666! Not a distinction of valor!

That was the number of expensive, acute care hospital beds occupied by older folks who are waiting to be transferred to long-term care in Horizon hospitals as of July 12, 2025!  Not exactly the apocalypse but sobering.  Apart from religious literature explanations of that number, the real negative message for New Brunswick families is that a huge number of beds that should be used to process patients who have serious, acute and often life-threatening problems are not available.  Those beds are occupied by persons who need nursing home (round the clock nursing supervision), special care (round the clock support), or enhanced home support.  None of these options come close to the cost of acute care hospitals!
Add to Horizon’s shocking total is the 318 number from Vitalite which brings the provincial total to 984!  That would be the equivalent of three DECRH’s filled entirely with elders awaiting the level of long-term care that their condition warrants!  Let that sink in for a minute as a taxpayer or as someone whose loved one is languishing on a stretcher in one of the corridors in the Emergency departments.  If that is considered acceptable, then on what basis would it be seen to be acceptable?  What value system would lead to that view?

Furthermore, as has been described for policy makers for decades:  acute care beds are the worst care option for persons whose needs are at the level described as level 2 or 3.  At those levels, people need help with most activities of daily living, comfortable accommodation, nutritious food, security, help with medications, and access to physician or extramural care periodically. 

Case in point:  recently a patient was transferred from a care facility because he “needed a higher level of care.”  Over to the hospital where the only option was a TV room being used to house multiple sick people with no bathroom!  How is that a standard of care that could be seen even remotely as acceptable?

In the hospital environment, long-term patients regress and certainly normally see no improvement in either health or emotional status.  The evidence of this fills many volumes in professional books and journals.

The Lamrock Report, published well before the last provincial election, had the elements of areas in our complex health and long-term care system that need to be overhauled in order to fix what otherwise would be described as a total failure of public policy.  To deny the use of the term crisis suggests complete lack of understanding of the issues, the human toll, and the serious waste of resources that is happening before our eyes.

This comes as no surprise except to those who don’t quite understand how the health and long- term-care system works (or doesn’t).  The issue of Alternate Level of Care in hospitals has been a problem since the inauguration of the national hospital system in 1959.  Piece by piece, steps have been taken in each province to respond to the increase in need for long-term care facilities.  The voluntary non-profit sector has been active as has some very progressive companies with terrific vision.  New Brunswick has had a mixed approach in recent years, with absence of provisional vision in decades on this file.

In some other provinces, acute care hospitals have developed ACE units in selected hospitals to complement the service for elders.  These hospitals recognize that acute care for seniors requires a different skill set and different programming than acute care for kids and younger adults.

As Lamrock outlined, the big issue for NB is that it now has what is a serious crisis complicated by the total absence of a plan.  So, to get this huge number under management, hit and miss action often has been the order of the day.

Long-Term Care service provider organizations are waiting for direction; actually, they have been waiting for well over a decade!  Is the answer the creation of more nursing homes?  That does not happen very quickly.

More special care homes?  Quicker than nursing homes.  More home care?  Nova Scotia is ahead of New Brunswick on this issue despite more than a decade of discussion with government in New Brunswick.

The danger that policy makers need to avoid is jumping to politically attractive alternatives without examining the issues in their entirety.  It makes good photo-ops to cut ribbons on buildings and programs.  But that would be only a small part of a real solution.  Another photo-op to be avoided would be simply publishing “a plan”.  The shelves are littered with plans for long-term care going back many years!

Just as the Premier has halted changes in Nursing at Horizon in order to effect meaningful engagement with staff and unions, similarly a serious plan needs to be completed that shows evidence of engagement of government with experts in the field, persons who operate facilities successfully and thoroughly understand the sector.

The argument often in the past has been: “these people have vested interests!”  And so do all those on the other side of the table:  politicians, civil servants, unions, advocacy groups all have their interests.  Wisdom comes from discerning the difference between vested interests and legitimate and essential expertise and knowledge and getting that engaged.

The short answer is that changes need to be made in Home Care Services, Special Care Homes, Nursing Homes, legislation, regulations, and the civil service.  This is not a one-way street if we are serious about preventing what otherwise will be a train-wreck.  And this time, change needs to go well beyond the temptation to add new programs or new beds alone.  Lean Six Sigma teaches us to ask “why” 15 times in order to get to the real issues.  If the real issues are not resolved, we will have this panic again soon.

Nursing Homes Without Walls has been a welcome addition to the repertoire but still the numbers of ALC patients continues to spiral.  That great program came from the vision and leadership of Dr. Suzanne Dupuis Blanchard with good support from Social Development, albeit in the absence of a plan for long-term care.

In my last commentary I called for overhaul of the Civil Service.  All major human organizations, if they want to survive, needs to undertake serious soul-searching periodically.  If not they grow stale, become stagnant,  lose market share and profitability, compromise their performance standards.

In New Brunswick, over half of the provincial budget is consumed by health and long-term care which, in turn, is regulated by hundreds of people all of whom have dreadfully important jobs.  We need to get a good scorecard that represents Access to Primary Care Services including Emergency department access and the effectiveness of the long-term care system.  The regular calls that I receive would suggest that the public would say the score should be much better relative to the huge investment of public funds.

These are public services in which historically the civil service with its many departments and staff, have been the custodian, regulators, financing agency,  policy establishment, planners.  Performance indicators?
One bit of good news is that there will be a wonderful new nursing home opening its doors in Oromocto in December.  Sixty beds will relieve some of the pressure on the DECRH, presumably.

Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com