Horizon again: are we surprised?

Two weeks ago, they hit the 666 for ALCs.  Andrew Waugh’s article on July 31, 2025 should be sobering for anyone who has had those dreadfully long waits in the Emergency Departments of hospitals.  What does that have to do with old folks and alternate level of care, you ask?  Everything.

Running an efficient emergency department requires superb staff with lots of skill and training, good modern equipment, access to great diagnostic and therapeutic supports, and space that is properly laid out and equipped to function efficiently.  Our emergency departments have all that.  But they remain in a state of chaos during many hours of the day and week.

Chaos can be managed by these talented people when they are administering life-sustaining care to those whose conditions are medically life-threatening.  But when the department is overflowing with those whose conditions are concerning but not emergency, that is a different story.

Based on their training, staff know and are committed to giving care priority to people with acute chest pain, acute abdominal distress, stroke symptoms, premature labor, fractures and multiple trauma.  Having that compromised with frail elders who have problems but not at that level introduces a serious challenge to otherwise great care and public service.

The stories of wait times often for many hours to get the attention that patients or families believe to be essential are well beyond any justification.  It meets no reasonable standard of excellence.

I actually had that problem personally.  Last year after not feeling well for 3-4 weeks, I delayed going to Emergency because I was not experiencing the level of pain I had been told to expect for suspected heart issues.  I did not want to wait for hours to be assessed; I was just feeling lousy!  Finally, on a Monday morning in early July I could stand it no longer and called 911; I believed correctly that EMTs would ensure that I got to where they deemed I should be.  They were marvellous and they were right….it was a serious heart attack that soon resulted in major surgery at the Heart Centre.

In talking with many people with different health issues, there is often a reluctance to go to Emergency for the same reason.

The chaos and long waits stem from the fact that acute care beds and many stretchers in the emergency department are occupied by persons in which physicians have determined that they need to be in a care facility for their safety and well being.  The immediate crisis is over but symptoms prevail that can include a wide range of things that can compromise mobility, safety, or even survival.  But they don’t need to be in the emergency department, nor should they be.  Nor should they be in an acute care bed!

The Nursing Home Plan 2018-2023 was published and called for 600 nursing home beds to be completed and opened along with 407 memory care beds.  Most of those beds have been opened with 60 to be opened in December 2025 in Oromocto.

But the plan was not a long-term-care plan in the least.  It was a plan with specific reference to nursing homes and memory care.  The reference to Alternate Level of Care patients in hospitals was referenced and the plan describes the numbers (not specified) as unsustainable.

In reading the plan as released to the public, I could see no evidence of a detailed analysis of the ALC population.  Further, I could see no evidence of discussion of what policies and strategies need to be in place to deal with the ever-growing ALC population except for a line about healthy aging and shifting away from nursing home care to healthy aging and in-home care.  This has been a dream of some for many years, the problem is that notwithstanding the best efforts of policy-makers any emphasis on healthy aging has thus far had no impact on the numbers of persons requiring long-term care.

In my review I could not see evidence of careful study of the wealth of information housed in Health Council files and reports.  Examination of that material along with analysis of all of the current programs that provide long term  care should have brought the authors to the understanding that all those people living at home at risk do not need nursing homes.  Some will respond to efficient home care, the majority do very well in special care homes which should leave nursing homes for those who genuinely need 24/7 access to nursing supervision and care.

To their credit, The Social Development Department has done well in getting those memory care facilities operating.  Those that are licensed to provide care at that level do a magnificent job.  There are just not enough and the process has been painfully slow.

Other success stories have been the development of the Nursing Homes Without Walls and the relationship with Extramural that added much clinical strength to Special Care Homes.  These are wonderful programs, along the initiatives taken by Dorothy Shepherd and now by Dr. John Dornan to modernize primary care.  Wonderful programs that will have large impacts in the future for care.  But it will be years before there is measurable impact on the potential ALC population.

But there is so much more to do and soon.  The Emergency Departments will continue to function with what some have described as shocking overcrowding, some have said “third world”, until the issues preventing the efficient flow of patients in hospital are resolved.  The good news is that most of the issues requiring urgent attention do not require a huge increase in government debt or immediate strain on the budget.  Long-term care facility development does not require capital spending from government by virtue of how long-term care is financed.

The public and policy makers need to feel and see a sense of urgency.  Have we and they become numb to the impact?  Have we allowed the huge public issues of the day to get Senior Health and Long-Term Care to drift to agenda item 25!  Tariffs, economic distress, inflation, social and political crises, education crises, crime, homelessness, drug abuse….and the list goes on.  It becomes important to people when they have a loved one that needs emergency care at some level.

Many of the people I have heard from (former politicians, civil servants, physicians and nurses) remark that: “Ken, I had no idea!”  Then I often refer them to reports and presentations that have been predicting this level of crisis for well over 20 years.

Government just has to get beyond the old thinking that they can fix it.  They cannot fix it anymore than they can fix the educational system.  They need new approaches, new blood, new thinking.  A proposal was recently floated for the government to engage a Royal Commission to give plans for overhauling the education system.  I am at that point in my own thinking with Long-Term Care.  There have been far too many studies, reports, and plans over the last 20 years. 

We know what has to be done and we have seen over 20 years that government alone cannot get it done.
General George Patton, of World War 2 fame, said “better to drop a pint of sweat than a gallon of blood.”  We need the sweat to be invested in a strategy that works for Long-Term Care and Emergency Care.
 
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