Dire Circumstances with ALCs:

 Andrew Waugh wrote a most interesting assessment of what he has determined to be the approach of the current government to New Brunswick’s Alternate Level of Care disaster.  As he reported in the August 9 edition of the Brunswick News publications, the direction apparently set by the Premier at the time of the State of the Province Address was to take steps to make sure the situation does not get worse.

Apparently, in that discussion with media, the Premier used the term “dire” to characterize the ALC crisis in New Brunswick.  On this topic, words matter.

According to Google and AI:  dire circumstances refer to a situation that is very serious, dangerous, or critical, often involving hardship, suffering or a potential disaster.

The reality, based on hard fact, is that the situation was at that level over a decade ago and all during those years, the service provider organizations have been trying to get the attention of government, both elected and civil service, with some clear ideas and probable directions that could serve to add relief and start the process of managing eldercare in a coherent, systematic, and compassionate manner.

Over-crowded emergency departments are no new thing.  They had symptoms of overcrowding back in the 1990’s and since that time it has gotten progressively worse.

The senior population, and I am certainly one of them, seem to have become “numbed” and tend to accept that hours of waiting in emergency departments, stretchers in the hallway for both young and old, staff run off their feet……. that’s the way it is.  Any other demographic would be up in arms very publicly demanding direction.  But not so much for my generation.  So much for “grey power”!

The evidence suggests that the situation was left in the “dire” level for so long it is now at the ‘disaster’ level.

Back to Google:  disasters are serious disruptions to the functioning of a community that exceed its capacity to cope using its own resources.
The hospital being the community whose purpose is to render quality, efficient clinical care to patients, has its normal functioning compromised very often and deals with situations that represents serious disruptions that place them in a position of exceeding their ability to cope using their own resources.  Every day!

Words matter.  When serious health and long-term care service providers make observations that sometimes chill the bone, it is wrong to assume that they simply represent some vested interests, that somehow, they are looking to pad their resources.  I know many of the best operators personally, I know what motivates them, what keeps them going and those that I know, I highly respect.  I would feel comfortable in their facilities if that were my need.

 Government does not have infinite resources, but the assumption that taking steps to fix broken systems automatically translates into “mega dollars” from the public purse is a false fear.  That lack of insight has prevented government from developing a coherent plan for 20 years so here we are…stuck!

When you are stuck, you have some options.  Do nothing and sit still.   In doing that, someone else eventually has to get you unstuck.  Not my choice!  But the province has done that for two decades on this file. 
For all those years that service provider organizations have been trying to communicate with government, there has seldom been an apparent willingness to have open discussion of the real issues in long-term care.  I have been part of many of those meetings while trying to help organizations break through the barriers.  Even when Ministers have shown interest, it is often difficult to get a true exchange of information and knowledge on issues of relevance.

A welcome note is the comment of Minister Cindy Miles who said: “all issues are on the table”.  This was in her press scrum in the last few days in responding to the Horizon plea for help.  In the Waugh’s article published on August 20, the Minister mentioned the creation of a new Long-Term Care Plan and, apparently, she has a broader group involved in its creation.  That is a very good start and I know all the participants very well; they are solid.  As Waugh’s article mentioned, Jan Seely has been pioneering the need for reform for well over a decade while a succession of governments has only given lip service.  Hopefully this time it will be different…but I have been fooled before!

All issues on the table would be novel and potentially very helpful!   Dorothy Shepherd, when she had both Health and SD portfolios at different times, tried without the support of senior government, apparently. This could be the first government in two decades to do that!  All issues mean “all issues”.  Not just the issues we want to discuss or the issues that we think should be discussed.   Not just the issues that present no political risk.  But every major issue, including systemic issues, that have been compromising the development and management of senior and long-term care for decades.  The Minister will need courage and the support of the premier to get “all” on the table.

As of June 30, there were well over 700 vacant long-term care beds in New Brunswick.  If the crisis is as it is said to be, and I believe it is, how can that number of beds remain unoccupied?  In 2019 there were over 1000 vacant so there has been just a bit of progress, but not much.

The old excuse that has been used to describe vacant beds, “staffing issues”, is lame and is largely indefensible.

And the prime focus on nursing homes by government and health authorities, as Seely points out, is misguided and flawed. 
 
You see, all means getting “sacred cows” on the table and honestly evaluating what is working, what is not working, what systems and methods serve to hold the system back. The “regionalization of DSD services” was a novel idea during the Graham government time.  It was a bold idea and initiative.

But like any major systemic change as huge as that was, the change needed to be nurtured and cultivated to ensure that it is structured and staffed in a manner that delivers the efficiencies promised.  Has that ever happened?  What would be the evidence? 

Persons who really understand the long-term care system and its regulation and standards could name the “all issues” in a day of informed brain-storming.  It would not be easy but not impossible with the right people with the right backgrounds, experience, and sincerity of goals.  This type of exercise is no place for egos nor is it a time for political temerity.

The issues, once described, will not get resolved in a day nor a week nor a year.  But we have to start where a succession of previous reports has left off.  For the sake of those who will come behind us, we can’t leave this on their plate to fix.  But nine months to two years in hospital waiting for long term care is not a system to be accepted either.

Todd Leader is an inspiration for us all!  He was given the mandate to reform Mental Health Services in a key zone of Nova Scotia.  He is a Professor at St. Mary’s University in Halifax with certification in Clinical Psychology and Social Work.  By insisting on Client-Centred programming, the results are described in his book It’s Not About Us!  Imagine health and long-term care transforming with the patient and the resident as priority!

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