​Nursing Homes Without Walls and Other Priorities in Health and Long-Term Care Reform:

The health and long-term care systems in New Brunswick have been left so long without firm vision and direction that Minister Dornan, Minister Miles and Premier Holt have a monumental strategic challenge in order to get the pieces moving in tandem to provide the essential results of reform.

By now, the public is well aware of the need for Primary Care Reform and Reform of Emergency Departments.  The term “unattached patients” or “orphan patients” is an unnecessarily degrading term to describe taxpayers who have simply not been able to get through the long list of thousands of people waiting for a regular slot on the list of one of New Brunswick’s terrific physicians.  And it gets worse when they, or anyone else, has occasion to visit the Emergency Department in one of New Brunswick’s larger hospitals, only to be met with uncomfortable waits of up to 24 hours “to be seen”.

The most recent example that was brought to my attention was a person who actually suffering from a serious cancer requiring prompt diagnosis and treatment.  Under the circumstances described, sitting in an Emergency Department waiting room for seven hours was tragic at best.  I am not in a position of any executive authority nor with any particular influence, but I have heard those stories for far too long. 

In my own case, just in the last year, I experienced serious cardiac symptoms for weeks before eventually giving in to call the ambulance.  I was fearful of the long waits because mine were not the classic acute chest pain symptoms.  I was confident the EMTs would get me to the care required and they did!

This is no time for scapegoating; there is enough blame to go around.  I am suggesting that all those with a stake in these issues lay down the political swords and simply acknowledge that government has a super complex group of issues to deal with in order to make sense of health and long-term care.  And it cannot be done with one piece of legislation or one set of regulations or a press conference.  All of the issues, which are many, are interconnected and related.  You can choose to pick of the one issue that you think will make people happy but in so doing, an equal or larger group will be upset because you missed the other important health and long-term care priorities.

For instance, dealing with the Emergency department, and now Urgent Care, backlogs and wait times require, for sure, major reform of primary care.  Dr. Dornan, our Health Minister, is advocating a Collaborative Care Model as described in the recent book written by Dr. Jane Philpott, an outstanding physician/politician/now Academic leader and government advisor.  Collaborative Care, like other models referenced such as Integrated Primary Care, are aimed at finally getting health professionals working in teams in providing primary health care to a defined cohort of the population.  Vitalite Health Network has been moving that agenda with some vigor for the last two years or more.  They have had a number of physicians within the network who have been pushing for, and actually developing, those models for a few years.  Collaborative Care models enable the physician to concentrate on that which really requires a physician’s attention while a Nurse Practitioner or other members of the team manage many of the situations that do not require that level of intervention.

With the Aging population, this is particularly essential because many of the health issues faced by thousands of patients are a reflection of some form of chronic illness, follow up from surgery or major clinical interventions, and such.  Care protocols and standing orders make primary care much more efficient.

I have seen similar models at work years ago in teaching and rural settings that enable patients to be cared for efficiently and very well.

Long Term Care Reform requires major reform promptly in order to take a lot of pressure off emergency departments.  On any day in recent years, corridors in Emergency Departments have been lined to overflowing with patients who need care.   Horror stories continue to be heard at the coffee shops and church lobbies that are heart-wrenching.  But many of those patients who require care, need to be admitted either to an acute care bed or a short-stay unit, perhaps even in an Acute Care for the Elderly Unit.  But that cannot happen because so many acute care beds are filled with people about whom it is said “waiting for a nursing home”.  The reality is that no more than half of those people require admission to a nursing home while the rest could be accommodated in Special Care Homes or Home Care with comprehensive home care service.

Governments have repeatedly believed that by approving the construction of a few new nursing homes that problem is being fixed.  Not even close!  Nursing homes are wonderful facilities typically with terrific caring staff.  And in the months leading to an election, they attract interest. But in terms of long-term care, they are the most expensive arrow in the quiver.

Complementing the new nursing homes development, government needs to:

1. Fully embrace the Nursing Homes Without Walls concept.  First introduced in New Brunswick by Jodi Hall (then CEO of the Nursing Home Association), and picked up by Dr. Suzanne Dupuis Blanchard of the UdeM faculty, the idea here is for nursing homes to become the local entity to oversee the health and social status of elders, particularly those living alone.  There are thousands of elders doing just that.  For years, the issue of loneliness in that population has been the topic of academic studies and workshops.  The Nursing Home Without Walls would keep a roster of such people living in their area, know their health and social status, ensure they receive the health and support care they need by engaging with other agencies such as Extramural and a variety of home care programs.
   
   

In Norway, this has been accomplished for years with the requirement for each nursing home to have a Seniors Day Program that is a tool for connection with seniors in their area.

1. Take long-term care from the Family Services Act and Merge it with the Nursing Homes Legislation to create one single piece of legislation that regulates home care, special care, nursing homes, and all elements of long-term care.
   
   
2. Based on new legislation, a comprehensive plan for all of long-term care needs to be fast-tracked.  We know what such a plan needs to include; we just need to do it in record time.
   
   
3. Training and regulation of all the disciplines that serve in long-term care must be modernized and harmonized.
   
   
4. Meanwhile, fast-track an organized, systematic re-structuring of all the elements that comprise the issue of Alternate Level of Care Patients.
   
   

Meanwhile, Dr. Dornan has more than a plateful in steering the reforms required for Primary Care and Emergency Departments.  He is a superb physician who understands the issues well.   The reforms required, regardless of legitimacy, will be a great test of leadership and courage.  In resolving complex issues in the past, governments or their agencies have often found it useful to engage support from strong people who can help to “carry the mail”.  That happened preceding some of the reforms of 1992.  Then the DECRH did that in 1991 to resolve some very difficult program issues.

In the January 25.24 issue of Brunswick News publications, in commenting on health reform issues, I  gave a 50/50 chance of seeing meaningful reforms.  I trust this government will enjoy a measure of success with the very daunting issues that require reform.
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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