​Gridlock in Long Term Care: the system is designed for mediocrity

Since 1966 I have worked in hospitals or nursing homes, most of those years in some key leadership roles, with a few years in civil service as well.  After 48 years of full time working, I “retired” only to get caught in a series of consulting assignments that largely related to senior and long-term care.  And now, at age 79, I am honored to still be working with some superb people, all of whom are trying to make the health and long-term care system more consumer-friendly, operate more effectively.

In 2016, Dr. Suzanne Dupuis-Blanchard, a noted nurse-researcher at University of Moncton and national influencer, and I were asked to co-chair the New Brunswick Council on Aging.  We both accepted but only after being assured by Social Development Minister Cathy Rogers that government truly wanted to implement the changes that would make a serious improvement in the senior and long-term care system.

The Council heard from many groups and individuals and had consultants and Social Development staff supporting its work.  After nearly a year of deliberations, the report (An Aging Strategy for New Brunswick) was presented to the Ministers of Health and Social Development in January 2017.  The report was widely and enthusiastically welcomed by many service providers organizations and advocacy groups, and it did include recommendations which, if taken seriously, could have formed the basis of much change that would have minimized many of the major problems that now cripple the health authorities.

Government archives and shelves are filled with reports going back 30 years or more.  Each made recommendations that would have, if taken seriously, mitigated most of what attracts public anger now:  waiting times, access to care, human resources issues.  But here we are, 2024, and the issues that have been covered in the media for years, and strenuously in the last 3-5 years, are still with us!

If we are so smart and well educated, why the foot-dragging?  Why have the numbers of frail seniors occupying hospital capacity in acute beds and emergency departments gotten to the crisis level that it is reported to be?  Why the crises in Primary and Long-Term Care?

It is not as if these are new problems; both have been going from simmer to boil to crisis.  Indeed, during those years many outstanding people from Scandinavia, the Netherlands, the United States and other parts of Canada have been in New Brunswick explaining innovations in both areas that are making a difference in their jurisdiction.  In long term care, it was over 15 years ago that New Brunswick heard from the University of Bergen in Norway and the Dementia Village in the Netherlands, for instance.  It was 2009 that New Brunswick was introduced to working models in Manitoba that were having a serious impact on the care of persons with Dementia leading to virtual elimination of the crisis experience that so often leads to hospitalization.

Long Term Care is largely an extension of the health system, required when the physical and/or mental condition of a person gets to the point at which living independently is no longer possible without serious assistance.  In all provinces except in New Brunswick, Health and Long-Term Care are part of one governmental department that regulates both areas.  It used to be that way in New Brunswick when a single Department of Health and Community Services administered and regulated not only the conventional health functions but the entire social services portfolio that included what we now know as Long-Term Care.

Under the Bernard Lord government, the decision was made to split Health and Community Services by creating a new Department of Social Development.  I will not speculate as to the rationale and it may be the case that together the combined department represented a huge concentration of power and resource within government.  It probably made some sense to separate some of the purely welfare functions but separating what honestly is a health care function (home care, special care, nursing home care) created silos that have served as the classic illustration of how related functions of government do not collaborate.
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Make no mistake; the people who populate both departments are fine people and serve the province to the best of their ability.  I have had the pleasure to become acquainted with many over the years, including now, and find very few who do not come to work every day with the intent of doing great work for the province.  This is a large department with some 1300 people employed at some level in a variety of offices around the province anchored by a central provincial office in Fredericton.

The old adage of “form following function” applies so well.  Health care services include a broad array of programs from pre-cradle to grave.  The health and well being of individuals follows a natural pattern that ties to the aging process.  Long-term care is every bit a health service as is emergency service and acute abdominal surgery.  It just so happens that at various junctures in the aging process, the health service needs of people change; in the aging care field, the reliance on social supports, rehabilitation and mobilization services take a priority that is higher than acute, skilled surgical care.

Following “retirement” from York Care Centre in 2012, I commenced offering my knowledge and experience to a variety of organizations engaged in the long-term care sector; that consulting experience has been a joy and eye-opener in ever so many ways, the major reward being the satisfaction in helping solve problems.

In 2016, when asked to Co-Chair the Aging Council, I invested the best part of a year (paid $1200!) because I was passionate about seeing the Long-Term Care System grow and develop to a standard-bearing level, a model for the country.  We had done that at York Care Centre as Loch Lomond and a few others had also done.

Now looking back on what could have been the basis of an exciting new plan for the province, the human in me says “why did I waste my time?” because while some wonderful nursing homes have been opened, the system itself remains balkanized.  So, I scratch my head and put on my large organizational cap, applying the principles of Good-To-Great, the Jim Collins Classic.

Since the Aging Council Report was published there have been:  two Premiers, 7 Ministers of Social Development, two elections and another pending, 3 Deputy Ministers, 4 turnovers of Assistant Deputy Ministers, 4 turnovers of the long-term care administrative section management.  No organization has ever achieved service excellence with that level of instability at the top.

In my consulting work, I get to know them all and each one is a great individual, loyal, dedicated to making a difference.  But somehow in the civil service system it seems like musical chairs and I feel sorry for staff and Ministers who go to their portfolios anxious to make a difference.  But health and long-term care are as complex as the military establishment and does not turn on a dime.

So elected officials default to responding to public crises and emergency situations whereas the real need is to dig deep and respond to the question:  What needs to change in order for NB to get its health and long-term care system functioning efficiently and effectively?  And to that there is no sound-byte answer.  “Why” has to be asked a dozen times until the truth appears.
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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