John Chilibeck, in his article in Brunswick News on December 1, explained the Fraser Institute Report on New Brunswick’s budget surplus. In that report, the author said that the cost of senior health care will take the New Brunswick government from surplus to significant deficit. As a senior I did not get upset at the author! Writers are intended to report and explain facts. He did so with quality.
Who is the villain here? What is there about being a senior that causes health care costs to be incurred at 5 times that of persons 20 years of age? Am I, at 77 years of age, now a villain? Should I and my fellow seniors be demonized? Not at all. Here’s why.
When the national health system was established in 1959 in Canada, health care services were pretty basic and rudimentary. Up until that time, most of my parent’s friends and relatives scarcely ever were in hospital and, if they were, it was for something emergent and threatening to life or limb. Surgery normally, except in teaching centres, tended to be low volume and limited to procedures that did not require replacement of body parts, implants, joints, lenses, transplanted organs, or reproductive organ reconstruction.
Most of their routine care was in the family doctor’s office in which the doctor knew everything about you and worked with you with a fairly limited range of medications and other therapies.
Within ten years of the introduction of “Medicare”, provincial finance ministers were beginning to panic as was the federal government. The foundational 50/50 cost sharing was starting to be distressed as patients came out of the woodwork to receive their “free care”. One surgeon told me, many years ago, of the rush to get old hernias repaired! Up to that point, men would wear hardware to mitigate the effects of the hernia; now it could be fixed in an hour without cost to the patient!
In the years from then to now, there has been a revolution in health and long-term care with rapid increases in transplantation surgery, reproductive care technology, many variations on cancer treatment unheard of in 1959. Joint replacement surgery, reconstructive surgery, plastic surgery, burn treatment, open heart surgery, various forms of transplantation surgery.
I recall hearing distinguished speakers at national conferences in the 1970’s who would show projections of the impact of the changing population demographics on health budgets. Even in those days, the probable impact of joint replacement surgery was causing concern to economists and planners. That was the time for governments to commence serious planning of how health and long-term care should be adjusted, if not re-shaped, to enable public policy to deal with the aging population. But no, a series of governments, in their need to placate and get re-elected, have dropped the ball. In New Brunswick, a progressive government in 1992, supported by stellar civil servants’ with expertise on this file, commenced a reform strategy that by now would have seen serious system adaptations made to accommodate the aging population and its health needs. But the ball was dropped not by one but by several governments.
What balls have been dropped relative to the impact of aging on health?
Primary Care screams to the top! If you are young with a sports injury or even with diabetes, a visit with your family doctor is not a big deal; in and out in 10 minutes. But if you are in my age group, according to the Health Council you will have at least three co-morbid conditions, sometimes referred to as “underlying conditions”. For the seniors accessing the system who have those conditions, a 10-minute visit with a busy practitioner, particularly if the sign in the office says you are “limited to discuss two things”, is out of the question. Most that I have encountered who fit the health council criteria not only have the three conditions but need time to be heard, time for examination, time for exploration of diagnostic and therapeutic options. In more serious cases, this would be “case management”. In other words, seniors with multiple health conditions need a form of routine primary care that is different from the conventional family practice. Clinics such as PRIME in Winnipeg and Linda Lee throughout Ontario show that patients managed in non-traditional forms of primary care tend to avoid the crises that otherwise would see them in the local Emergency Department then admitted to hospital.
Competing for top billing would be long term care. Most seniors are healthy; we are not all frail and in need of constant care. But for those who do, the approach to organization of care in New Brunswick gets a low rating. Why is that? For many, many years academics and practitioners have made the point that most people do not want to live in an institution and would prefer to live at home. But as one or more of those chronic conditions gets worse, they need support not normally available in a home. This may take the form of periodic visits from Extramural personnel, homemaker service, meals on wheels, remote cardiac monitoring.
That which is purely health care works like a charm through Extramural; home support, on the other hand, is not such a pretty picture. While everyone else in the health and long-term care system are compensated at respectable levels negotiated by their unions, home care workers and special care home workers are funded by government at just a bit over minimum wage. For good, highly-motivated people who love working with seniors, the compensation model has been atrocious and the representative associations have been trying to get improvements for years. Yet they struggle to recruit and retain good and reliable people to serve our frail elders.
With a convoluted process to enable seniors to access long term care, a series of “system navigators” are springing up across the province. Rather than fix what is broken in the systems, the neglect has left the door open for this group of skilled and knowledgeable people to earn a living showing families and doctors offices what should be simple and straightforward.
It has been said for years that the huge increase in the numbers of persons occupying hospital beds while awaiting long term care can be fixed…………and it can but only with focus, leadership, and transitional funding. This was to have been fixed in part two of health care reform but governments after McKenna failed to follow through with a plan. So here we are in 2021 and we have seen, now, the introduction of the beginnings of a plan for health and long-term care. But the current dysfunction is so deeply-rooted that it will take energy, commitment, and seed money to repair systems.
So, the Fraser Institute is right! I would not wear too proudly the badge of budget surplus because it comes with a huge cost, the cost being borne by those who stop me in the barber shop, supermarket, church parking lot, and call at home who are struggling to get the care they need and deserve. It is not rocket science. Just political will.
Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News and author of Health Care Reform in New Brunswick. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.