One of the huge problems in health and long-term care services is that typically decisions get made regarding services, the organization of services, the timing of services, who delivers the service by persons occupying positions of authority. Decisions at a high regulatory level are made by government officials who may or may not, usually not, have had training and experience in the area of concern by the regulation. This phenomenon is not uncommon in governmental regulatory agencies.
At a clinical or direct service level, decisions get made by staff who are engaged, as is the case in nursing homes, to provide direction for administration, care, activity and such. Decisions are influenced by government regulations, national and provincial best-practices, and collaboration between service providers including physicians. Often equipment suppliers play a role as they introduce the best of technology at “trade shows” and communicate new technology to service providers.
Important in the policy and regulation development, therefore, has been the influence of government regulations and research findings that come from the academic world. Most of these sources provide good and timely information but never in my career have I seen a book like Wading Into Life’s Changing Tides. Written by a bright, alert, intelligent former teacher and author of other books, Mary Ryan’s experience has been remarkable and worth reading for in it she tells of the transition from a perspective that we, in long term care, can only describe intellectually. It is one thing to have a physician, nurse or social worker describe the transition and what it entails, but, oh, quite a different story when told by the patient experiencing it.
Think of it: one day you are going through life as the bubbly, vibrant active intellect that Mary Ryan has been. Just chatting with her for a while and seeing the books she has written gives a good introduction to a very special person. As I read it, I was taken with the things that I probably did not consider when I was active in the system. She describes the shock to her system in learning to adapt to fairly sudden immobility along with other health issues.
She describes in much detail how important are the observations made by staff along with the shift-to-shift communication and transfer of information. Excellent performance by staff is recognized by residents to a level that many may not even consider. With residents who are suddenly reliant on others, often the little things make such a difference up to and including smiles, attitudes, voice tones, being aware of details of care.
A favorite topic of mine in these columns has been the management of a positive workplace culture and Mary makes so many points in her writing that all relate to the quality of the workplace. Changing and maintaining a great workplace culture is not a topic taught in professional schools or even traditionally in Business Administration programs. But it is a key critical success factor for quality service and residents and families can tell the difference!
In the current context of the health and long-term care crises in New Brunswick, the Health Authorities have prioritized Emergency Departments and Long-Term Care as two major issues that are largely responsible for the huge back-logs and overcrowding in emergency departments and the growing numbers of acute care beds occupied by frail elderly patients. These matters are beyond crisis and have been growing in importance for two decades as governments have kicked the can but never offering real solutions.
Mary’s book puts a human face on what is, to policy and decision-makers, yet another issue on the long list of problems to which policy makers are required to respond. There are over 500 human beings like Mary Ryan who are occupying hospital beds, along with many more at home, all needing quality, structured, professional long-term care. Just imagine for a moment being a human being, reliant on others for your care, feeding and safety, and spending two months to well over a year in a hospital room, probably with at least one other roommate that you did not choose! I worked in hospitals all my life but my experience as an elder patient for just a day was unsettling to say the least.
My graduate school thesis at University of Toronto in 1969 topic was what we now call ALCs or patients occupying hospital beds who really need some level of long-term care! That is fifty-five years ago! In the discussions that have extended to embarrassing levels and lengths, the policy-makers have held endless meetings for as long as I can remember in New Brunswick, most conversations ending with a yawn masking a low level of understanding of urgency. How often have I heard from retired or retiring regulators, service providers and policy makers this refrain as they often are now dealing with either a spouse or parent requiring some level of long-term care: “I never knew it was like this! Holy smokes it is difficult and time consuming.”
We can and must do better; if we think the system is in crisis now, just wait a few short years! If essential course correction is not done in the long-term care system, it will be a pretty bleak picture. The key message of Mary’s book is the issue of listening to the people which the good folks at Shannex seem to be doing so well. The journey from healthy, independent living to the arrival at nursing home is the key for health professionals, care delivery personnel, regulators and policy makers. The journey does not need to be as it is. We are smart people in New Brunswick; we have well trained service providers at all levels. It is obvious, based on all available evidence, that keeping frail elders in hospital waiting for appropriate levels of care is not only expensive but brutally inhuman. Hospitals do their best under great duress.
Government has owned these issues since 1969. In New Brunswick in the 1990’s we began to see challenges with ALCs. Since then, with all the tinkering and changes either enacted or imposed by government, the access to necessary required services has deteriorated.
Thankfully the Vitalite Health Network is doing some creative things with primary care by listening to people on the ground. Now is the time for a total provincial commitment that is ever so much more than words, promises, apps and photo 0ps. I’ve said it dozens of times: the right people with the right background and values with the right motivation and a willingness to lead effective change in the same room with a clear mandate; politicians, with respect, need to exit stage left. There have been stellar examples of such change management across the country.
Listening to the people is not synonymous with the typical public consultation for which government departments are quite famous. Members of the public often view these consultations legitimately with skepticism expressed as: seen one, seen them all! Getting the right focus means sitting for quality time with articulate people like Mary Ryan and many others and asking the right questions.
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@example.com or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.