“Is this the one or shall we wait for another…. if I live that long…?” So asked a prominent, articulate senior of 90 years of age who has seen the dark underbelly of New Brunswick’s senior and long-term care system. She is one of thousands who have been waiting to see the system modernized and brought into sync with the current age. The TJ editorial, “The Gospel According to Kelly” seemed to pan the Lamrock Report as did the quotes attributed to the Premier. Both, on the surface, seem insulting to any New Brunswicker who has had experience of managing in the system or attempting to effect change and improvements. Not in the last three decades has there been an effort by government to create any plan for this sector despite many volumes of reports on seniors’ care done. Just three months shy of eighty, I have worked professionally in health care administration for well over 5 decades! Starting at the bedside, where I was taught by great nurses and physicians at VPH, at the age of 19, the fine art of providing care to vulnerable people I completed 7 years of training followed by decades of work experience. Most of my friends say: time to retire, Ken!
When Kelly Lamrock approached me nearly 18 months ago to serve (voluntarily and without compensation) as one of eleven members of an Advisory Committee to collaborate with him and his great staff in conducting a review of Long-Term Care, I could not resist! I have been fooled by such invitations before, but understanding his willingness to listen to real issues, I signed on. Long-Term Care has needed a “deep dive” for decades. You have to be totally tone-deaf and unaware of current events not to know that the system has been in crisis and, if left uncorrected, will be in disaster zone soon. Some new nursing homes have recently opened and another new one is in planning for Oromocto that will be a couple of years away. But long-term care is so much more than nursing homes, as has been outlined in these columns in recent months. The huge number of seniors without access to effective primary care, the growing number of persons with Dementia, the huge number of hospital beds occupied inappropriately by persons requiring long-term care, the spill-over impact on the volume of frail seniors frequently backed up in emergency rooms….and the long-term care beds that remain vacant despite full awareness for well over 5 years. Unlike some other provinces, New Brunswick has never created a vision and plan for long-term care. The province has, under the regulatory structure of the Department of Social Development, a collection of long-term care services (home care, special care/adult residential facilities, and nursing homes that, together, provide care for upwards of 15,000 vulnerable people. That is in addition to all those on various waiting lists for admission, those who will soon go on a waiting list, and those desperate people occupying hospital beds who should not be there. With the trending in the population profile in New Brunswick, we are headed from crisis to disaster in a few short years. New Brunswick has not peaked yet so we need to get it fixed now. Lamrock’s report is wordy, large, and contains way more recommendations that one could implement in a year or two. It was not intended as a quick fix but to identify how the province got so broken so that the brokenness can be fixed. In my world of executive leadership, our mantra always was: “if you cannot name it, you cannot fix it.” There has been a complete avoidance of vision for the system and plan to drive toward that vision. Consequently, as the report outlines, various governmental authorities gather in “silos” for which the NB public service is notorious. Knowing that some will defensively deny the “silos”, let me confirm that in my health leadership experience and consulting in this province there is not a day that goes by that evidence of silos is not alive and well. Practically speaking, that simply means that the service for which the public is paying and should be expecting is seriously compromised. Of the hundreds of submissions to the Advocate’s office, many of them outlined “elephants in the room” or major issues that have compromised service for years and never get identified or fixed. The 78 recommendations distributed amongst the seven themes all have their roots in major issues that need attention, some now and some after much more review. The report is wordy because the Advocate wanted to capture the reality of what vulnerable adults experience in the absence of great long-term care commencing with the banana story with which many resonate. Trivial you say? Not so because it is the canary in the coal mine or a symptom of much larger core issues. In the absence of any provincial plan, as I experienced in another province in which I worked, we should not be surprised that the Departmental staff, typically really great people, operate in an atmosphere of ambiguity if not, sometimes, confusion. This is the point at which his first report, directed to the role of Executive Council, takes on prominence. Left without strong vision and direction, government departments and divisions are left with living within their budgets and following regulations. From my consulting experience in long-term care, I can recite cases that were absolutely tragic in results in which blind adherence to regulations took priority over using wise and informed judgement. During my tenure at York Manor, now York Care Centre, I had the pleasure of seeing what can be done with vision and a team committed to that vision. That experience, along with others in CEO positions elsewhere, confirmed that strong, positive leadership and vision in this greater area of Long-Term Care is not only essential but can be incredibly satisfying as families find caring, well-trained people to whom they entrust their loved ones. The great people who work in nursing homes, special care, and home care have been pleading for vision and direction for many years. That is why Dr. Suzanne Dupuis Blanchard and I accepted the roles of Co-Chairs of the Aging Council in 2016. But governments, in their wisdom, failed to establish a structured process of follow up to its recommendations, choosing a route that has not met the intent of the council for future direction. Former Social Development Minister Dorothy Shephard said it well in the legislature: “you cannot fix health care until you fix long-term care.” Absolutely right! Taking the steps that will rescue the system and provide serious alternatives to hospitalizing frail elders, government cannot do that alone. As good as they are, they just do not have the experience and training in the care sector that is required. To be fair, those in the care sector don’t typically understand government either. But what if you created a process that brought thought leaders from both sides together around the same table with the same evidence and facts. What if they came to communicate, collaborate, and find workable solutions rather than to negotiate. That could turn the tide in New Brunswick and set up an entirely new level of trust and collaboration between the public service and those sectors that actually deliver essential care services. 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
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AuthorKen McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada. Archives
May 2023
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