Hope on the horizon

When it comes to managing the pandemic, Nova Scotia is and has been a shining light. The outcomes in the province have drawn international attention for being among the world’s best. Currently, Omicron hospitalizations run .2 – .3 percent.

Politicians and the people of the province put this down to Dr. Robert Strang, Nova Scotia’s Chief Medical Officer. During the pandemic Strang has served under three premiers from two different parties and been trusted by all. When he recommended closing provincial borders it was done. When he asked people not leave their county he was backed up by then Premier Stephen McNeil who famously told Nova Scotians to “stay the blazes home!” That became a popular t-shirt and appeared on the ‘welcome to’ sign for the town near the premier’s home. 

Strang is a very (small ‘c’) conservative person, who is open in dealing with the news, but not known for over-promising or seeking popularity. His only promise is for more hard work and diligence. In his most carefree moments he is cautious and methodical. 

So it was a bright spot in his January 3rd, 2022, public briefing when breaking beyond case counts, testing numbers and vaccinations delivered, he said, “January will be a tough month. I expect the Premier and I will have some more hard decisions to make. Omicron is pushing us to the limit and creating a difficult balancing act between controlling the virus and limiting significant impacts of restrictions. None of this is easy and we need every Nova Scotian, including the Premier and me, to be at their best.” As if channeling Churchill, he continued, “let these challenges bring out our finest qualities for all to see. We will get through this. Pandemics do end. So let’s get through it by working together, caring for one another and treating each other with kindness and respect. The challenges we are facing are manageable and they are temporary. But the legacy we leave with our response will be permanent.”

In an interview with the CBC’s Halifax morning program, Strang reiterated, “Omicron is so infectious that even small numbers of people getting together is an opportunity for the virus to spread. So, I think this is a short-term peak. We may have a similar kind of spike a week from now related to New Year’s (gatherings). 

“January is going to be up and down with high case numbers, but I think we have things in place that we can slow down the spread. That’s our goal — not to prevent spread, but slow down the spread to limit the number of people at any one time needing hospitalization.

“This pandemic will end and I think Omicron is likely to be the way out of this. As we get through February and March, things will settle down, and myself and lots of my Public Health colleagues really feel that by the time we get to spring, we will be really robustly able to move into the endemic or “living with COVID” phase.”

The assessment of Strang and his colleagues across Canada is this is the final phase. Life – and travel – will develop a new normal, just as we developed new normals after 9/11, SARS and successive collapses of the financial markets.

Spring may not just bring back the leaves, but offer some liberation and freedom to safely live our lives. For once hearing “the end is near” is good news.

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Vaccinations and false prophets

In their final COVID briefing for 2021 Premier Tim Houston and Chief Medical Officer Dr. Robert Strang continued to urge people to get vaccinated. Not just for their booster shot, but for first and second vaccinations!

Two years into this pandemic it beggars belief that some people still think it’s a hoax. Why? For it to be a hoax someone has to benefit or profit, so who do they think are profiting? 

Last week (December 21, 2021) in line for my booster shot one man mentioned the group of people who stage a weekly protest outside a Berwick restaurant. Their  complaint is with the required mask-wearing inside. This is a provincial emergency regulation prompted by the pandemic. Yet this group target a local business as if they are unique and trampling their rights. It is nonsensical. All the neighbouring businesses, like those across the province and country, require mask-wearing inside.

The rural area outside Berwick seems to be home to one of two religious clusters who question the validity of the pandemic, don’t believe vaccines are beneficial and reject mask-wearing as a factor in personal and societal protection. Instead, they see a conspiracy to undermine their freedom, to inject poison into their bodies and attack their faith.

In expressing their faith they seem to cherry-pick Biblical ideas. Instead of helping others, they find enemies and evil – concepts which always sell for religion and stock prices. The lessons of the Good Samaritans on the Road of Damascus, the idea of helping others, is not high on their faith list.

For those people of faith who still question the prudence of getting vaccinated, consider that Her Majesty the Queen, a woman of great faith and Supreme Governor of the Church of England, and the Pope are vaccinated. So is the head of the Greek Orthodox Church and Russell M. Nelson, President of the Church of Jesus Christ of Latter-Day Saints (The Mormons). The executive of the South Baptist Convention are also all vaccinated and urge all their members to be vaccinated. 

Those who seek a religious exemption from vaccinations do so without the endorsement of religious leaders. Leaders of the Greek Orthodox Archdiocese of America said while some people may have medical reasons for not receiving the vaccine, “there is no exemption in the Orthodox Church for Her faithful from any vaccination for religious reasons.”

The Holy Eparchial Synod of the nationwide archdiocese, representing the largest share of Eastern Orthodox people in the United States, urged members to “pay heed to competent medical authorities, and to avoid the false narratives utterly unfounded in science.”

“No clergy are to issue such religious exemption letters,” Greek Orthodox Archbishop Elpidophoros said, and any such letter “is not valid.”

The Pope said, “Thanks be to God and the work of many today we have vaccines to protect us from Covid-19. These give the hope of putting an end to the pandemic but only if they are available to everyone and if we collaborate with them one with the other. Getting vaccinated, with vaccines authorized by the competent authorities, is an act of love.” He added, “Vaccinating us is a simple but profound way to promote the common good and to care for each other, especially the most vulnerable.”

So, for those faithful who believe their church opposes vaccination, think again. None of the Christian churches believe there is a religious reason to avoid vaccination. Those who preach against vaccination are simply false prophets.

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Botched booster shots

I haven’t seen The Hunger Games, but more than one person has liken it to trying to get their booster shot.

The front line people are working hard to make it happen, but as so often happens in Nova Scotia, the backroom people make work and life more difficult for the front-liners and public.

Case in point are the current walk-in/pop-up vaccination clinics being held around the province. At first blush they seemed to be for those who still needed their first or second vaccination. This includes school children. The Town of Kentville posted on Facebook that a vaccination site would operate from the town Rec Centre (old fire station) on December 20, from 2-to-7. 

I asked on Sunday if it was also for booster shots. After the clinic opened on Monday, the Town was able to confirm that yes booster vaccinations would be available. So I jumped in the car and was parked and in line at 3:12 Monday. At 7 pm a woman came out of the clinic and said they could do the next 11 people and might have enough vaccines for a couple of more. I was 10th in line. At 7:15 the same woman came out to say they had used up the vaccines they had out. So the woman ahead of me was the last to be vaccinated.

I spent four hours in line in -8C weather for nothing. A woman who had been in front of me, but left 45 minutes earlier because she had a 6:15 hair appointment said she wished she hadn’t taken her menopause medication. A hot flash would have been welcome in that cold. When I got home I had to use my right hand to bend the fingers on my left hand to be able to reach into my pocket for keys to my flat. It had been that cold.

By my quick count 96 other people waiting for vaccinations were sent home.

I don’t fault the workers, but I do fault those arranging this vaccination site. The Rec Centre is the smallest room available in Kentville. The current health restrictions limit it to 25 occupants. Nine of those occupants were workers. Meaning only 17 people could come in at any one time. And after each vaccination you have to be observed for a minimum of 15 minutes. We were told that for some people the wait stretches to 30-to-60 minutes, further limiting clinic access.

For my first two vaccinations (in an empty store in Dartmouth and drive-thru in Wolfville) it took five minutes to greet each other, answer the COVID questionnaire and have the jab. Then we were sent to a large hall and a parking lot to wait out our 15 minutes. In those situations each health worker processed 8-to-9 people an hour. Yesterday in Kentville because of the occupancy restrictions they could do four.

The Kentville Fire Department has an auditorium which is six times the size of the Rec Centre. Plus it has a foyer and is completely flat. At the Rec Centre able-bodied people were sent out of back door, which required walking down a small flight of stairs. However, those in wheelchairs and walkers had to manoeuvre past people coming in the front entrance. This slowed the flow down and kept people standing in line in the cold for long periods.

Last evening, a dozen of us left standing by the entrance, were told there was a clinic Tuesday at the Annapolis Valley First Nation bingo hall from 10-to-2, and then at the Berwick Gym from 2-to-7 and another Wednesday at the Wolfville Lions from 10-to-2. A Valley Regional Hospital worker was told to check her emails because a message was sent saying health workers could be vaccinated at VRH on Wednesday.

Well, Tuesday morning I drove to the Annapolis Valley First Nation for the walk-in clinic only to find it is for Wednesday. Furthermore, in spite of the NShealth.ca’s website saying the clinic is open from 10-to-2, the Band Councillor says her email gives the hours of 2-to-7. [This afternoon while I was in line for the Berwick vaccination clinic the First Nations called to say the 10-to-2 time had been confirmed for Wednesday.]

The other non-sensical aspect from Monday evening was the explanation that many of the workers had driven 1.5 hours to get to Kentville, so had another 1.5 hours to return home and then Tuesday several had to drive three hours to Yarmouth for a clinic and three hours home after the clinic. NSHealth.ca does not list any clinics for Yarmouth or Yarmouth County. So more confusion. And why would people have to drive so far? Didn’t we ask retired health care professionals to pitch in? If pharmacists are qualified to deliver vaccinations, why aren’t recent nursing and medical retirees capable of delivering them?

For a list of walk-in/pop-up clinics check out:

https://www.nshealth.ca/drop-in-vaccine-clinics

To find out about open appointments near you, Gabor Lukas of the Air Passenger Rights Association, suggests adding this to you search:

https://vaccine.topgroups.ca

A postscript: Tuesday afternoon while I was in line at the public walk-in vaccination clinic at the Berwick Town Gym a notice was sent to one of my email accounts from the organization managing vaccination appointments (I had one for Dec. 31 in Middleton). The email said acknowledged my rescheduled appointment. I am impressed by this. I was trying to find a way to cancel my Dec. 31st time slot so that it would be open for others. So points to the system for that.

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Pay more to save more

Long term care workers are staging protests about low pay and working conditions. If we don’t listen to them our whole health care system could collapse.

I say the health care system could collapse because roughly 60 percent of hospital beds in Nova Scotia are occupied by people waiting to be placed in long-term care. Prior to the pandemic, the average wait time was eight-to-12 months! During the pandemic the wait times haven’t gotten better because of staffing issues at facilities and reductions in available beds because the early wave of LTC deaths made us re-think the shared room model most facilities utilized. On top of this were additional health protocols which slowed acceptance of people into care for fear they could unknowingly be contagious.

If we don’t speed up the flow of people from hospitals to long-term care beds we slow down the delivery of medical services to all. As I mentioned in October, a friend was in the operating room with an IV in his arm when his procedure was cancelled because there were no available hospital beds. That’s disappointing and infuriating for patients and inefficient for the system. The medical team is still paid. The OR needs to be re-sterilized, so more costs. This patient still had needs and twice-a-week homecare. That’s more cost. So the system pays twice for the procedure, the patient suffers longer, plus all of the ancillary costs for providing interim care. 

One of the reasons for the slowness in moving people from hospital to LTC is staffing. Staff turnover in LTC facilities in Nova Scotia runs around 30 percent. This is costly. Facilities have to advertise, then interview for positions. When they hire someone that person has to learn about the facility and become familiar with the residents. During that learning/training period they’re not as efficient as a long-time employee. They can’t handle the same volume of work, which means existing staff pick up their slack.

Staff turnover centres around working conditions and pay. LTC is physically and emotionally demanding work. This week the manager for Grandview Manor in Berwick, which is one of the province’s better facilities, said they have just lost 19 caregivers. She also noted that the residents they are receiving are sicker than before, yet the resident-staff ratio set by the province hasn’t changed. Adding to the delays and frustrations is a waitlist for the LPN training program. So like nurses, we are creating staffing shortages by limited educational openings. At Grandview this means managers are now changing beds and cleaning rooms. 

The Grandview manager also said caregivers are paid $17.50 – $18.96 an hour. And to get to the $18.96 rate the employee has to be certified and have three years’ experience. That’s who for those who stick it out for three years.

The rate is set by the province. This is above the minimum wage, but it’s nowhere near what it should be. Not only is LTC hard work the money isn’t enough to live on. Rents have become so high that a LTC facility in Kentville owns two apartment buildings, plus has deals with several landlords to provide housing for their staff. Other facilities are have similar arrangements.

During the federal election, Liberal Leader Justin Trudeau said LTC workers would be paid $25 per hour. This fall we learned that the Halifax Regional Municipality considers $20.80 to be a living wage for the city. The Centre for Policy Alternatives now says $22 is a living wage for HRM. And in September a Small Claims Court in Pictou awarded a plaintiff $25 per hour to clean manure off their property. 

The Prime Minister, HRM Council and the Courts say $20 – $25 per hour is a minimum amount people should earn. LTC workers aren’t earning this and, as vital as their work is for the residents they care for, many don’t see their future in this. The more workers who leave long-term care, the more people who will occupy more expensive hospital beds to be cared for by RNs earning two-and-a-half times the rate paid to LTC staff. 

This is an unsustainable situation. To fix it, we have to build more beds, hire more staff and pay them better. It’s the cheaper solution to both better health- and long-term care systems.

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Get serious about corporate governance

The problems with the Nova Scotia Health Authority start at the top, in the executive suite.

In the last 30 years Nova Scotia has had three major structural changes to the way health care has been organized. Yet with those re-organizations, coupled with the multitude of charges made throughout provincial health care, the same problems persist: surgical wait times, ambulance delays, doctor shortages, staff and public dissatisfaction, lack of beds and the on-going neglect of the Victoria General Hospital. 

For 50 years the Legionnaires bacterium has existed in the pipes at the VG leaving the region’s largest hospital with water so toxic it is only safe for flushing toilets. How did this ever become acceptable? How did any an executive – whether a person and a group – not act? In 2016 CBC’s Jean Larouche contacted 14 former health ministers and all said they were never asked for money to fix the VG water issue!

So, it is encouraging to see the new government swiftly target both management and governance of the Nova Scotia Health Authority. Removal of the NSHA CEO and board of directors suggests real change is afoot. We’ve changed everything else about health care, but made the mistake of repeatedly seeking out executives with the same skillset as those they replaced. It hasn’t worked.

This is a prime opportunity to rethink who heads the NSHA. Why do we think it has to be a doctor or nurse? Yes, we need someone with medical training to head the treatment side of the NSHA, but to manage all the other aspects of health care we need someone who understands: building maintenance, human resource management, meeting service targets, budgets, catering, laundry and other auxiliary services. Medical school doesn’t train you for that.

The big problem has been trying to do health care management on the cheap. This is an oxymoron because since it was created the NSHA has abandoned its raison d’etre, which was to consolidate management and redirect money to front-line care. Instead, the NSHA ramped up the executive ranks. In 2019 it had over 2,700 managers, directors, supervisors, consultants, vice presidents and CEO earning over $100,000 per year.  

We created a medical conglomerate that embraced ancient management structure with too many reporting and decision-making layers to act. Their mission seemed focused on limiting liability.  They appear to have done little in terms of successful doctor and nurse recruitment and improving delivery of care. 

Since the creation of the NSHA the board of directors have been invisible. Hidden behind a wall of secrecy so the public have no idea what the board has done. The minutes of their meetings are generic platitudes with suggest a snail-like pace of deliberations. They took a year to create their committees. Other than having lunch five or six times a year, what have they accomplished?

As the government considers who should run the NSHA we need them to bring in an activist board of directors. The pleasant group of accomplished volunteers who have been in place at the NSHA and its predecessor authorities haven’t worked. The boards seem to just have been rubberstamps lending legal credence to the wishes and actions of the health executives. We have no indication, no example to point to, to suggest otherwise. 

To make the board more representative of the people of Nova Scotia, rather than an exclusive club for well-off volunteers, we should ensure there are dedicated board seats for a registered nurse, a doctor (either in practice or recently retired) and someone from the patient perspective, whether they are a former patient or involved family member who had authority to make health decisions. It is absurd to have a health board which lacks first-hand patient experience. 

One of the biggest things we can do to make the board fully representative of Nova Scotians is to pay directors for their time. Then it becomes something they are fully focused on vs an every-other-month day out. To put $5 billion in the hands of volunteers suggests the government doesn’t take the board of directors seriously. The NSHA budget is twice the annual budget of the Province of Prince Edward Island, and five times the Halifax Regional Municipality’s budget. Neither PEI or HRM are managed by volunteers. It is unrealistic and limiting to rely on volunteers to over-see such a huge responsibility.

The NSHA budget is a huge sum of money and should be governed by something more serious than a volunteer board. A paid board makes it more accountable to the shareholders, who are the people of Nova Scotia.

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The NSHA’s on-going failures of care

Tim Gottschall’s experience in seeking care for his late mother, Hilda Gottschall, is all too familiar. Like so many other broken-hearted families, the Gottschall’s learned that Nova Scotia health care can be deaf to patient needs and family desires.  

Mrs. Gottschall was diabetic. Diabetes presents its own set of problems, which are well-known to medical professionals. Yet hers seems to have been treated rather cavalierly. During a phone consultation her doctor determined she was having a medical emergency. Her doctor told Tim to bring his mother to the Halifax Infirmary, where he (her doctor) would have a team assembled to handle her case. But the ambulance refused to take her to the Infirmary and delivered her to Dartmouth General. This forced Tim Gottschall put his mother in his car and drive her across the bridge where a medical team was waiting to do an amputation!

After a month in hospital his mother was sent home. That’s when Tim discovered a gangrenous toe! Naturally, Tim didn’t understand why she was discharged from hospital.

This time she went to Dartmouth General. Tim did all he could to make staff aware of her previous medical history, which included two cardiac events and a bedsore that had been successfully treated. Because of COVID restrictions he felt his mother wasn’t getting the care she needed. “Physiotherapy – they didn’t return my calls,” he told The Herald. He finally got a meeting with the hospital administration where he laid out all their failures, like not bathing her, not giving her physiotherapy or engaging with her, and a newly developed bedsore. 

“Bedsore” is too benign a word to describe the gaping fist-sized hole she had. I know of another recent case (2020) where a patient in another facility also had “a bedsore”. But that sore measured 6 inches by 2 inches and was open to the bone!! If hospitals don’t treat bedsores as a significant issue, those who are patient families and friends damn well should scream the place down. We have had too many cases in this province – and too many unfulfilled promises by the NSHA – to resolve the bedsore problem.

Gottschall’s are critical complaints because when you talk to those who work in long-term care they say the majority of residents they receive are far more ill than a generation ago. I question the harm being done to patients while in hospital. They go to hospital with one set of medical issues, which are addressed, after which a type of neglect seems to kick in for those people waiting to move into long-term care.

In 1990 an elderly relative of ours was taken by ambulance to the Victoria General in Halifax. By the time her daughter, who followed the ambulance in her own car, found a parking space and entered the VG security was ready to charge the daughter with elder abuse.

The VG admission team found the patient had a broken collar bone, broken hip and was malnourished. The problem for the VG, and the then Capital District Health Authority, was this woman was a transfer patient from the Hants Community Hospital in Windsor, where she had spent the previous three months. During that time two hips were broken, as well as her collar bone. 

Through investigations we learned these broken bones were the result of falls that happened because her call bell wasn’t answered she attempted to get out of bed to go to the washroom by herself. The malnourishment occurred because while food was brought to her, it was usually placed out of reach. Bedside tables get shoved aside during doctor visits, personal care sessions or room cleaning. Staff forget to move the table back to where it had been and food services staff were told not to move a table. So the food was there, but the patient was physically unable to reach it. Staff would remove the tray without asking if she ate or why she didn’t eat.

In 2012 there were national headlines about the “lack of nutritional value” of the food served to Canadian hospital patients. The nutritional value was so poor that anyone exposed to it for 30 days would most certainly become malnourished. How does anyone recover from any illness when they are in such a state?

It’s because of the lousy hospital food in terms of nutrition, not taste, that we even have a body called the Canadian Malnutrition Task Force (CMTF). In 2016 the head of the CMTF, Heather Keller, made media rounds promoting a proper diet as key to good health. 

At the time Keller was making the rounds, chef Joshna Maharaj was working with the Scarborough Hospital for Sick Children to create more flavourful meals for patients. News reports at the time said, “Out went bland prepackaged meals. In their place, meals using fresh basic ingredients, seasonal fruits and vegetables, and meats from local producers.” Maharaj’s “changes got lots of media attention, support from foundations and seemed like a good idea. BUT, once she moved on, hospitals returned to their old habits and tasteless – and harmful – menus.”

So where are hospital menus in Nova Scotia now? A healthy diet is critical when you consider that between 50-60% of patients in this province are hospitalized for eight or more months waiting for a long-term care placement. 

Poor nutrition, lack of physical activity (at most patients might be sat in a chair or walk around the nurses’ station), and mental stimulation (think months laying in bed looking at a TV screen) seem to compound the declining health of people waiting placement.

The Gottschall’s experience is featured in The Chronicle Herald of Friday, Nov. 3, 2021:

https://www.saltwire.com/halifax/news/local/dartmouth-man-says-mom-90-suffered-in-hospital-before-her-death-100653668/

The fact that his mother endured a bedsore which he described as “a hole” shows another area where headlines have done nothing to improve care.

Fist-sized bedsores which caused death were the headlines in 2018. Even then the proliferation of bedsores, which are a clear indicator of a failure of care, were a decade-old story in Nova Scotia.

The failures in Nova Scotia health care are not new. They are well documented. The NSHA has promised action on them and then relied on the short memories of the public and politicians to do what it always does. Study the problem, but not act.

These kinds of prolonged failures should constitute a criminal offense.

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No beds, no care

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.

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Curious COVID count and conditions

Today, September 14, the Province of Nova Scotia said 72.2 percent of the population was fully vaccinated. That is lower than the 75 percent required for the province to go to the fifth stage in the recovery.

Since the vaccination count was specific enough to include the .2 percent, I question our numbers. Nova Scotians who received a vaccination – either one or both shots – outside the province haven’t been counted. That’s because we currently have no way of confirming their vaccinations. Or we don’t accept any confirmation from any jurisdiction outside Nova Scotia.

Given the number of people who seem to have received vaccinations, whether travelling on business or to see family or who spent winter at their southern vacation homes (and I know a number of people in these categories who received vaccinations in Ontario, Alberta, BC and Florida) could we have met that 75 percent criteria if these people were counted? 

My second concern is the curious impediment we have to vaccinating people. For some reason hospitalized Nova Scotians are unable to be vaccinated while patients. I know someone who had two hospitalizations in the last month. They spent a total of 14 days at Valley Regional Hospital in Kentville. While a patient he asked about getting his second vaccination and was refused. He was told it would have to be done at a vaccination clinic. There was no mention of getting a vaccination at a pharmacy.

Since pharmacies can also administer the vaccination I don’t understand why a fully accredited hospital with doctors, RNs and pharmacists in-house can’t vaccinate a patient. There are several thousand people in hospital on any day of the week. Vaccinating them would also raise our numbers. It would also seem to make sense. So why isn’t this done?

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To fix the NSHA start with corporate governance

Nova Scotia’s new Premier, Tim Houston, and Health Minister Michelle Thompson are to be congratulated for their swift action on health care. Less than 20 hours after taking their oaths of office they fired the Nova Scotia Health Authority CEO and dismissed the board of directors. 

One can only image how many years our new health minister, a former nurse, has been thinking about what she would do if it were up to her. Let’s hope this era of change is more front-line driven.

I was skeptical about the election campaign platform to re-organize health care. In the last 20 years we have had two major reorganizations of health care. We have also studied, tweaked, changed and modified all aspects of it. And the same problems and issues persist. The one constant has been the health care executives, who have survived changes in government regardless of their on-going performance failures. Until now. So starting with a clean slate is a positive step.

What is worrisome is devolving management to local areas because our history shows an uneven level of and access to care. As I have previously said, localized health authorities were fiefdoms, where the health executives controlled, some suggest stacked, the health boards. Members of three of the previous nine boards told me they were bullied, disregarded and silenced. Plus, with a decentralized system bad decisions are more easily hidden when they are localized.

With this accelerated pace of change, I and those in the medical community I consult, have two ideas for the Minister’s consideration.

The first comes from one of the province’s senior surgeons, who suggests we make health care a Crown Corporation. Ideally, it would be a national organization, but given how impossible it is for the federal government, 10 provincial governments and three territories to accomplish anything (the 2003 National Health Accord they all supported went nowhere) we could scale his idea down to a provincial crown corporate structure. 

This doctor is frustrated by the lack of universal governance in health care and how political decisions factor in to how and where health care is delivered. 

A Crown Corporation for health care is a radical idea, but the doctors and health consultant I mentioned this to are supportive. A retired family physician said, “The current ethical problem and source of difficulty is that government assesses, regulates and insures the services government is said to deliver.” A rural practitioner felt “it certainly bears thinking about.” And a health care consultant said, “It really does reframe the concept.” All were excited by the idea.

While the idea may cause traditionalists in the NSHA corporate headquarters to spit out their coffee, it seems an interesting idea for front-line care givers.

The second idea on reorganization of the NSHA is also about governance. We need an activist board of directors. I wonder how often, if ever, the previous directors said “no” to the health executives? Or have they just been cheerleaders lending legal credence to the wishes and actions of the executives?

The new NSHA board should look less like members of a country club and more like the province. Political parties work to ensure women, Acadians, the First Nation and African-Nova Scotians are represented in the Legislature, so should the NSHA board. We should have dedicated board seats for a registered nurse, a doctor (either in practice or recently retired) and someone from the patient perspective, whether a former patient or involved family member. We need these frontline voices to counter the glowing spreadsheet solutions presented to the directors.

And we should pay directors for their time. It is absurd to put billions of taxpayer dollars in the hands of volunteers. We don’t even trust film classification to volunteers. 

The NS Film Classification Board pays movie reviewers $50 per half day, plus expenses. That rate, like the rates for all of the Province’s agencies, boards and commissions, was established in the 1970s. It’s ironic that the province’s largest single expenditure is overseen by people working for free. We don’t trust film classification to volunteers, so why would be put our health care system, the province’s largest expenditure, in the hands of people who couldn’t review a movie?

By compensating NSHA directors we open up the board to a wider cross section of the province and not just the well-connected. We could bring in the self-employed, for example. Effective boards are more than nice lunch on a quarterly basis, interrupting the rush through an agenda. Corporate directors have four or five days of prep work for each board meeting. That time and commitment should be recognized. And for something as important as health care we need more than the usual generic background of usual government appointments.

As we look for a new NSHA board let’s look outside the small, semi-incestuous pool of Halifax-based directors and recruit people with ideas, questions and experience delivering and receiving health care in this province. We have seen that you get what you pay for.

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Senior advocates expect Tory government to honour their promises

A press release from the Advocates for the Care of the Elderly (ACE) congratulates the new Progressive Conservative government for their election win. And as a reminder of the Party’s promise to seniors summarizes those campaign details.

The press release says in part: “In every election change is promised but it is not often that major commitments are made to senior citizens living in Nova Scotia’s overcrowded, understaffed Long – Term Care system” says Gary MacLeod of The ACE Team ( Advocates for the Care of the Elderly). Post horrendous Covid 19 deaths in LTC the Progressive Conservative Party and Premier – Elect Tim Huston have made significant measurable promises of 2,500 single bedrooms, 2,000 new health care staff, 4.1 hours of care each day and the necessary funding to produce a generational change in how Long-Term Care is provided in Nova Scotia. “There will be relief today among the 400 seniors waiting in hospital for a Long-Term Care Placement. I can image a few tears shed by the 1,000 seniors and their adult children providing care while they live alone at home in precarious situations. For the 20,000 expected to need LTC by 2030 I’m sure they’re seeing this as a good first step” say MacLeod.

Good governance is reliant on political party’s matching their election promises with budgets, legislation and policies. “Thankfully the Progressive Conservatives have provided measurable Long-Term Term Care  commitments and timelines which all Nova Scotians can hold them accountable to” says Paul Jenkinson of The ACE Team.

“The ACE Team is looking forward to working with government  to measuring government progress on commitments made and to advocating for other improvements in Long-Term Care” says MacLeod. End of press release.

ACE are not newcomers to the long-term care issue. They have been involved for almost 15 years. They have first-hand experience, extensive research and a multitude of practical ideas for making the lives of those in care better. A new government would be wise to listen to them, to engage with them and not waste time on more studies of known facts and situations.

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