October 7, 2021 – 11 am. I have just returned from my second trip this morning to Valley Regional Hospital in Kentville.
My first trip at 8:20 was to drop a friend off for a “procedure”. My second at 10:40 was to take him home. He was prepped, in the operating room with an IV in his arm when the procedure was cancelled. The OR nurses were there, the surgeon was there, the anesthesiologist was there.
What wasn’t there were empty hospital beds.
The procedure required anesthesia. Anesthesia requires that he be monitored for 24 hours. As the surgeon told him, it’s the fear of litigation if something goes wrong.
Since he lives alone, an overnight in hospital is required to absolve the medical team from liability. But with no free bed they couldn’t operate. They will call him in a couple of weeks when there is an opening in the surgical schedule – no doubt due to another cancellation. This means he has at least two more weeks of life-altering discomfort, which prevents him from working or doing anything outside his home.
This cancellation is not only personally costly to my friend, it is also hugely costly to health care. The surgeon, surgical nurses, anesthesiologist all have to be paid. The OR had to be reserved and prepped for his procedure, then has to be re-sterilized before it can be used again. And will whoever is next scheduled for that OR get their procedure done or will it also be cancelled? Will there be a hospital bed available when the next opening is found in the surgical schedule?
What this does is double or triple treatment costs since my friend still has to undergo this procedure. Outside of the hospital costs are additional costs of VON home care. To help quantify this, if the procedure cost $1,000, then the aborted one plus the yet-to-be-scheduled replacement one plus the weeks of home care make this a $2,500+ cost to the NSHA. Thinking about how wide-spread this type of situation is means we’re wasting two-thirds of our surgical budget on delays and cancellations.
The lack-of-beds situation is not new.
For nine months in 2009-10 and for seven months in 2019 – 20 I was at Valley Regional every day visiting family members. In both situations, once a medical condition was addressed, we waited six-to-eight months for long-term care beds to become available. As recently as 2020 50 percent of the beds in VRH’s two medical units were occupied by people waiting to go into long-term care. I not only did my own head count, I confirmed that figure with two hospital doctors. At the same time another doctor confirmed that 40 percent of the beds in the Yarmouth hospital and 50 percent of beds on the South Shore were occupied by people waiting long-term care placement.
Across the province on any given day over 700 acute care hospital beds are occupied by people who are well enough to leave hospital, but not well enough to live on their own. That means many others who have pressing medical issues can’t get care and treatment because of this bed shortage. My friend is one example. Not building new long-term care beds is a false economy since we are bleeding money on postponed, multiple treatments, which often lead to sicker patients.
The bed shortages have been with us for over 20 years. Health care executives like to say it, like everything else, is a complicated issue. In reality it is a shared failure of politicians and health care executives.
We need more long-term care beds. We have known this since the 1990s. Demographer David Foot wrote his best-selling book, Boom, Bust & Echo in 1996 and Boom, Bust & Echo 2000 in 1998. These were international best-sellers which predicted the impact of aging on health care. In my international travels I have seen resorts – from the Ritz Carlton in the Caribbean to ski hills in Banff – change their operations and focus because of Foot’s research. Nova Scotian politicians and health care executives appeared not to read about demographic change and needs. Foot’s research, like most of the health studies done, are “received with interest” and shelved, unread and not acted on. A Google search will show you how consistently Nova Scotia’s Auditors General complain about NSHA inaction on their recommendations.
While we focus on the need for long-term care beds for the elderly, we ignore an even greater need. In the fall of 2019 Moody’s Analytics said the declining health of millennials “have serious long-term consequences for the performance of the U.S. economy.” Blue Cross Blue Shield’s The Health of America Report® issued at the same time found “millennials are more likely to experience major depression, hyperactivity, high cholesterol and Type II diabetes, among other behavioral and physical conditions.”
The chief economist at Moody’s told CBS News these medical problems “often require costly, long-term care.”
A Kentville doctor confirmed he and his colleagues are seeing millennials present these illness at VRH. The doctors had considered this as just poor lifestyles on the part of individuals and only realized it was a generational trend when I brought these studies to their attention.
The bottom line is millennials are going in to care before their Baby Boomer grandparents and will be in care for twice as long.
The pressure on long-term care beds is multi-generational. It’s another health care trend Nova Scotia isn’t aware of or ignores. Meanwhile, the leisurely contemplations of those who populate the NSHA executive suites will continue to negatively impact the health and well-being of all Nova Scotians.
Delaying the creation of more long-term care beds is not fiscally prudent nor is it a solution to current and future needs. It also hampers the ability of the system to deliver timely medical care to all Nova Scotians.