​Long-Term Care is beyond Crisis in New Brunswick: it is catastrophic and a risk to the Health of New Brunswickers

Hats off to the Holt government for initiating more collaborative clinics and getting the approach to licensure of foreign-trained physicians producing tangible results.  They are apparently acting with some swiftness to commence reforms that have been needed for decades.  Health Minister Dr. Dornan seems to be off to a good start. 

Finance Minister Rene Legace sent the first signal from government that I have heard since 1992:  he used the language of reform in referring to the health portion of the budget.  Previous governments have avoided using the language of reform.

The discouragement that tens of thousands of New Brunswickers have experienced for the last two decades has been deep seated and justified.

The feelings of discouragement have been equally palpable when persons in need of emergency care describe their challenges with the full waiting rooms and corridors filled with sick people.  One of the root issues there has been the hundreds of beds occupied by persons awaiting proper long term care placement.  These have all had volumes written about them in these newspapers.
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Over 40 years ago, in the late 1970’s and the 1980’s, health economists and public health leaders made a simple and profound observation:  if you think things are tough in health care now, just wait until the Baby Boomer generation hits the system.  The system has had 4 decades to prepare for the level of distress that was forecast at that time. 

In those days, health officials were beginning to “get spooked” about the rapid development of clinical services totally unheard of when the Canada Health Act was adopted. Hospitals now were showing all the characteristics of advanced science and technology, now experiencing the early results of what is now well established as a revolution of technology in health care. 

High-risk pregnancies, Neonatal Intensive Care, In Vitro surgery, complex neurosurgery, cardiac transplants and reconstruction, lung transplants, joint replacement and re-construction, many, many invasive procedures along with laparoscopic surgery, and revolution in cancer diagnosis and treatment.

And there has been so much more.  When I started my career, many of those things were in their infancy; suddenly, they were becoming state-of-the-art care.  And Ministers of Finance were having a rough time.  Just try to balance a health and long-term care budget in that environment!  Costs have been escalating at 2-4 times the rate of inflation and it has become fashionable to find people to blame when governments really wanted and needed balanced budgets.  I remember it all vividly because I have invested 5 decades on the blunt end of those pressures.

Academics and researchers, along with some informed economists and public policy authorities, were pointing to the need for government and health related groups to engage in some pretty serious soul-searching and planning for the future.   They were raising the serious question of the inability to manage the growth in demand for services that were already available let alone the highly-expensive new technologies.

And they were right, but in so many areas their warnings have not been taken so seriously as to reform public policy.  And therein is the crucial issue.  Public policy just has not kept pace with social and health care trends and developments.  The development of these technologies has never been a secret!  Researchers in every medical school and health sciences complex across the world have proudly displayed the miracles that have been happening.

One of the points that health economists made in those days was that of the total expenditures by government for health and long-term care, a large proportion is expended in the last 3 years of life!  So as the population profile changes with a larger proportion of seniors, by definition the cost of health and long-term care will increase exponentially.  That has been happening and will continue to happen regardless of any government’s preferences.

While waiting for a coherent public to emerge, hospital services and expensive technologies and Long-term care have been developed in New Brunswick in a rather helter-skelter manner.  The dream and intent of the Reforms introduced in health in 1992 was that difficult and controversial process was to be the beginning of developing and maintaining health and long-term care based on sound planning.  At the time, the leaders made the point that New Brunswick does not have the resources or population base to afford competition and duplication of scarce resources and skills; rather, the wisdom of the day was that the NB systems would be developed with a provincial strategy and policies that would govern the orderly development of services and the structures that govern them over time.

Public Policy is so critical.  In my earliest days of training over 50 years ago, professors with expertise in organizational development drilled into the young students of health administration the importance of strong policy, accountability and structure to enable organizations to achieve the goals that society expects.

Health and Long-Term Care constitute the single most complex element of public policy on the governmental agenda, so say the researchers and major authors in management structure.

Health and Long-Term Care have been dominated for decades with issues of human resources, clinical education and training, collective bargaining, organizational culture, organization of services.  Medicine and nursing have both undergone major metamorphosis that influences the numbers of professionals required along with the skill levels and regulatory issues.

These and hundreds of other issues are highly politically charged yet really complex at the core.  Sound-bite responses to crises and issues are not helpful; indeed, they can be very damaging if not misleading.

We live in a system in which we have elections at least every 4 years and that cycle always brings as many interpretations of issues and solutions and we have political candidates.  My experience, having invested my life in the sector, is that much of what consumes “air time” is often not much related to real issues.

Kelly Lamrock has done us all a favor by publishing What We All Want which is the assessment of the Long-Term Care System and what can and should be done to repair it.  That report represents, in my professional opinion, the classic illustration of essential long-term care services being developed, or not, based on little to no public policy and direction.  In his press conference when he introduced the report, he made the point that as the Minister of Social Development, he was not made aware of the depth of the seriousness of the issues in long-term care.  And so it is in the system that governs essential services.

Minister Dorothy Shephard made a profound point in presenting her last budget to the legislature: “you cannot reform health care without first reforming long-term care.”  The profound observation is based on the fact that health care is a continuum that starts with Primary Care and goes through Emergency, Acute, Rehab, then to Long-Term Care.  They are co-dependent parts of a whole.

Public Policy 101!
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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