​Long-Term Care Alliance: solution or just another voice for more money?

Long-term care is in a larger crisis than most would acknowledge.  When you are trying to help elders in getting the level of care they need, then you see it up close and personal; or if you are assisting a patient of any age in getting emergency care, you see the reality up close.  Many of the serious pressure points in the health system can be traced back to the log-jam created by the thousands of seniors who get into health crisis then end up in acute care beds or, worse still, on stretchers in corridors for days, weeks and months in hospitals.

As these columns have outlined many times in the last 5 years, dealing with the issues that need to be fixed in order to create the system that our society needs and deserves is not a simple task.  If the understanding of policy decision-makers is not complete, as it often is not, much energy and investment can be directed unintentionally to the wrong places with little or no impact.

An acute and detailed understanding of the system is absolutely required at the tables in which planning and strategy takes place.  Public servants, great and dedicated as they are, will not come to the table fully equipped unless they have had training and experience in administering services and programs inside the system.  Managing a government division or a section or, even, an entire department, does not afford the level of practical knowledge that is essential to getting systems fixed.

To wit, in 1992 when McKenna authorized the regionalization of hospitals, his advice was coming from people with impeccable backgrounds in medicine, nursing, health administration, public policy, and health strategies.  Not just one such person but a team of people with decades of hands-on experience.

The associations representing nursing homes, special care homes, and home care have in their membership some persons with advanced training, leadership skill, and the hands-on experience of leading and direction people and systems.  They understand labor relations and human resource management, fiscal management, excellence and governance at a level that you can learn only if you have been there.

The “ask” in this case is not simply for more money nor is it grand-standing nor politically motivated in any way.  These associations, and I have been personally involved with each of them over many years, want the same thing that the public wants…. systems organized in such a way that we can say truly that we have an integrated system that enables persons to access services and move from one level to another as their health condition changes.  That is what the aging process requires; none of the people that I know suddenly wake up one day and decide to go to a nursing home!

In the aging process, changes are often subtle, gradual, until there is a more serious stage that requires more intense care and supervision.  If there are roadblocks between levels of care and service, and they are truly legendary in New Brunswick, those roadblocks can be removed and must be removed…. now!
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Since those roadblocks have been in existence and understood by many for decades, how do they get removed.  Certainly not by sitting in committees and kicking the can down the road.  Change of the magnitude required is very difficult, requiring legislative change, regulatory change, and people change and re-assignment.  That is what happened in 1992!  Was it tough?  You bet.  Do some of the veterans still bear scars?  Yessir.  Were those changes good and long-overdue?  Absolutely.

It is true that most small, community hospitals have either changed radically or have been replaced by clinics or merged with others to create one larger facility.  The truth was then that small community hospitals across the continent were closing due to the dramatic changes happening in professional training, standards, economics, demographics, and more. 

So it is with long-term care, which is a huge element in the health and social system.  Sectors and parts of the system, be they in the regulatory structure or in the service delivery structure, need to be organized and administered so that services are smooth, easy to access, efficient transitioning from one level to another.  This is what has been described for decades by researchers and leading academics as the essential direction for health and long-term care.

Is that what has been the case in New Brunswick?  Not even close.  It is time to face the realities that have been referenced in so many reports in the province that it is embarrassing.  Deferring decisions and “kicking the can” has been so frequent with a succession of governments that we now have this dreadfully inefficient system that takes such a toll on thousands of seniors.  How long do we need to wait for sound strategic direction the likes of which we saw initially in health in 1992?

But the government and its wonderful cadre of public servants cannot do what needs to be done.  They can amend legislation, change regulations, re-structure the regulatory structure and even promise to build new facilities.  But the action required is urgent and the time line for effective change could be cut by two-thirds if government could seriously undertake engagement and collaboration with the service delivery sector.  To work well, government must realize and admit that they represent half the package; the other half is the service delivery sector.  Only with a new means of effecting collaboration and engagement will anything serious take place in real time.

The creation of a stand-alone Department of Seniors and Long-Term Care would make a great deal of sense.  With long-term care embedded in the otherwise huge department of Social Development, the issues that contribute to the tragic ALC crisis have never had the focus that they need.  It is not a matter of willingness but rather a matter of this function losing its place in priority for executive and ministerial time when issues of welfare, income assistance, child and adult protection, mental health require such prominence on the agenda of the leadership.  So, the important issues of importance not only to seniors but to the efficiency of the health system get buried amongst all other issues that compete for ministerial and public attention.

These three associations have people with great training and decades of experience.  Individually these great people may not have an in-depth knowledge of how the regulatory and legislative systems work, anymore than the civil service staff would understand the details of operation of care delivery.  Both sectors play absolutely critical roles in making the systems function and to function with optimum effectiveness, the regulatory people need to recognize the value of true collaboration and engagement.  And those relationships run both ways.

Once good people come to the understanding that they need each other, that neither group knows, by themselves, what they really need to know in order to achieve excellence, then the system can take off like a rocket!

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