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.
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.