FREDERICTON – Concerns about
the challenges alternative-level-of-care patients create for the
provincial health system made headlines throughout 2012, as people
studied their current impact and tried to forecast data about the
future.
As New Brunswickers age, they often require increased levels of care. Sometimes home-care services are all that is required.
But if the person is battling the onset of
dementia, or contending with multiple or serious chronic health
conditions or diseases, they may require a higher standard of care.
Many patients receive the care they need at
their local hospital as they wait for placement in a long-term care
facility, staying for months, even years, before they’re assessed and
accepted at a nursing home.
With New Brunswick’s aging population, high
rates of chronic illness, and serious fiscal challenges, it’s the kind
of issue that could create a perfect storm for the provincial
health-care system in the coming years, especially if strategies aren’t
created and implemented now to help find efficiencies and improved
service-delivery models.
Last January The Daily Gleaner reported that
three of every 10 hospital beds at the Dr. Everett Chalmers Regional
Hospital were occupied by alternative-level-of-care (ALC) patients –
patients that would be more appropriately cared for in nursing home
facilities.
At the time, Dr. Tom Barry, the Horizon Health
Network’s chief of staff and a longtime Fredericton family physician,
said spacing concerns had eased slightly in some health-care facilities,
but were still creating bed crunches in other zones.
“In Moncton and Saint John, the percentages of
ALC patients have dropped down (to about) 25 per cent. Fredericton,
Miramichi and Upper River Valley are still struggling (at a rate of)
anywhere between 30 and 33 per cent (bed occupancy rates),” he said.
The number of hospital beds occupied by ALC patients in Fredericton hovered at about the same proportions in May 2012.
But the numbers were slightly higher at the
Oromocto Public Hospital, where four of every 10 acute-care beds were
occupied by people who would be better served in a long-term care
facility or a specialized home-care setting.
Back then, these figures were higher than the
Horizon Health Network’s organizational average. Statistics showed that
about 23 per cent of the regional health authority’s beds were being
used to care for ALC patients.
Nicole Tupper, executive director of the Dr.
Everett Chalmers Regional Hospital and the Oromocto Public Hospital,
told the newspaper this past spring that facilities across the province,
and across Canada, are struggling with spacing issues that have grown
partly due to the increasing numbers of patients who require long-term
care.
“Right now our average is higher, absolutely,” said Tupper this past May.
“We have seen our percentage, or our number of
patients, higher than we’re at currently. We have seen it lower. So
it’s one of those things where it’s impossible to predict. We manage it
as best we can to try to meet the needs of those folks who are, through
no fault of their own, (receiving long-term care in the hospital). It is
an issue, there’s no question.”
She confirmed that some ALC patients will stay at the hospital for weeks or months, but others will be there for much longer.
“We have a couple of patients, and I can’t
give you the exact number off the top of my head, who have been here for
longer than a year or two,” she said.
“We also have patients who have been able to
transition back to the community or to a nursing home in weeks or
months. It is quite variable, depending on the individual patient and
what their needs are.”
By the end of June 2012, statistics provided
by the Department of Social Development showed that 717 New Brunswickers
were waiting for a placement in a nursing home at that time. Of that
total, 452 applicants were waiting in hospital.
Social Development Minister Madeleine Dubé,
who served as New Brunswick’s health minister for most of 2012, came
face to face with this issue during a visit to the Grand Falls General
Hospital earlier this year.
Though she was there to open a new laboratory
and day-surgery suite, a physician took some time to tell her about the
hospital’s most pressing problem.
“Almost every one of the 20 funded beds in the
Grand Falls General Hospital is filled with a senior awaiting placement
in a nursing home or in the community. Sometimes, every bed is filled.
The other patients, who are in the hospital for medical reasons, are
being cared for in the emergency room, causing hours of unnecessary
waiting and congestion for the patients there,” wrote Dubé in a
governmental blog posting.
“I sat in the emergency room’s nursing station
and talked to a doctor about the situation. All around me, nurses were
doing their best to cope with what had to be a nearly impossible
situation. The doctor was asking me for help and I could understand why.
Could we add more hospital beds? Why can’t we just add more nursing
home beds? My answer to him was that there will be more nursing home and
special care home beds, but there will never be enough to meet the
demand for what’s coming.”
She said that by 2021 every hospital in New Brunswick could be facing the same shortage of acute-care beds.
Similar concerns were raised by Dr. Tim
Christie, a philosopher and epidemiologist who specializes in medical
ethics, at a public lecture he gave at the University of New Brunswick
in November 2012.
Christie described the provincial government’s
$329-million strategy for expanding and renovating nursing homes across
New Brunswick by the year 2016 as a “catastrophe designed to happen,”
explaining that even when he uses conservative forecasting models he
predicts a shortfall of between 1,363 and 2,271 nursing home beds.
Shortly after his presentation, he told The
Daily Gleaner this shortage of nursing home beds will also spill into
the public health-care system, creating bed shortages at hospitals
across the province. If that happens, he said, it could cause frequent
cancellations of non-essential surgeries, make it more difficult for
people who need a higher standard of care, and force hospitals to care
for patients for extended periods of time in the emergency room area as
opposed to an in-patient ward.
“Right now, the acute system is managed so
well that they’re able to problem-solve this. They’re making it so that
they’re not delaying surgeries, they’re not cancelling them, they’re not
postponing them. And they’re working hard to do this,” he said.
“But the point of our research is that at some
point the problem is going to become so big that you can no longer have
management solutions. You’ll need actual, final solutions.”
The good news is that health-care providers, and provincial policy-makers, are working to address these issues.
Also in November, more than 325 aging-care
stakeholders from across the province gathered in Fredericton for the
first ever Summit On Healthy Aging and Care. The event gave health-care
providers, government decision-makers, administrators, advocates,
researchers, seniors and other partners an opportunity to get together
in one room and discuss the challenges on the horizon and plan
collaborations and shared strategies for the future.
John McLaughlin, chairman of the Premier’s
Panel on Healthy Aging, told the crowd changes in this province are
going to be profound in the coming years.
“Fundamentally, the story we’re talking about
for seniors and this next chapter is a positive, optimistic story of
engagement, of involvement, of giving back to your community. The
narrative about seniors, and the seniors agenda, must be presented as a
positive story of inclusion, of engagement embedded within which are
lots of serious challenges,” he said.
“If we take those two narratives and we
separate them, if we have different communities and different
dialogues, we’re going to fail to address any of the issues before us.”