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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7 Responses to Long-term care investment critical to healthy health care

  1. buddyboy546 says:

    From Canada’s Criminal Code, ¶219:
    “Every one is criminally negligent who in doing anything, or in omitting to do anything that it is his duty to do, shows wanton or reckless disregard for the lives or safety of other persons.”

    It almost fits.

  2. care worker says:

    The staffing issue needs to be fixed first, then expand beds. I disagree that it will save money however, I would think that any money put to solving the LTC issues will just free up beds at hospitals which will immediately be filled. Thus saves no money in acute care. This I believe is why the government is hell bent on doing nothing, to do nothing does not increase costs and it would appear that the only concern is the budget. Until the government accepts the fact that the system is going to cost more no matter what, nothing will get done.

    • I agree that the health care budget won’t decline. I’m not advocating that. When I speak of it costing less, I mean on a per patient level. I struggle to refer to those people occupying acute care beds while waiting for long term care as patients.

      These people were ill, but are now medically stable and able to transfer to a different form of care. Because they don’t need the level of medical care they once had, the cost of providing their extended care would drop IF and when they move out of hospital.

      We have just had a family member move from hospital to long-term care. For eight months they were in a semi-private room in hospital. Their 24/7 care givers were fully qualified RNs. The basic pay for a full RN in Nova Scotia is around $84,000. Plus, because they were in hospital a doctor saw them every day.

      In a LTC facility the care givers are paid $18/hour, roughly $31,000/year about 40% of an RN salary. Plus the hospital doctor is diverted from attending to a sick person. Throughout the hospital most staff are unionized and therefore are paid slightly more than the staff in privately-owned LTC facilities. Because of universal care, the government is paying for that patient’s/waiting person’s care.

      When that person moves to a LTC facility, lower-paid staff are looking after them. A doctor may seem them once a week vs seven times a week. Plus, the individual contributes to the cost of their care. A low-income individual would pay approx. 80% of their pension income towards their care and the government tops up the rest of the cost, which is about 2/3rds of the monthly sum. If that individual has the financial ability to cover the monthly LTC costs, then the government is saving roughly $3,000/month over the minimum hospital costs.

      So my point is it’s foolish not to pay the LTC care givers more money to make it a more attractive career option. With more LTC employees we could open more beds. And with a few more LTC homes plus all existing beds open we could free up 700 acute care beds for people who have a real medical need. We would reduce the backlogs in ERs. We wouldn’t have designated hall spaces for patient beds. We might even speed up some treatments and surgeries and relieve pain and suffering faster. The system would start to function as it was designed to.

      Non-patients occupying hospital beds are also being cheated out of quality of life. LTC homes have social programs to enrich the lives of their residents. Acute care hospitals are not designed to provide these life-enriching programs. Medical staff have to be ready for medical issues and can’t, as much as they would like and are willing to, provide the entertainment and social activities that these people deserve.

      My point on costs is that we’re paying more for less all around.

      • care worker says:

        In a gov subsidized home pay rates for ccas are a bit higher maxing out at around 18.80 per hour, that would be the normal home, they are also unionized and it works out to around 38 to 39 grand a year. plus benefits like pension plans health plans etc but yes dramaticly cheaper. my point was that all those hospital beds would still be full because of the backlog in the system for everything from surgeries to god knows what. Any expansion of ltc is just costs on top of costs. Also the quality of care in homes is decreasing because they cannot keep staff. the turnover rates are so high that consistency of care is impossible and most leave before they get good at the job. the places have become revolving doors of staff. both CCAs and registered. I am not trying to be disagreeable if that is the perception, I personally believe that the message you are sending is vitally important.

      • I don’t think you’re being argumentative. The reason for this blog is to voice ideas and hear from front line workers, parents and families – those people who haven’t been heard by politicians and health executives.

        I have spent a significant amount of time in LTC facilities. I know people who work in them. I know about the high turn over. I believe if we paid $2 – $4 more an hour we could cut down on that staff churn. That would save the facilities money (it costs to advertise, interview, train and bring people up to speed) and be better for residents. If facilities weren’t so understaffed, the quality of programming for residents could improve.

        My goal is quality of life and care for those in need of long-term care and those requiring short-term acute care. If those 700 hospital beds were open, more acute care patients could be seen and backlogs, which create suffering and angst for families, would be reduced.

  3. peter loveridge says:

    for 10 years the government has being trying to perpetuate the myth that all elderly people can be cared for at home. Well, in my world, I have dozens, if not hundreds of elderly couples in their late eighties more or less getting by supporting each other. Now consider if one of them gets something major, like a fractured hip or a stroke. You really think the other, equally frail partner can get the recently disabled one on and off the toilet? Well, someone from home care may come but virtually never at night. Any children likely in their 60’s and may be in Alberta. In addition, I have some patients who are seriously rich , and though money is not a problem, they can’t find caregivers at any price. In this situation the ER becomes the nursing home of last resort. The red tape for nursing home admission takes months ( not us, the papers are filled within 24 hrs) and the whole thing just makes the teeth grind

    • care worker says:

      I agree with you, the idea that everyone can stay at home would work if it was 1955 and grandpa or grandma moved in with the kids, and mom did not work etc. The reality is that folks have their kids later now and both parents have to work, so filling in all the hours that homecare does not cover is impossble and just leads to the care giver needing to be cared for or actually needing a home themselves.

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