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Minister Cindy Miles approved the implementation of the priority for admission to long-term care for hospitalized patients as recommended by a desperate CEO, Margaret Melanson, last week. In her approval, she mentioned that government would like to ensure that level of crisis does not recur.
Newsflash! It will and it has! This is the second time in two years that this measure has been invoked. As Andrew Waugh reported, in late 2023 it was invoked by the Tory government and now, less than two years later, by the Liberal government. I was consulting with the long-term care sector at that time in 2023. As the Premier has correctly referenced, the Alternate Level of Care (ALC) issue is not new. Its origins extend back half a century! In 1959 the seeds were originally planted as the Hospital Services and Diagnostic Services Act provisions were rolled out across the country. That was the beginning of Canada’s “free hospital care system”, as it has been known on the street. In some quarters, people seem to think this crisis “just happened”! It has been growing under the noses of policy-makers and regulators. It all started innocently and I recall, in the 1990’s, the debates in the DECRH about the need to levy a charge for hospital days involved when ALC patients occupied acute care beds. The actual policy and governmental regulation were that admission to an acute care bed was restricted to those patients in which it was “medically necessary” for them to be there. Actually, all acute care hospital services were subject to that specification: medically necessary. More precisely, everything done by way of admission, diagnostic tests and therapies, special nutrition, special medications, surgical procedures were governed by that those two words: medical necessity. The onus was on the physician, since they have been and still are, the guardians of the admission/discharge decision, to be able to justify everything based on their professional judgement of “medical necessity”.
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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? |
AuthorKen McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada. Archives
October 2025
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