​ALC’s Again! And Again! And??

Despite any “emergency measures” put in place, the situation with elders occupying acute care beds in hospitals awaiting long term care continues to grow.  Government intervention is supposed to resolve problems!  Not so much on this file!

Ask any of the great physicians in practice for reasons and you will get different responses.  Ask civil servants and you will get some responses.  Friends in the political world will give some other responses depending on their exposure to this disaster and at what level and under what circumstances.  From Media friends, another assessment depending on who they have interviewed recently on the topic.

There are lots of opinions.  The advocacy associations will have yet another list of issues and they tend to be closer to the real issues because it is their lived experience every day and many have been advancing advice for decades.

The Lamrock Report had some nuggets of gold.  In 200 pages and 59 recommendations he covered the waterfront of long-term care, the best analysis done in NB in my lifetime.  It is an exhaustive report and the nuggets need to be taken seriously and dealt with strategically; otherwise, we will have this problem, only worse, in a year, two years and more.  When you need to build a system, you have to start somewhere; the system will not appear by itself.

In the last 20 years I have invested weeks and weeks, yea, months and months, reading, talking with serious experts in the field (nationally and internationally), discussing issues with politicians, civil servants, service providers and advocacy groups.  Some of those with whom I have interacted are legitimately “international thought leaders”.  These are not people who simply have an opinion based on a neighbor’s experience.
I have had great interactions with colleagues in Norway, Netherlands, Quebec, Ontario, BC, Alberta, Manitoba, Nova Scotia, PEI and more.

Lamrock started his first press conference on the release of his report by observing that what really is needed in NB is a strong statement of Vision from the Executive Council Office.  That, he said, is an underlying issue because the lack of vision enables instability and change at the whim of whoever manages to get elected in any cycle.

Based on all of my interactions with groups and from some consulting experiences in recent years, this is what I believe to be the 10 issues that must be on the table in response to Minister Miles’ promise to consider “all issues”:
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1. Vision:  “without vision the people perish”: inscribed in the House of Commons as taken from Proverbs 29:18.  One walk through overcrowded emergency departments and over-crowded acute care units demonstrates what happens in the absence of vision.  Chaos.
   
   
2. Service Organization and Re-branding:  within long-term care there has been lots of confusion as to the roles of facilities, the consistency of programming, where do residents with intellectual challenges fit into long-term care and other residents who are not elderly.  Over 600 facilities with a wide array or roles, focus of expertise, recognized service levels.  If it is confusing for those in the system, and it is, then it has to scream confusion to the public.  A proposal was submitted in 2022 for the Department of Social Development to engage in a process of trying to fix the ambiguity and fuzzy nomenclature.  Indeed, there are some real issues of resident safety at stake.
   
   
3. Legislation:  long-term care consists equally of home care, special care, nursing home care.  Failure of any one of the sectors creates lots of problem for the other sectors and the hospitals.  Yet the system is regulated by two distinctly different pieces of legislation.  To the public, that means little; to those who understand public policy, it means everything.  You can’t get any sense of systems thinking, coherent policy direction with the divide that creates in the bureaucracy and in the service delivery system.  But that has been in place for over 30 years!
   
   
4. Financial structure:  the nursing home financing system and methods were established in the 1970s and have not been materially changed since then.  Special Care home financing similarly is archaic and unclear.  Home Care, as well, is archaic and does not help operators in their challenge to continue to improve skills and employee retention.   This is a topic that could fill many pages to fully explain and has occupied lots of discussion with limited action.
   
   
5. Human Resources and Workplace culture:   long-term care is reliant entirely on having wonderful, highly-motivated staff with passion for their work.  One of our key mentors at York Care Centre, Karen Flam from Maimonides Geriatric Centre in Montreal, reminded us that “passion is the rocket fuel for excellence”.  In the over 600 organizations that constitute long-term care, there would be a volume of issues ranging from recruitment and retention to workplace culture and toxicity, union relations, and a whole range of Human Resources Management issues. 
   
   
6. Assessment Processes:  ask any family member who has tried to get their loved one to the source of service to meet the needs of their Mom or Dad and inevitably you will hear a litany of challenges.  Attempts have been made to simplify and streamline but there seems to be sufficient “grey zone” and challenge that it is time to get both systems clearly on the table with some external assistance at the table.  I have heard issues from the public and professionals since 2006.
   
   
7. Regional Service Delivery Offices:  The Department of Social Development has regional offices around the province who play a major role in awarding licenses to operate, surveillance of service quality and performance to regulations, inspections, public disclosure, investigations of reported service problems and more.  It is a pretty complex piece of business and government owes it to the public to ensure that those offices operate with the staff resources they need to get the job done including training and experience in the field they are supervising.
   
   
8. Education, training standards, and certification of programming and content for nursing home boards, owners, operators, administrators, care directors.
   
   
9. Licensing, Inspection, disclosure and surveillance of long-term care programs.  These programs, in place as they are, for many years, should be critically reviewed, assessed, modified as required, re-structured as required.
   
   
10. Standards of Operation and Accreditation:  The Department of Social Development establishes standards of operation for long-term care service provider organizations.  As services go, these are the minimum standards.  They have standards for home care, special care, and nursing home care, and the standards are intended to represent service that will be safe for the residents.  The National Accreditation Program, that typically surveys hospitals and nursing homes, goes beyond basic government standards by introducing the concept of best practices.  That is, how are things done in the “best of the best” be it governance, human resources, clinical organization, medication management, food service, training and much more.  In New Brunswick there are 78 nursing homes in the province.  Sixteen homes participate in the national Accreditation program.  That is all the 15 Shannex homes and Loch Lomond.  What about the other 62?
    
    

These issues are really interdependent and it would take many pages to explain what each of them means and how they relate to the ALC issue.  Suffice to say they all are related because the issue will not go away by itself nor will high-sounding phrases or assurances solve it.  As Lamrock said, we need a plan so that a system can be created that will give some assurance of providing a bedrock of superb services that will meet real need, not just someone’s perception of need.  As we found in the reforms of 1992, it is not easy nor is it for the faint of heart.  But the end result will be more than satisfying for those who have the courage and endurance to see it through.

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