Pandemic politics and long-term care

I haven’t been posting during the height of the COVID-19 pandemic because we needed to have a single focus to deal with the virus and rebuild the economy. Now that we are crawling back to health I shall be more active.

During the pandemic closures, one of my real-world friends and colleagues posted on Facebook, “I’ve been thinking furiously of late about the life cycle and how and where we live toward the end of our lives. My generation (approaching 70) will do everything we can NOT to end up in a seniors’ residence, where, as we have learned with this crisis, conditions are often horrific and (this is the most heartbreaking part) many people are dying alone and uncared-for.

“My generation, the boomers, is large in numbers and outspoken. Things must change. I hope fervently that this crisis will provide the impetus, but how tragic that this is what it takes to make society consider how we treat our elders.”

Her post was one of many about the situation in long-term care facilities across Canada. I can’t count the number of people who posted on social media: ‘this is terrible, someone should do something’.

It is terrible. But to those who have paid attention or experienced it prior to this pandemic have long known the problems and issues. It’s part of why I launched this blog.

And now the Canadian Institute for Health Information has used COVID-19 statistics to confirm the poor situation in Canadian long-term care. In Canada 81 percent of COVID deaths were in long-term care facilities, while world-wide the average is 42 percent! In Nova Scotia 97 percent of all COVID deaths were in long-term care! We beat Alberta, Ontario and Quebec, where 70 percent of deaths were in care.

In Nova Scotia, the Advocates for the Care of the Elderly (ACE) have been lobbying for better facilities, more staff and improved care for over 14 years. Conservatives, New Democratic and Liberal governments have heard ACE’s complaints, concerts, predictions and recommendations, and have allowed the problems to continue under the guise of “studying” the issue. Well, when do you have enough study? When do you act?

Former NDP cabinet minister Graham Steele in his book, What I Learned About Politics: Inside the Rise-and-Collapse of Nova Scotia’s NDP Government, told us that politicians and organizations love to say something is being “studied”. Study sounds like something is being done, when the real purpose of any study is to give cover for inaction.

Any premier or health minister who claims to being surprised by the conditions under which our parents, grandparents, older relatives and friends are living is being dishonest. They know what’s happening. However, they have insulated themselves from direct front-line contact to have a layer a deniability built in.

As for the comment that someone should do something, it is uncomfortable to hear, but we need to look in the mirror. We are the someone and the solution. The problems in long-term care exist because of complacency and how many families use these places as warehouses for the elderly.

People claim they would do more, but are so busy. Well, are you too busy to love? Social media is great for launching go-fund-me campaigns for strangers and petitions for all manner of causes, but beyond a few clicks and digital transactions, how involved do people get with the lives of their older family members, former friends or neighbours?

My mother was in a nursing home for eight months. I went to see her every day. A granddaughter who lived nearby went several times a week. My sister went in weekly. We let her know she wasn’t forgotten. And the facility management knew we were involved in her life and care. In those eight months I saw many residents who had no visitors. The only people who touched and talked to them were the staff.

Another family member is currently in care. The facility was on our watch list based on the experiences of others we know. Until the pandemic locked us out, her husband took two meals a day with her. I went in four or five times a week and one of her daughters also visited. (The others live too far away.) Again, we were/are present and involved in her life and had no problem with how she was treated. But again, management knew we were involved. So many of the other residents I see strapped into chairs in front of television sets day-after-day have no one to visit them and no one to pay any interest in them beyond professional obligations.

The problem is equally shared by the public, politicians, and bureaucrats.

The bureaucrats and provincial ministers who have legislative and legal over-sight of these facilities and responsibility for those in care, have turned blind eyes to failures in care and building maintenance. They have hidden behind crown immunity and bogus interpretations of privacy regulations to protect themselves from real responsibility. They receive the pay, perks, privileges and pensions regardless of their performance.

One of the most telling examples of the laissez farie attitude of bureaucrats was the death of Gilles Duceppe’s mother. Duceppe is the former leader of the Bloc Quebecois. You would think his national profile and political connections would assure his mother is well cared for. But in January 2019, the 93-year-old Mrs. Duceppe got up in the middle of the night and accidently wandered outside into -35 degree weather wearing only her nightdress. The door locked behind her. The official cause of her death was listed as hypothermia. In reality it was neglect.

When Mrs. Duceppe went outside an alarm rang. A staff member turned off the alarm and didn’t bother to check why it sounded. No one did a bed check to see all residents were safe. Mrs. Duceppe was outside for six hours in plain view of a security camera that no one monitored. There was no need for her to die. Not then, not that way. Her family are suing the facility.

If that can happen to the mother of a high-profile politician, what hope is there for the rest of us?

There are numerous other problems in long-term care facilities, like acts of violence, which are discounted and covered up. Each act is considered a one-off incident, when in reality there are thousands of acts of violence in Canadian long-term care facilities each year. This is resident-on-resident, resident-on-caregiver and caregiver-on-resident violence. I don’t have the number at my finger tips, but a few years ago I was told the level of violence was over 4,000 acts a year! Much of this is hidden under the cloak of privacy or given a pass on the assumption the offender is of diminished capacity. That’s not acceptable.

So what can we do?

First, visit the person you know in care. If you’re at a distance call them or call the home to discuss their health and care plan, and for regular reports. Then ask someone else to visit.

Secondly, write, email or call your MP, MLA/MNA/MPP to express your concerns about senior care, about a specific home and individual if you know one.

Thirdly, insist on better pay for care givers.  The people who work the front lines are only paid $18/$20 per hour for physically and emotionally demanding work. They burn out, which creates high staff turn-over. This turnover is upsetting to residents and is inefficient for facilities which have to spend an inordinate amount of time and money recruiting and training new staff about the residents and procedures.

Fourth: we need real inspections done on a regular basis by inspectors who have the authority to force facilities to act asap to correct their deficiencies.

Fifth: we need more long-term care beds. In Nova Scotia over 700 hospital patients aren’t actual patients. They were, but now they are waiting for a long-term care placement. This volume represents up to 60% of acute care beds in most rural hospitals. Collectively these 700 occupied beds are equal to the largest hospital in Atlantic Canada. If we had more long-term care beds we could save the expense of building a $4 billion new hospital in Halifax. That is a massive, political planning failure.

I suspect government planners have resisted creating more long-term care beds because they figured the problem would die out.

Those planners have overlooked the new demographic in need: millennials. Two 2019 studies in the U.S. found millennials are in worse health than their grandparents and are going into care decades earlier than other generations and will be there for many more decades than their grandparents.

So, in building long-term care beds we need to develop separate facilities to accommodate younger residents. Right now anyone needing long-term care goes to a facility occupied by the elderly. That isn’t fair to teenagers and other younger people who may be paralyzed by an accident, born with a genetic disorder or have another need. It’s also a different type of care, so is unfair to the care giver.

Until we sort out long-term care and do so meaningfully, we should immediately stop talk of replacing the VG in Halifax. If we emptied those 700 acute care beds we might not need a replacement hospital.

Better long-term care, better healthcare, better government starts with us. We are the ‘someone’ to do something.

 

 

 

 

 

 

 

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COVID-19 survivor story

Each day during this pandemic we are bombarded with numbers. We start and end the day with the number of people who have tested positive for the virus, how many are hospitalized, and how many have died. We hear about “the curve”.

A poster from the 1918 Spanish Flu pandemic found by the Kings County Museum in Kentville, Nova Scotia. A century later the message is still valid.

In a way, the current situation reminds me of the Vietnam War, when the American media reported the running daily tally of U.S. deaths, and the early days of the AIDS epidemic. In the early days of AIDS no one knew what it was, how it was transmitted and who was at risk. It was an invisible killer hitting clusters of people around the world. The longer we were aware of it, the wider we understood its spread and how broadly based the infection was.

The problem with only focusing on numbers and the inconvenience of staying home as nation after nation, continent after continent are locked down, is the risk of overlooking the devastation to those who died and those who have/had the virus.

I have grown short tempered with those who have nothing better to do than question whether the way governments have reacted was necessary. And who constantly question whether deaths are properly reported. On social media one person posted the same question every day for two weeks, challenging mortality numbers. His position was that older people would die anyway, so how can we say their death was really due to coronavirus vs their heart condition or cancer?

My position is, like a war, we do what we have to do now to save people and the economy, then we can question and second guess and challenge what happened, when and why. But first we have to limit the spread and pain and death as quickly as we can.

Coronavirus is not a theoretical issue for me. One of my friends and work colleagues came down with and was hospitalized in New York with coronavirus. He survived. But it was a trying time. His friends around the world were concerned. His parents are in Australia and couldn’t get on a plane and be with him. No one could. It was hell for him and worrying for his family and friends.

Here is his survivor’s story:

His is one of the lucky faces of coronavirus. Hundreds of thousands of other people and families have not been so fortunate. Think of what the world has lost.
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A series of questionable bills from Valley Regional Hospital needs investigation

It has happened to us.

Rick Anscomb’s experience with Valley Regional Hospital happened to us.

A February 20th Herald article “Man was in no state to sign NSHA document, wife says” tells how Anscomb of Kingston suffered a stroke, was rushed to Valley Regional Hospital in Kentville on December 11 and charged for his hospitalization.

https://www.thechronicleherald.ca/news/provincial/valley-man-was-in-no-condition-to-sign-nsha-document-wife-says-413030/

Sharon Anscomb has no problem with the medical care he received, but is furious that they were charged $510 for his hospitalization. Insurance paid $420 and she refuses to pay the outstanding $90 because they maintain the stroke incapacitated him and he didn’t know what he was signing. Sharon wasn’t present when the paperwork was done.

Scanning The Chronicle Herald files I found a November 6, 2018 article “New Mom ‘high as a kite’ when signing $13,000 hospital bill.” The article details how 24-hours after an emergency cesarean section, Beverly Burns, a Nova Scotian living in South Korean, was given “a pile of documents to sign”. She told reporter Nicole Munro, “I didn’t know if it was a nurse or a doctor I was speaking with and I don’t know what they said to me because I was out of it.”

https://www.thechronicleherald.ca/news/local/new-mom-high-as-a-kite-when-signing-13000-hospital-bill-257193/

This seems to be a pattern with Valley Regional Hospital, and perhaps the NSHA. It happened to us. Our bill was for $2,945.

On October 30, 2017 my sister was taken by ambulance to Valley Regional Hospital (VRH). She was diagnosed with a Bilateral Cerebellar Infracts (a rare type of stroke). As well as being disorienting it impaired her vision. She had surgery right after the stroke, followed by two subsequent surgeries which helped restore some, not all, of her vision.

In the VRH ER she was given six drugs, sent for a CT scan and put on two courses of Ringers Lactate (R/L).

The drugs given her list dizziness, drowsiness and confusion among their side effects. One of the drugs is the equivalent of valium.

Medical professionals tell me that multiple rounds of Ringers Lactate show how dehydrated she was. The R/L continued for two more days. I’m told when you are that dehydrated you aren’t coherent and are too disoriented to be considered competent.

Yet, after all this a VRH admissions clerk decided my sister, like Anscomb and Burns, was legally competent to sign a request form for a semi-private room. The request form states she was willing to pay $150/night for the room. This contract was signed without a witness other than the admissions clerk and without the knowledge of her husband who had briefly left her bedside. Only after she left hospital when the $2,945 bill arrived for a 20-night hospitalization did we learn of this request form.

In response to Anscomb’s experience an NSHA spokesman suggested people contact the authority Patient Relations line. And mentioned payment terms can be arranged. It wasn’t the money it was the principle and legitimacy of the bill. Sharon Anscomb made the call and says she wouldn’t again waste the time trying to talk the NSHA.

We all wonder how sick you have to be to qualify for free health care? A Yarmouth doctor told me “only 3 in 20 of our beds are public.”

This doctor said, “Ah, the deviousness of bean counters. The beds other than the three bedded units are a mixture of doubles and singles, there is a charge to occupy these. Now if the only available bed is one of these, they can’t charge, but happened often enough that the hospital would put someone in the three bedded unit, and they’d rather pay the extra money so they could sleep at night. Given that 98% of the beds are now occupied all the time, and there are patients in lounges and corridors this doesn’t happen often. But when the hospital was planned, the management was told this was a way to increase the hospital’s income.”

We challenged our VRH charge. An NSHA fax to Kings North MLA John Lohr’s constituency office listed my sister’s diagnosis as “vertigo” and maintained the room charges were correct. Vertigo is one of the multitude symptoms of a Cerebellar Stroke. The NSHA billing department seems to have cherry-picked this symptom to focus on as the cause for her hospitalization.

We continued to challenge the NSHA on this bill. From our perspective she was in no state to enter into a contract. She was traumatized by both the stroke and loss of sight. The medical notes of the day say she couldn’t sit up unassisted.

On May 11, 2018 Marlene Morrison, accounts receivable manager, collections and inquiries, wrote my sister “Mr. Lynch indicated that there may have been a medical condition that rendered you incapable of signing this form. Based on that concern, we had a medical team review your chart and they confirmed there was no medical reason that would have prevented you from signing the form at that time.”

Morrison’s letter, which has no address or telephone number, said, “Our Credit Management Clerk, Theresa Driscoll, will reach out to you to set up a payment plan within the next two weeks.”

May 26, 2018 Driscoll requested payment and added, “If payment is not received within 20 days, your account will be forwarded to Service Nova Scotia for collection.”

We refused to pay the $1,805 balance – an insurance policy had paid $1,140. Service Nova Scotia requested the Canada Revenue Agency apply any tax refunds and credits to the debt. The CRA says this is allowed under subsection 164(b) of the Income Tax Act.

With every fibre of our bodies we don’t believe this is a legitimate charge.

With my sister’s and brother-in-law’s written permission I got my sister’s 1.5-inch-thick hospital chart. That’s how I know what medications she was given, when and how seriously dehydrated she was.

I asked the NSHA what training the admissions clerk had to judge competency? Like most young people, the admissions clerk has her life spelled out on line. Her previous employment was in a New Minas sushi restaurant and Halifax sex shop. Work is work, but what specific training and experience has she in judging competency?

I asked who gave this clerk permission to access my sister as she lay in the ER? Can just anyone employed by the NSHA walk into a treatment room or does a member of the medical team give permission. And if a doctor or nurse gave permission, who was it? And why didn’t anyone speak to her husband who was only out of the room for a few minutes? And why didn’t that medical professional witness the signature and vouch for the patient’s competency?

On February 21 I found Morrison’s email address and asked for the names and qualifications of the medical team she claims reviewed my sister’s medical chart and concluded she was competent to enter into a contract.

In addition to my sister’s medical chart, I also have a copy of the NSHA Record of User Activity report. This lists the names, times, dates and reasons for NSHA staff to access a patient’s medical chart.

I can’t see where any cluster of doctors had visited the chart to conduct the review Morrison claims took place. However, I did see overlapping views of the same set of pages by 13 clerical, accounting and management staff, including Morrison, who read 19 pages. I checked with the College of Physicians and Surgeons of Nova Scotia. They have no prohibition on patients knowing such information.

Erin Beaton, Director for Quality, Safety and Patient Relations for the Western Zone responded. “In April 2018, a medical review was completed by Dr. Lois Bowden Western Zone Executive Medical Director, Dr. Rebecca Brewer Emergency Department Physician, and Tim Murray Manager of the Emergency Department. Robyn Llewellyn, Assistant Manager of Health Information Services along with Linda Plummer, Director of Health Information Services, thoroughly reviewed the admission process.”

Beaton’s letter continues, “the clerical process the Health Records admitting clerk followed that day aligns with the NSHA admissions process. The process requires the admitting clerk to confirm with nursing staff if the patient can be seen and is capable to understand and answer questions. If not, the clerk then inquires if there is a delegate (next of kin, or family member). At that time, there were no concerns related to capacity or competency therefore the admitting clerk proceeded with the process by seeing the patient. This includes confirming all patient information, whether the patient would like to request semi‐private or private accommodations and if they have private medical insurance. The clerk explains there is a fee for these accommodations if they are requested. It is not the clerk’s responsibility to know what type of coverage a patient has or if it covers the complete cost.”

“Based on the extensive clinical and administrative review, NSHA considers this file closed and the amount charged remains on the account.”

The NSHA description of “semi-private or private accommodations” makes it sound like the patient is checking into a hotel rather than being so ill they need to be hospitalized.

Beaton, like all bureaucrats, is focused on “process”, in this case the “admission process” vs medical condition and legal competency.

A problem with Beaton’s position is that it’s wrong. She may be accustomed to people accepting her word, but I fact check everything. The NSHA Record of User Activity report didn’t list Dr. Brewer accessing the chart in a three-month window when we originally complained about the bill.

I contacted Dr. Brewer. She emailed, “I did not review her file.  …  I am not sure why my name was included in the letter you were given.”

Since the NSHA is wrong about the medical review panel, what else are they wrong about?

Another question I have is whether the NSHA’s admission process meets the legal standard for binding contract since people being admitted to hospital from an ER are at their most vulnerable and often highly medicated? What legal opinion have they to support their position that the process is sufficient? They seem to have established a low bar for competency.

Retired medical professor and retired family physician Dr. David Zitner has reviewed my sister’s chart. Reading the Interprofessional Notes – where doctors record their daily patient observations – Zitner says, “The October 31and Nov 1 notes suggest problems that would interfere with the ability to read and sign forms.”

“She had double-vision. It’s documented. She had to be under supervision. There is nothing in the documentation to indicate she was compos mentis to sign the form.”

Zitner also said it is not clear why Ativan, a Valium-like drug, was given and notes it can impede competency.

After reading the charts he said, “It seems crazy to me that anyone from NSHA would persist in demanding payment.”

The bottom line is that I believe we were improperly charged and that the NSHA haven’t been honest with us. The NSHA bureaucracy seems incapable of admitting when they are wrong. Or when caught. They can’t claim it is a one-off mistake since so far we know of three questionable cases: Anscomb, Burns and us.

If it happened to us, Anscomb and Burns, how many other questionable contracts exist? Who else in Nova Scotia have either been improperly billed for care or denied access to care because they couldn’t afford to pay?

There is another troubling thread to this. Burns is from Greenwood, which suggests a military connection. Anscomb is retired from the military. My sister’s medical chart mentions “husband was engineer with military (pension)” and “pt [patient] has a small pension from previous husband (DVA)” then details their insurance plans. It seems lot of financial notes were gathered and suppositions made for a free health care system.

Given the reticence of the NSHA to admit their mistakes, it would seem reasonable that the Auditor General to investigate how many Nova Scotian patients and families face questionable medical bills. The NSHA isn’t about to do it.

In the meantime, for those who feel they have been improperly charged for care, ask to see the medical chart. Pay attention to the day of admission, the nurses’ and doctors’ comments and medications administered. That lays the foundation for the level of need and ability for informed consent by a patient.

In the meantime we have a $3,300 bill for a second hospitalization. Valley Regional is turning in to a good little earner for the NSHA.

 

 

 

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Long-term care investment critical to healthy health care

When one government does something that’s on them. When successive governments adopt the same policy we have to consider the influence of bureaucrats and sector advisors vs political philosophy. Based on that supposition I have come to question the advice given to the current and previous governments concerning long-term care in Nova Scotia.

In 2009, I was told that it would take an average of eight months for a bed in a long-term care facility to open up for someone in hospital. It would take 24 months for someone who was still living at home. In October our family was told a long-term care placement (from hospital) would take eight-to-12 months. In a decade nothing has changed in Nova Scotia and appears to have gotten worse.

What is different now is that there are open long-term care beds in Kentville, Wolfville, Windsor, Middleton, Truro and across the province! These beds are open because of a shortage of long-term care workers. The staff shortage is due to low pay – $18/hour – for a physically and emotionally demanding job. This may be above minimum wage, but it’s not enough. We need an immediate injection of at least $2 an hour more for these workers with the expectation of further increases. Otherwise the decline in caregivers will continue.

It sounds crazy, but a large pay raise might save the system money.

Hospital overcrowding means these hallway beds are where some ER patients at Valley Regional Hospital can find themselves. Other provincial hospitals also have dedicated hall space for patient beds.

Nova Scotia is currently warehousing seniors in hospital beds waiting for long-term care placement. The scale of those waiting for placement is higher than a recent comment from the Nova Scotia Health Authority suggests. A November 30th article (NSHA looks for home for woman left at the hospital) said “there were 59 people in acute care beds in Nova Scotia without an appropriate place to live because their needs are too complex for current facilities outside of acute care.”

This statement overlooks all the medically-stable people waiting in hospital for a long-term placement. For example, Valley Regional Hospital has a 10-person transition unit for people waiting placement. No one had left it in three months. VRH doctors confirm that 50 percent of the beds in Medical Unit B are waiting for placement. There may be more people waiting in Medical Unit A.

In September a Yarmouth doctor told me 30 of the 80 beds in Yarmouth General and 50 percent of South Shore hospital beds are occupied by people waiting to move. This situation is occurring across the province. The PC Health Critic has suggested 700 people are occupying acute care beds in provincial hospitals waiting for a long-term placement. That’s almost the entire capacity of the VG!

This delay in placement is causing a crunch on the front lines as we run out of hospital space for sick people. From Amherst to Lunenburg to Kentville hospitals are opening hallway beds.

The province is budgeting billions of dollars to build new hospitals, but the question becomes whether we wouldn’t have enough acute care capacity IF those waiting for long-term beds had places to go?

A new challenge to our long-term care bed inventory is the doctor shortage. In December Shannex announced that until a physician is found to attend to residents of Debert Court they can not accept new admissions (unless the prospective resident has a physician) and that any resident requiring medical care will be sent to hospital and not re-admitted until a physician is found.

The Advocates for the Care of the Elderly (ACE) have been on the case for 13 years. According to ACE founder Gary MacLeod, “The Tories, under Rodney MacDonald crafted a Ten Year Long-Term Care Plan that called for the replacement of nine aging long-term care facilities throughout the province along with the creation of 1500 new long-term care beds by 2014. By the time the Tories were defeated by the NDP only 900 of the proposed 1500 beds were created. The NDP called for the creation of 300 new long-term care beds while campaigning for election, but these were never mentioned again. The incoming Liberals never had a long-term care plan except the Minister’s declaration of no more money for bricks and mortar for new long-term care beds and a policy of keeping people in their own homes as long as possible without saying how they proposed to do this.”

MacLeod says in 2015 ACE was “introduced to the possibility of the creation of a new Five Year Long-Term Care Plan.” After four years of meetings ACE learned the plan was on “hiatus” pending the outcome of the Expert Panel for Long-Term Care, which was “not mandated to talk about funding or new long-term care beds.” MacLeod says only five of the report’s 22 recommendations have been acted upon. “In short, another report about more talking about health care.”

ACE says government policy to keep people in their own homes as long as possible fails to consider “the toll this takes on an elderly caregiver who either dies or becomes a long-term care patient themselves. When an intake worker assesses a person for long-term care they never take into account the frailty of an elderly caregiver who may have multiple chronic ailments that could wind up costing the health care system additional thousands of dollars.”

MacLeod’s scenario is the type of issue illustrated by the exasperated husband who abandoned his 73-year-old wife at the South Shore Regional Hospital in 2019.

The keep-at-home policy also doesn’t factor in the stress and cost to nurses who travel in all weather conditions to deliver care. One recently retired Valley nurse drove 185 kms per shift to see 12 clients. They were not paid for their mileage and in five years twice wrote off a vehicle.

Holding people in hospital who don’t need medical care is fiscal folly. The government wasn’t able to provide actual daily costs for an acute-care vs a long-term care bed, but given the salaries and other higher hospital costs it is realistic to expect those beds to cost twice as much as a long-term care bed.

This isn’t a short-term needs bubble. We need to stop thinking in terms of senior’s care. New reports warn that millennials will also need care.

In the United States Moody’s Analytics says the declining health of millennials “have serious long-term consequences for the performance of the U.S. economy.” A Blue Cross Blue Shield The Health of America Report® found millennials are more likely to experience major depression, hyperactivity, high cholesterol and Type II diabetes, among other behavioral and physical conditions.” A Kentville doctor confirmed he and his colleagues are seeing this at VRH.

The chief economist at Moody’s told CBS News these medical problems “often require costly, long-term care.”

Delaying the creation of more long term care beds and scrimping on salaries is not fiscally prudent nor is it a solution to current and future needs.

 

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There should be no football tax on health care

The proposal to bring a professional football team and stadium to Halifax raises many questions.

Since the proponents of the stadium want the Province to contribute money and concessions on ownership of former federal lands, it’s fair for people outside HRM to be concerned and need clarification.

One of the proposed revenue sources is a two-to-four percent levy on hotel bills.

I wonder about the impact of this entertainment tax/levy on health care. HRM is the region’s medical centre with the greatest concentration of medical specialists.

So, like medical pilgrims, people come to Halifax for appointments, tests, treatments and surgeries. They bring their sick kids to the IWK. The bulk of these people travel with a family member or friend, who often need a place to stay. Every day hundreds of hotel, inn, lodge and B&B rooms in HRM are occupied by people who are here for medical purposes. A levy on their accommodations is a type of tax on health care.

While $4-$8 a night may not seem much to some, to families whose main income earner is ill or who have to take time off work, this adds up. In the U.S. this type of surcharge is called “drip pricing” and is getting push-back from the corporate community as well as being the subject of lawsuits in Nebraska and Washington, DC.

When thinking about this I discovered a similar hotel levy had been proposed to pay for sporting infrastructure in Glendale, Arizona. Glendale is a city of 230,000 a few miles outside of Phoenix. A federal judge rejected the levy on constitutional grounds.

We are a different legal system, but it is worth studying the Glendale experience since one of their former team owners is also a backer of the Halifax stadium proposal. The proposal for Halifax seems to mirror the deal the owners of the Phoenix Coyotes had with the city for managing the Gila River Arena. This link provides details of a similar-sounding proposal:

The Super Bowl Comes To Glendale, The City Ruined By Sports

I understand a passion for sports, but in Canada and Nova Scotia we have expensive sporting history to consider. An example is the exuberant former Montreal Mayor, Jean Drapeau, who famously said, “The Olympics can no more run a deficit than a man can have a baby.” Well, Montreal’s 1976 Olympics were so costly – 13 times over budget – that it took the city 40 years to pay off the Games’ debt.

In 2008, Glendale invested $14 million to host The Super Bowl. They lost $1.6 million.

More recently and more local was Halifax’s winning bid to host the 2014 Commonwealth Games. The public was told the games would cost $785 million, generate $2.4 billion in economic benefit, increase the province’s annual GDP, create 18,000 jobs and leave a legacy of “world-class sport facilities and programs”. Proponents said, “We are not going to see the kinds of overruns that other games have seen.”

But investigative reporting later learned that the real budget for the Games was $1.72 billion and would be closer to $2 billion. A consultant hired by the organizing committee criticized the organizational structure, business plan, proposed ticket prices, budget projections and said the positive assumptions – like higher attendance and ticket prices – were based on a “we are different” concept.

If Halifax is to host a professional sports team and stadium, perhaps we should look at the model provided by Green Bay, Wisconsin. Green Bay is a city of 109,000 people so it is smaller than HRM, yet is home to the Green Bay Packers, the winningest and most successful football franchise in the NFL. The Packers have no public money involved in the team or stadium, nor do they have a single owner. For lack of a better description, they’re sort of a cooperative.

The Packers are a community-owned team. They sell shares to the public and have 360,000 shareholders. Their last share offering in 2011 raised $67.4 million. In 2003 the Packers’ home, Lambeau Field, underwent a $295-million redevelopment that increased capacity to 80,000. The Packers’ organization paid for that.

It’s out-of-the-box thinking to raise money for professional sports by selling shares to fans and supporters, but it doesn’t divide the community and doesn’t put an extra burden on those who have to travel for health care.

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The NSHA needs more executive cuts

The Nova Scotia Health Authority announced some paring of their executive ranks, but it isn’t enough.

https://www.thechronicleherald.ca/news/local/ns-health-authority-cuts-vp-positions-pledges-to-give-local-zones-more-power-380091/

The article says three vice president positions have been cut. Whether those former vice presidents go or stay in some other capacity isn’t enough. The NSHA has not lived up to its mandate. I can say that because merging the province’s nine health authorities under one umbrella organization was my idea.

In 2009 my mother had a small stroke while having blood work done at Valley Regional Hospital in Kentville. Another health problem occurred and over nine months of daily visits to VRH I saw and heard many things that didn’t make sense. As a former newspaper publisher/business owner I saw ridiculous organizational and communications problems.

Prior to our family’s exposure to the system I used to believe everything would be great if only government gave health care enough money. I have since learned that no one in health care has any idea of how much money is enough to make the system work.

Doctors and nurses at Valley Regional told me their problems and issues, then connected me to their colleagues across the province. I learned universality of their issues. One issue was how medical talent and assets where under-utilized. While Halifax surgeons couldn’t keep up with the need, operating rooms in Windsor, Middleton, Pictou and other hospitals were dark. Surgeons were leaving the province because they couldn’t get operating room time.

In 2010 I started writing about health care on this blog and for The Chronicle Herald. I proposed merging the nine authorities into one to reduce duplication of management, streamline delivery of care, redirect CEO and VP compensation to front-line workers and utilize all provincial assets to speed up the delivery of care to produce better patient outcomes. Previous articles on this site highlight the extent of the executive duplication.

In February 2013, long before the writ was dropped for the October election, the former Leader of the Opposition, former health critic and a member of the Liberal Party office met me in a Wolfville coffee shop to discuss a vision for a merged health authority. Meanwhile former Health Minister Maureen MacDonald and Premier Darrel Dexter rejected the concept and repeatedly said they weren’t going to import chaos to NS health care.

When the Liberals took office they were astonished to learn how advanced the Department of Health’s planning was for a merged health authority. While the NDP publicly decried a merged system, behind the scenes they were working on the very idea.

In the last six months I have been at two public meetings in the Valley where people have wishfully mused about returning to more responsive local health authorities. They forget how poorly served we were under the previous nine health authorities.

Under our previous nine-authority system the goal was to treat patients within 100k of their home. This resulted in backlogs in some places and under-utilized facilities and medical expertise in others. If you were a patient in Windsor, because that was under Capital Health, you would have to go to Halifax rather than Kentville, which is closer. Nine health authorities were territorial.

The problem with the NSHA isn’t the system, it’s the management. We hired the same people who frustrated us when they managed the smaller health authorities to run a much larger organization. And perhaps stung by Opposition criticism of her spend-thrift ways at the Annapolis Valley District Health Authority (AVDHA), where administrative expenses were 8.3 percent of budget which was 60 percent above the national average, NSHA CEO Janet Knox kept a tight reign on information about provincial health. So tight was the information flow that the NSHA executive offices are constantly referred to as Fort Knox by Valley Conservatives and front-line medical workers.

Staffing is one of the great NSHA secrets. The NDP government introduced the Nova Scotia Public Sector Compensation Disclosure Act, which requires publicizing the name and compensation figures for anyone receiving $100,000 or more from the taxpayer.

The purpose of the compensation disclosure act was to give taxpayers a type of public oversight of expenditures.

Originally, most of the health authorities, universities and other organizations covered by the Act listed the names, titles and compensation of the province’s 1 percenters. Even the AVDHA provided this information. However, when the NSHA was formed job titles were dropped from the compensation report.

Retired Halifax physician and Dalhousie Medical School lecturer Dr. David Zitner often says, “you can’t manage what you don’t measure.”

Without job titles there is not real transparency in management of the NSHA. Without job titles, the compensation disclosure is merely a prurient act. Having job titles would allow us to see if organizations, like the NSHA, are top heavy in managers and executives. It could provide insights into problem areas in staffing and help the public understand how our money is spent.

This year’s public compensation numbers are a prime example of this transparency failure by the NSHA and government.

In fiscal 2017-18, the NSHA filing listed 884 names. However, fiscal 2018-19’s filing contains 2,699 names! This wasn’t a massive, across-the-board pay raise, but the distribution of public service award distributions, which for senior executives ranged from $49,441 to $132,183. For privacy reasons this isn’t detailed in the filing.

If we can read an individual’s name and compensation, how is it more invasive to know that part of the package was a one-time payment? How is it more intrusive to know their job title or area of responsibility? This level of secrecy doesn’t make sense.

The NSHA has a spreadsheet – which they provided – showing the names, job titles and amounts paid to these thousands of staff. John Gillis, director of content and media relations wrote in an email, “Regarding inclusion of titles in the reporting, the audited document posted complies with what’s directed in legislation, but acknowledging the value of understanding the roles of the people identified, we have always made available on request a version that includes that information.”

What is troubling is that of the 2,699 people paid over $100,000 this year by the NSHA, 725 were vice presidents, directors, managers, coordinators, consultants, advisors, analysts, and some other managerial title holder. Other managers and executives earning $99,999.99 aren’t listed.

The raison d’etre for merging nine health authorities into one organization was to streamline management and direct money from the executive suite to frontline care. These executive numbers show the NSHA is not keeping with the vision for merging health authorities. Not enough heads have rolled at the NSHA.

When I wrote my first book, Sweat Equity, Atlantic Canada’s New Entrepreneurs, I learned that government and civil servants love process. The disconnect is that entrepreneurs – and the public – focus on results and outcomes. This is the problem with the NSHA. They’re health bureaucrats who love “process”.

The other problem with our health executives and decision makers is their disconnect with front-line care. When Knox was head of the Annapolis Valley District Health Authority, she worked from the corporate headquarters in the industrial park in Kentville. In the nine months I made daily visits to Valley Regional I only knew of three visits she made to the hospital. I knew that because I heard nurses groan, “What is SHE doing here? She only shows up when something’s wrong.”

The NSHA headquarters is again an anonymous glass office building in an industrial park in the HRM. Once again, health decision makers are disassociated from the front lines. They don’t see patients, doctors, nurses, other health workers or the worried, concerned looks of patient families. Health executives need more than a spreadsheet relationship with what medicine in this province looks like.

A post script:

The former Chief of Staff to the NDP Premier of Nova Scotia has written The Chronicle Herald to praise part of what I wrote and disagree that the NDP were working behind the scenes to merge health authorities. He wrote, “The NDP respected local decision-making. And yes, there were detailed plans for more efficiency in the backroom, to free up funds needed to ensure everyone had access to a family doctor.”

But the CoS claims this was not about merging the nine authorities. That’s his historic perspective of his party’s actions. The Liberal government found the organization done under the NDP so advanced it saved them a year of planning. That assessment came from the top levels of the current government. It boils down to: he said, he said.

Believe which version you want. I’m sticking with the Liberal story because our family’s experience under NDP health care was so hellish. Health care under the NDP was not great. It was so poor that it inspired me to launch this website.

 

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A system held together by tape

The state of Valley Regional Hospital in Kentville illustrates the frustrations the public have with the Nova Scotia Health Authority, government and the state of provincial health care.

Valley Regional Hospital is one of the province’s newer facilities. It’s a critical element in making Kentville one of the province’s four main medical centres. And as the main health facility in Nova Scotia wine country it’s a recruitment star. Yet, it seems to be falling apart.

Everywhere you look is duct tape. I’ve been going to Valley Regional on an almost daily basis since mid-June. In six months the only fixes I’ve seen are the application of new pieces of duct tape on existing problems. Thinking back, some of these duct tape fixes have been in place for years.

In addition to floor tiles taped into place, are gashes in walls of patient rooms. Some holes have tape on them, some show a start to a dry-wall fix which was not completed, others are ignored. Then there is the chipped furniture both in patient rooms and nurses’ stations as well as stuffing busting out of split upholstery in nurses’ chairs. Nova Scotia may not be the richest place in North America, but we’re not a Third World country. Our leading hospitals shouldn’t look like we are. It’s untidy looking and a health hazard.

This is troubling because loose tiles or degraded under-floors are a hazard to patients, visitors and staff. The holes in walls and nibbled-away furniture are places which can’t be cleaned and therefore become breeding spaces for bacteria and superbugs, thus making

Inside Valley Regional’s main entrance, just past the information desk and leading to the business offices is this loose, duct-taped-in-place tile.

patients less safe.

I don’t fault the maintenance staff for this. The blame is squarely on hospital management. Either they haven’t given the maintenance department the money or authority to fix these things or the executives are blind to the problems. That’s not surprising given how rarely hospital and health care executives are ever on-site.

Since the NSHA can’t look after those facilities in its care, they shouldn’t be given more to manage. Our needs seem to be above the abilities of the NSHA executives.

Top of the steps leading to the cafeteria from the main atrium of Valley Regional Hospital are these loose tiles.

Taped tiles in the main atrium of Valley Regional Hospital.

Another tape fix at Valley Regional’s main atrium.

This cluster of duct-taped tiles in the corridor leading to Medical Units A & B are so loose they click when stepped on.

Another main corridor tape fix at Valley Regional Hospital.

This duct tape is over a weakness in the floor. There are layers and layers of tape. Wheel a gurney or wheelchair over this or step on it and the area just beyond it and the floor sags. If someone were on crutches they could go flying. The underfloor has failed. The only thing holding this section of floor up is the linoleum. This is between Medical unit A & B.

There is a thin line of red tape around the admissions window at Valley Regional’s ER. The linoleum has a long-existing, never-fixed problem with the seam between two pieces of flooring.

Duck tape covers a corner in a room in a holding unit.

Different room with damaged corner. No duct tape yet applied.

A different patient room gash in wall.

Same patient room, different hole in wall. Both are breeding grounds for disease.

This unfinished dry wall repair is in a different room in the same medical unit.

This is a hall station where the dry wall finish has been eaten away by hand cleaner.

Nibbled away door bottom for yet another room. How does this happen?

The corner of a patient night table has crumbed away. Another rough, unwashable surface on which gems can breed?

The construction of a new dialysis unit – the one announced in 2012 – has blocked off an emergency exit for Medical B.

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How safe is our drug supply?

A Facebook – and real world – friend just alerted me to this article, which details how the U.S. drug supply has been outsourced to China.

This is a surprise to him, me and all our Facebook friends. Is this another area where we have become too complacent about health care?

I have smugly assumed that the drugs prescribed in Canada are crafted in sterile, modern laboratories by highly paid professionals situated either in Canada or Europe. Now I am not so sure.

What other false or overly-trustworthy assumptions are we guilty of?

Read it and weep:

https://www.nbcnews.com/health/health-care/u-s-officials-worried-about-chinese-control-american-drug-supply-n1052376?fbclid=IwAR0qQvt_ud-5TFLQjrFvcvdoDQVvY9bhpcrwIv3TBwUv096-nox1TorOUIU

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The misallocation of Nova Scotia ambulances

Once again Nova Scotia’s ambulance service is in the headlines. This time a widow is questioning whether the response time – which appears non-existent – contributed to her husband’s death.

Problems with our ambulance system are an on-going issue which health executives have consistently failed to resolve.

In the fourth quarter of 2011-12 the former Capital District Health Authority reported taking 144 minutes to off-load patients from ambulances instead of meeting the 20-minute provincial requirement. Capital Health promised then Health Minister Maureen MacDonald to improve performance by 10 percent per quarter. Capital Health’s self-imposed deadline gave them until September 2015 to meet the provincial requirement.

On March 21, 2019, when ambulance line-ups outside Halifax hospitals dominated the headlines I asked Minister Delorey who in his department monitored Capital Health’s progress and if the Halifax hospitals ever met their self-imposed targets. Neither the Minister or anyone in his department responded.

The Minister has called for a review of the circumstances which caused this recent death. But what is the point if no one is held accountable and nothing changes?

The availability of the emergency services is impaired by our misallocation of assets. A great percentage of the calls EHS ambulances and paramedic teams make are non-emergencies. EHS are operating an expensive taxi service, transporting patients between medical facilities as well as residents of nursing homes and long-term care facilities to and from hospital.

Patients moving between hospitals need the safety and security of medical expertise provided by paramedics. However, most long-term care residents don’t. They may need to go to hospital for a treatment, appointment, procedure or medical test, like an x-ray. These are necessary trips, but no more of a medical emergency than that of the person who drives themselves to hospital for similar reasons. The reason an ambulance is used is either due to physical impediment (like being bed-ridden or confined to a wheelchair which can’t fit in a regular vehicle), lack of alternative transportation or a fear of litigation.

The Department of Health and the NSHA seem populated with people fixated on ‘what if’ scenarios. What if the resident needs help while being transported? Well, what if there is a real medical emergency and there are no ambulances and paramedics available? That seems to have been the situation this week.

At a March meeting about changes to the Valley Regional Hospital’s ER in Kentville, I asked the ER manager how many patients arriving by ambulance are emergencies. He said, “Anecdotally – and I don’t want to be held to this number – 50 percent of ambulance deliveries are an emergency.”

That means 50 percent aren’t an emergency.

Nova Scotia has 180 ambulances based across the province. Terry Chapman, business manager for local 727 with the International Union of Operating Engineers, which represent paramedics, says the employer’s data shows 162 ambulances are available each day. According to data compiled by Andy Muise, Project Coordinator, EHS Ambulance Operations Management, the service received 182,452 calls in 2018. Of these, 72,933 calls, or 40 percent of volume, fell under their urgent-need/emergency call breakdown.

So the bulk of ambulance and paramedic time is devoted to medical transportation.

NSHA and the Department of Health will tell us that scheduling ambulances are a complicated operation. It may be, but where is the proof anyone has moved on the problem?

According to someone familiar with the ambulance industry, most of the world has one ambulance per 8,000 people. Nova Scotia, because of our geography, has one ambulance per 7,000 people. HOWEVER, my source says, “Unfortunately as our population ages more long term beds are required and the lack of these resources in the rural areas force more transfers toward Halifax and make the pile up worse.”

“The wait time to unload is not an ambulance problem. It is the result of not having any place for the patients in the hospital so they pile up in emergency causing a backlog.”

Those transfer pile ups are also growing at regional health centres, like Kentville, where the bulk of hospital patients seem to be waiting for alternative accommodation.

After the Kentville update on ER improvements an ER nurse, stopped in the parking lot to scream, “We’re working in chaos in EVERY shift! Why aren’t we using former hospitals in Berwick and Wolfville for bed space!?!”

Hers is a valid question. Those former hospitals are mostly occupied by government offices, like school boards, which could easily relocate to other buildings. We should do a quick inventory to identify all empty or underused provincial property to see what could wiftly be rehabbed into long-care facilities.

For example, the former Colchester Regional Hospital inTruro has been vacant for five years. A former minister told me the building has asbestos. Well, it had asbestos when it was a hospital. Government House had asbestos and we found $8 million to remove it and make necessary structural changes. Whether the former Truro hospital is to be sold or demolished, the asbestos will require an expensive removal and disposal process. Using the example set by buildings of similar square footage, like St. Pat’s High School in Halifax, the cost of demolition would be in excess of $3.5 million. How much could that go to making the building useful again? Why not bring it up to code and offer a sweetheart deal to a proven nursing home operator as an incentive to add 150 new long-term beds to inventory?

As for freeing up ambulances so they are ready for real emergencies, why not invest in local services like Kings Point-to-Point Transit, which services those with mobility issues. To mitigate liability and provide patient support, make an CNA or LPN available to travel on non-emergency transfers and supervise the hospital handover. That’s a cheaper alternative to using a paramedic team and ambulance.

My industry advisor says, “The problem we have is not the ambulances. In my view our problem is the management and structure. We should consider “farming out” the management to someone like the CEO of a corporation and apply basic business principles to the problem(s). Now we have a health system run by government using the only tool they know: throw more people and more money at the problem.”

All more money and people have done is buy time for those in charge. It’s time for new service-oriented thinkers, with clear performance targets to meet, to take charge.

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Dementia misdiagnosis?

I don’t normally write about medical treatments. There are so many websites of dubious background and knowledge promoting cures or mis-informed warnings based on little more than some celebrity musing.

Then there are the coffee shop experts who usually know somebody whose neighbour’s cousin had the same thing and this is what was done to fix them … I still believe in those who invested the time to earn their medical degree.

This is about a misdiagnosis. My family previously suffered from a misdiagnosis which our health authority refused to acknowledge, probably for fear of litigation. And I have a friend in England whose daughter had been diagnosed with bi-polar disease. For 10 years she was in and out of expensive clinics (£10,000-a-week) and treated with various antipsychotic drugs. But, as extraordinary as it sounds, after a decade the doctors realized this young woman had a thyroid condition! She was decades ahead of when such a condition normally impacts women and this, coupled with the drugs she received, enhanced her anti-social, self-destructive behaviour. Once her thyroid condition was recognized and treated ‘normalcy’ returned to her life.

Below is a piece I believe rates consideration. It is by a reputable writer from a legitimate media organization, who would have fact-checked and used first-hand, original sources about this new Canadian therapy. I believe this is worth sharing to expand the conversation of the provincial medical community:

https://www.ctvnews.ca/health/new-clinic-treats-patients-with-reversible-condition-often-mistaken-for-dementia-1.4525349

 

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