessness? Is it the legacy of residential schools? We don’t actually know,” he said.

Mary Bartram is a health policy expert at Carleton University. If the country is serious about reducing numbers in the North, governments need to deal with issues such as housing shortages and food insecurity, she said.

Nunavut often has the highest rate of self-injury and is plagued with housing shortages. More than half of the population depends on social housing, yet the Nunavut Housing Corporation needs 3,500 new units.

Households in Nunavut are also nearly four times more likely to suffer from food insecurity compared to the provinces, according to a study by the Canadian Institute for Health Research. Food insecurity is defined as insufficient access to nutritious and affordable food.

Bartram said a chronic lack of social workers in Northern communities has led to higher rates of self-injury. 37 per cent of the social worker positions in Nunavut remain unfilled on a month-to-month basis, according to an Auditor-General report from 2011.

Stress levels among care workers who remain in the territories is a “very real issue”, Hopkins said. Many of his patients are paramedics and social workers, people who are intimately familiar with the number of self-injury and suicide victims in the Yukon.

“These are people who have experienced vicarious trauma from constantly, constantly dealing with these things,” Hopkins said. “It’s difficult to get any respite from that.”

Bartram and Hopkins both said conversations about self-injury in the North must also recognize Canada’s history of colonialism.

Indigenous peoples make up more than 50 per cent of the territorial population.  Bartram said the legacy of residential schools and forced relocations contribute to a suicide rate that is five times higher among Indigenous youth compared to non-Indigenous youth.

Any effort to lower the rate of self-injury must “stress the importance of supporting Indigenous peoples, communities and governments to set their own priorities and implement them,” Bartram said.

$36 million in new funding for mental health for the territories has already started to flow, but the federal government has yet to disclose exactly where it’s going. Bartram called on the government to make those decisions public, to ensure the country is closing the gap in mental health outcomes between the provinces and territories.

The city of Edmonton saw a rise in reported hate crimes from 36 to 81 between the years 2014 and 2015, an increase of over 100%, according to an analysis of data that Statistics Canada uses to track hate crimes.

While Edmonton saw a major increase in reported hate crimes, other major urban centres in Canada trended in the opposite direction. Toronto, Ottawa and Calgary all reported less hate crimes in 2015 than in 2014.

“I have always had a hard time understanding why someone can harm someone else just based on a certain social characteristic.”

Despite the increase, University of Alberta lecturer and researcher Irfan Chaudhry said it might not necessarily be a cause for concern for Edmontonians.

“It is hard to say what the cause of the increase is, but it could be a case of increased visibility that hate crimes are occurring,” said Chaudhry.

Chaudhry said that it is important not to discount the issue of hate crimes in Edmonton potentially getting worse, but the context of increased awareness of hate crimes in Alberta, as well as outlets to report them, cannot be ignored.

Chaudhry spends the bulk of his professional time as a hate crimes researcher. His latest project, StopHateAB.com, seeks to make the occurrence of Alberta hate crimes more visible and easier to report. Through the site’s web portal, which launched earlier this year, people can document hate incidents or crimes they have seen or been subject to. It is because of sites like StopHateAB and various social media outlets that Chaudhry said it has become easier to not only report hate crimes, but also hate incidents as well.

A hate incident is when an act is hate-motivated, but no crime is committed. An example cited by Chaudhry is if a racial slur is uttered by someone while driving by a minority. It may be a legal grey area as well as difficult for law enforcement to do anything about. The site provides a space to document non-criminal hate incidents that still have an effect on Canadians.

“Hate crimes are the most extreme and observable against inclusive communities, but there are also microcosms that aren’t as overt that still chip away at a strong community,” said Chaudhry.

The site also includes an interactive heat map that show the areas in Alberta that have had the most hate crimes/incidents occur. The areas on the map that stand out the most are the province’s two major cities: Calgary and Edmonton.

Between the Edmonton police and not-for-profit online tools, Chaudhry said that increased visibility of hate crimes and accessibility of support services will be key in helping to stop them from happening. Chaudhry identifies himself as a visible minority (he moved to Canada from Africa when he was five) and said that creating a more inclusive community is a goal of his.

“Improving visibility is a big part of moving towards inclusive communities. I have always had a hard time understanding why someone can harm someone else just based on a certain social characteristic,” said Chaudhry.

The Edmonton Police Serve said that they refuse to speculate on why the number of reported hate crimes escalated so dramatically between the two years. Canadian Metropolitan areas as a whole registered 1362 reported hate crimes in 2015 compared to 1295 the year before.

The number of 2016 reported hate crimes in Canada, broken down by metropolitan areas, has yet to be released by Stats Canada. Although it may seem problematic on the surface, Chaudhry said that a continued increase in reported hate crimes in Edmonton in 2016 might just mean that the issue is being brought to the societal forefront.

“I don’t think there should be alarm if the number continues to rise in the 2016 [Stats Can] release,” said Chaudry. “Overall, I am cautiously optimistic about the situation [improving]”.