Health questions for campaigning virgins

An election campaign is a time when strangers come to our doors pretending to be virgins. They have no negative past and are full of promise. They are sure they can do better than others.

Can they? In Nova Scotia all three political parties have formed government. So, if and when they speak of health care, ask them what they and/or their party did when they were in office.

Here’s a list of who was in office, when:

Premier GI Smith (Progressive Conservative) 1967 – 1970

Premier Gerald Regan (Liberal) 1970 – 1978)

Premier John Buchanan (Progressive Conservative) 1978 – 1990

Premier Roger Bacon (Progressive Conservative) 1990 – 1991

Premier Donald Cameron (Progressive Conservative) 1991 – 1993

Premier John Savage (Liberal) 1993 – 1997

Premier Russell MacLellan (Liberal) 1997 – 1999

Premier John Hamm (Progressive Conservative) 1999 – 2006

Premier Rodney MacDonald (Progressive Conservative) 2006 – 2009

Premier Darrell Dexter (NDP) 2009 – 2013

Premier Stephen McNeil (Liberal) 2013 – 2017

For over 30 years the water at the VG was so toxic it is not fit for human consumption. You can’t even wash your hands with it. The only thing you can do with it is flush a toilet.

Ask those seeking office why their government allowed that to continue? Why wasn’t it fixed right away?

The Dartmouth General Hospital was built in 1976. But it was not finished. Until now three floors were left empty. Why?

Ask them – and yourself – why you would trust their party to form a government when in the past they were content to let these issues exist.

Some people see an election as a time and way to punish someone for a poor medical experience: the inability to find a family doctor, a wait for a hip or knee surgery or other treatment and/or for hours spent in an ER.

We are always mad at the government of the day and in our anger/frustration we forget why we rejected another party and voted for change. But do we get the change we think we’re getting or are promised?

The people who run the daily delivery of health care – the health executives – are the ones we should be angry with. We vote for change and get the same old care. For decades the same complaints have existed. The one constant over the years are the executives. They’re the ones we should be angry with. It’s cause and effect.

In an appearance on the CBC, The Globe and Mail’s health care reporter, Andre Picard, says issues in Canada’s health-care system is not in the medicine, but in engineering and administrative problems. “We don’t often make that distinction. We think we can cure what ills our system by just throwing more medical bodies at it.”

You can hear him here:

http://www.cbc.ca/radio/thecurrent/the-current-for-april-24-2017-1.4080024/canadians-too-accepting-of-mediocre-health-care-says-andré-picard-1.4080068

Picard says politicians do a lot of firefighting, fixing small problems without actually overhauling the system and making drastic change.

Nova Scotia has undergone radical change. We have merged nine health silos into one provincial health authority, which has cut some administration (not enough) and is working at coordinating resources. For example, over 670 patients were given the opportunity to travel outside their home health district to have knee surgeries. That saved them a long wait. We still have a waiting list, but now we’re using all provincial operating rooms and surgical teams, where in the past these facilities were under utilized. Prior to 2015, patients were given no such an option. That fed the long surgical wait times.

The other frustration comes from expecting a quick fix in terms of hospitals. Everyone knows the VG is a disaster in terms of problems with the building. That’s due to consecutive governments and health executives doing nothing to address major maintenance. Instead, we had window dressing and deferred maintenance.

In 2016 CBC reporter Jean Laroche asked the six previous health ministers why nothing was done to fix the water situation at the VG. All six said Capital Health never asked for money to repair the water problem! That is outrageous. How could health executives not ask to have the water problem fixed? And why weren’t they dismissed for such oversight? Conversely, how did ministers and governments not know there was a problem?

It’s worth remembering that when today’s opposition parties were in government they did dick all to fix the problems that still vex Nova Scotians. In the campaign-induced virginity parties and candidates don’t explain their inaction and acceptance of the status quo. Make them.

Vote for who you wish, but when they come knocking on your door promising the world, ask what their party did when they formed a government? Political memory is convenient. In December 2009 there was a brief health care strike. It lasted a few hours in the middle of the night. From the outside it looked like the best case scenario. But what was missed by the public is the disruption. In the weeks leading up to the strike surgeries and treatments were cancelled and delayed. Hospitals only took in the most urgent medical cases because no one knew who would be available to treat patients. After the labour situation was settled, it took in excess of three months to sort out the delays and cancellations. Then we almost had a paramedic strike, which was ironic given the then Minister of Health had been a paramedic.

Another on-going issue is doctor availability. One study says Nova Scotia needs 100 new doctors a year. Between April 1, 2015 and April 1, 2017 the province hired 177 new doctors. Just under the target. Of those only 71 were family GPs, the 106 others were specialists.

There are doctors willing to work in the province, but the rigidity of the Nova Scotia Health Authority (NSHA) in approving doctors for practice has been the roadblock. NSHA has a plan to open 74 Collaborative Family Practises across the province. It is, as Doctors Nova Scotia says, an aspirational vision. To achieve this goal, NSHA has resisted approving new doctors for solo or non-collaborative practice. There is hope that the authority is going to loosen the reigns to allow more doctors to establish hybrid practices with the idea it will be merged into a collaborative centre as they open. That would go a long way to serve Nova Scotians.

It may make the blood boil to learn that the Canadian Institute for Health Information says that as of 2015, the last year for full statistics, Nova Scotia has the highest number of physicians per person in Canada. Nationally, the average is 228 doctors per 100,000 population. In Nova Scotia there are 261 physicians per 100,000 people. Newfoundland has 243, Quebec 242, PEI 181, Saskatchewan 196 and Manitoba 204.

The Nova Scotia numbers might be skewed by the number of specialists. But it’s a competitive world when it comes to hiring doctors. In the U.K. two in five GPs are planning to quit their practices. The U.S. is facing a doctor shortage. Same for nurses. We’re competing internationally for medical professionals. The quickest fix is for NSHA to open up their regulations. Again, that’s for the health executives to do, not politicians. So direct your anger and frustration at the right group.

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Failing figures for hip and knee replacements

The Canadian Institute for Health Information released its latest annual wait-times report. Supposedly Nova Scotia has improved over the last five years on wait times for five priority procedures: hip replacement, knee replacement, hip fracture repair, cataract surgery and radiation therapy.

http://www.cbc.ca/news/canada/nova-scotia/hip-knee-replacement-wait-times-1.4044037

It’s a curious report. The numbers are for a five-year period from 2012 and 2016. If you check out the CIHI website for hip fracture repair, cataract surgery and radiation therapy the response is “no data available”. So how do we know those wait times have improved?

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-1-Western#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-2-Northern#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-3-Eastern#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-4-Central

As for hip and knee replacement, this is a story of cause-and-effect. The CIHI says the Nova Scotia Health Authority’s (NSHA) Zone 4, the Central Zone, is doing well. Results are poorer in Zones 2 and 3, with the worst in Zone 1.

Zone 1 is the South Shore, Yarmouth and Valley. In 2012 the Annapolis Valley District Health Authority (AVDHA), which was overseen by CEO Janet Knox and VP Medicine Dr. Lynne Harrigan, lost the services of Dr. Veljkovic, who was an orthopedic surgeon specializing in foot and leg surgeries related to diabetes. Dr. Veljkovic travelled this area, seeing patients in Kentville, Middleton, Yarmouth, Shelburne and Bridgewater. She left to practice in Ontario because AVDHA didn’t request funds to pay for her services! There is a quota which says AVDHA should have five orthopedic surgeons. Dr. Veljkovic was the 6th, so the health executives took to a strict bureaucratic stance to pay for five surgeons not six. Obviously, the need for such services is greater than the surgical quota suggests.

In Pictou, which is in the underperforming Zone 2, they also lost an orthopedic surgeon because the pre-merger health authority wouldn’t provide sufficient operating room access. It was a budget-stretching move. That surgeon moved to Florida with his wife who happened to be a family physician.

According to the Auditor General’s 2014 report, which relied on CIHI information, Nova Scotia only met national benchmarks for hip replacement 58 percent of the time. That’s a 42 percent failure rate. For knee replacement the failure rate was 57 percent.

Using the just released CIHI figures, Nova Scotia’s average success rate for meeting national hip replacement benchmarks is 56.75 percent. That’s a 43.25 percent failure rate. In 2014 only 43 percent of knee replacements were done to the benchmark. The current figures show this has slipped to 40 percent. Nova Scotia might be doing better than 2012, but we’ve slipped from 2014.

This is disappointing and confusing. Since the province-wide collaboration of facilities from the merger of health authorities, patients have been given the option of travelling to places like Amherst to have their knee replacement done faster than waiting for a surgical time closer to home.

We’ve assembled the provincial resources to give patients choice, the government has put additional money into orthopedic surgeries and we’re still lipping along when it comes to providing the level of health care Nova Scotians deserve. It proves what researchers, consultants and studies have been saying: money isn’t the only issue when it comes to delivering better care. The problem has to be management.

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Fresh blood

Officially, no one seems to know how many Nova Scotians are without access to a family doctor. Dr. Lynne Harrigan, VP Medicine for the Nova Scotia Health Authority (NSHA) recently suggested that 25,000 people could be without a doctor. Those are the people who put their names on a list maintained by the NSHA.

Other reports say 95,000 Nova Scotians may not have access to a family physician. In a curious summary Harrigan said the province was “struggling” to attract doctors to the Halifax Regional Municipality, but done well in recruiting for rural-based practices. That’s a different message than we’re usually told. Normally, the message is it’s hard to get doctors to go to rural areas.

Whatever the message, people in the medical community people are placing some of the blame on the doctor shortage to the NSHA’s reluctance to accredit doctors for solo practice. The NSHA is so fixated on their CCC master plan that they are ignoring requests by doctors willing to go solo.

As for recruitment how successful is it? And are we too limited in our search area?

World events are causing a flood of western-trained and/or accredited doctors to search for new places to practice.

For example, in February the British Medical Association found that 12,000 doctors trained in European countries could quit the UK because they feel less welcome following the Brexit vote.

https://www.theguardian.com/politics/2017/feb/23/thousands-eea-doctors-may-leave-uk-after-brexit-survey-bma?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+main+NEW+H+categories&utm_term=214567&subid=12294947&CMP=EMCNEWEML6619I2

In the U.S. Scientific American says that 8,400 doctors in practice are impacted by the current executive order regarding travel by citizens of seven Middle Eastern countries. And, given recent attacks on Indian engineers who were mistaken for Arab nationals, a further 50,000 doctors from India and Pakistan may be reconsidering their future in the U.S.

These add up to 70,000 trained, accredited physicians who may be ready for career change.

They speak English and have qualified to practice in comparable medical systems so would seem a ready pool to tap into. We offer personal and professional stability, a pleasant place to live and easy access to the rest of the world so foreign-born physicians can travel to conferences or visit family without fear. Are we considering pitching them?

Even if only a small fraction expressed interest this pool of talent could go a long way to providing a fast fix to our shortages.

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Hospital beds for stormed-stayed staff

On a sunny day like the ones we are experiencing in late February it seems odd to speak of stormy weather, but it’s still winter and who knows what kind of late winter or spring storms can hit?

Pioneer House is a former doctor’s home directly behind the Valley Regional Hospital. It sits empty, when it could be used for emergency staff accommodations. (Allan Lynch Photo)

Working in a storm is hazardous. It is confounding that on days and in weather conditions when the RCMP ask people to stay off the roads, health workers are still expected to come to work on time for their shifts, with no allowance for additional travel time or flexibility for when roads may be cleared and with no provision for safe storm transportation.

I’m told that hospitals have asked staff sleep over for the storms. Even though most hospitals have no spare patient beds, ambulatory care spaces are open to staff who are prepared to sleep on-site.

It’s not a highly appealing proposition for those whose shifts end at 3 pm and who are not scheduled to work again until 7 am. I’ve heard that one worker at Kentville’s Valley Regional Hospital was given a stretcher to sleep on that so aggravated her sciatic nerve she has had to take three weeks off work to recover.

The other confusing issue about staff sleeping over concerns meals. At Valley Regional the cafeteria is only open until 2:30pm weekdays and is closed weekends and holidays. There is a lobby kiosk providing cookies, coffee, sandwiches and soup that’s open until 7:30 pm weekdays and 6 pm weekends, but after a day of physically demanding work, that’s hardly substantial. And, staff staying in the hospital are expected to pay for their meals.

I also understand that in an earlier February storm a Cape Breton health care worker was involved in an accident and died on her way to work.

Even doctors are finding it difficult to get to the hospital or finding nearby accommodations on storm days. This impacts patient care because some treatments and surgeries have to be postponed due to the uncertainty of the surgeon, specialist or other professionals from getting to the hospital. There has to be a better, formalized plan to provide emergency accommodations – and meals – to stranded workers than pulling out a stretcher or expecting staff to sit in reclining chairs. In the days when we had teaching hospitals staff accommodations where only across the parking lot. People could safely walk to their shift or an emergency.

Ironically, Valley Regional Hospital is on the grounds of the former Nova Scotia Sanatorium in Kentville. The Sanatorium was a self-contained community with hospitals, post office, shop, fire department, gardens, two sets of staff accommodations and substantial houses for Doctors Miller, Quinlan and Holden. One of those houses remains. It’s called Pioneer House and sits in the woods directly behind the hospital.

Pioneer House has been used to provide accommodation for four or five patients in therapy. It has hardwood floors, a fireplace and a large, newish, substantial deck on the back. Now, like so many publicly-owned buildings, it’s left to deteriorate. This is a perfectly good, solid house that shouldn’t sit empty all winter, with windows partially open – as seen in the photo – as if to help speed the deterioration and perhaps provide justification for demolition. This is public property that could either be made into a clinic or provide staff accommodation for weather emergencies or visiting specialists.

Across the front parking lot from Valley Regional is a facility known as Fidelis House (http://fidelishouse.ca). Fidelis House was a project of the Kentville Lions Club. It essentially provides inexpensive accommodations ($20 a person), for family and friends of hospital patients. It is open 363 days a year and staffed 24/7 by volunteers. At various times student doctors and other visiting specialists have asked for a bed at Fidelis House. Fidelis House’s mandate is to the patient family, not the medical professional.

There is a need for close accommodations for medical and other staff, so why not utilize a solid property that is a 100 metres from the hospital’s rear doors?

To let this house fall into a state of disrepair is arrogant, wasteful and disrespectful of public property. If we looked around the province, how many other publicly-owned buildings are sitting empty and being allowed (encouraged) to deteriorate to the point where they are too far gone to restore? Executives in each authority should be held personally responsible for the wanton waste of such an asset.

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Stop politicizing health care

Universal health care is so important that it is considered part of Canada’s national identity.

It is the largest single expenditure of any government, consuming an average of 40 percent of provincial budgets.

I launched this website when I did because it was outside of an election campaign. I wanted us to have a reasoned, sustained conversation about health care that was more than the clichéd campaign race to see which political party can out promise the other on spending.

Until I became exposed to our health care system, I, like many Canadians, believed that health care would be fine if only it were properly funded. When I stopped grumbling about funding and started to listen and think I realized money wasn’t the answer. Otherwise we would have bought our way to good health. Over and over again, every study says the problems and issues with health care are greater than money.

Former TD Bank economist Don Drummond, who studied Ontario’s public service came up with a 100-item list for improving the province’s health care. He wrote, “Among those we talked to, none who manage parts of the system argued that more money alone is the solution to the problems of the health care system, including the ones they face. Indeed, some argued that the system is now well funded and that too much money would simply impede needed reforms. Certainly, the evidence of the recent past is that more money — political rhetoric notwithstanding — did not buy change, only more of the same, at higher cost.”

More recently, Dr. Danielle Martin, of Women’s College Hospital, Toronto, has written a book, Better Care, in which she agrees money isn’t the issue.

One of the long-term problems with health care is political opportunism. Political opportunism has cheapened the health conversation. It trivializes the issues around health care to a simple cheque-writing solution rather than making difficult decisions to address long-standing problems. Politicians have talked and campaigned as if they had no memory of what they or their parties did or didn’t do. In part, they can do this because the public memory is short and easily swayed by the headline du jour. U.S. Senator Strom Thurmond said, “If you say something three times in Washington it becomes a fact.” Many Canadian politicians operate on this premise, conveniently forgetting, ignoring or altering facts and history to their purpose.

The latest example of politicizing health care is a television commercial being aired by the Nova Scotia New Democratic Party. The new NDP leader, Gary Burrill, criticizes the current government’s austerity plans and says he believes “… there is a lot we can do. We can invest again in our hospitals, schools …”

The problem with this message is Burrill implies that the current government has done nothing by way of investment in hospital construction. His political message ignores the investments made by the current government in actual hospitals, in collaborative clinics and in realigning of the delivery of care throughout the province. Specifically, this government is mid-way through a major refurbishment and expansion of the Dartmouth General Hospital. Floors that sat unused for 30 years are being brought to use and a surgical tower is being added to the hospital. There is also a $6 million refurbishment underway of the Canso Hospital. Millions went in to the VG’s Centennial Building to repair damage done by flooding. There are more investments coming to the QEII, and a design team have been hired to plan a replacement for the VG. The final design will depend on the other metro medical investments. After 20 years, Valley Regional was given a timeline for a palliative care unit. And the current government is proceeding with plans for a dialysis unit announced by the NDP in 2012. Those are the tangible investments.

The current regime have made announcements for several collaborative care clinics. Now, Health care announcements are always dubious. In 2011, the NDP announced $1.5 million to study the future use and disposition of the VG. As we learned from former Finance Minister Graham Steele that study was to find a more palatable option than the $1 billion solution proposed in a study commissioned by the government before them. The NDP didn’t have the money and didn’t like the optics of such a grand plan, so they resorted to the safety of a study. The results of the study the NDP commissioned weren’t publicly announced, just quietly posted on a backpage on line. The plans, which no one was acting on, where shelved by the 2013 election.

On November 28, 2012, the NDP announced the construction of a new dialysis unit at Valley Regional Hospital. Only after the initial happy headlines was the public told it would be two years before the unit opened. That didn’t happen. Four years later the current government announced construction would start in 2017 and the unit would open in 2019.

Burrill’s suggestion that “we can invest again in our hospitals” ignores that when his party was in office no hospitals were built, refurbished, expanded or planned. The Truro hospital opened in 2012, but that project was done under a previous government and was two years late in opening, so should have had a Tory doing the ribbon cutting. Burrill’s message ignores what is being done now to fortify the bricks and mortar aspect of the health system.

As for doing anything for people, his predecessors reduced the number of teachers in Nova Scotia, cut $15 million in funding to classrooms, took 102 weeks to negotiate 104-week nursing contract, had a short health care strike (it only lasted a matter of hours, but caused months of disruption in scheduled care) and, according to Steele, twice legislated health care workers back to work.

On the subject of senior care, the Advocates for the Care of the Elderly (ACE) complained to the previous government about putting 600 new long-term care beds on hold. These beds were part of the previous government’s initiative for continuing care.

In January 2013 ACE wrote a letter to then Minister of Health David Wilson, which concluded, “In my opinion putting new nursing home beds on hold is placing a huge burden on the shoulders of caregivers without any thought of their well being, all in the name of the almighty dollar. I am beginning to believe that by not creating the new nursing home beds that it is a form of warehousing of the elderly in a hospital setting where they are forced to pay “rent” while waiting for a nursing home bed creating a source of revenue for the hospital. The government, in turn makes cuts to funding, as hospital revenues rise from other sources. This has been evident in the past two years where funding has been cut by hundreds of millions of dollars … Taking all what I have stated into account, it appears that our NDP government is probably the most anti-elderly government we have ever had.”

The two years of cost-cutting were done by the NDP.

Burrill seems like a nice man, but this message is disingenuous and disappointing because we’re back to politics as usual. Power for some, pain for many. Nova Scotians deserve better.

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Winter care and rural care

This week I heard from someone who works in a provincial nursing home. I am told staff are worn out because fresh staff haven’t been to get to work and since many of those who worked through the blizzards haven’t been able to get home they are sleeping on-site. That is the only way many can make their shifts and cover for those who can’t make it to work.

Care givers are exhausted. I’m told that because of the physical and emotional strain of being on duty 24/7, morale is really low.

Low morale is something I heard about last weekend while doing pre-storm shopping. Another caregiver, who works in a long-term care facility, said with cutbacks she only has 15 minutes with each resident. She can’t spend time with the residents to chat or hold a hand. And it’s ripping her heart out when she can’t sit a few minutes with an elderly person who is in tears. This is a woman we want in health care. She is totally dedicated to the resident, she’s a hard worker, someone who would crawl over broken glass to get to work, and is willing to do more than the basic outline of a job description. Her work has so changed it’s hurting her soul. Bureaucrats won’t understand that. And that’s one of the biggest impediments to the delivery of care.

If those who work in a defined space, like a nursing home or long-term care facility, who have colleagues on-site and back up, are demoralized and burned out, how must home care workers feel? How burned out are they attempting to delivery care in blizzards to homes which are buried in snow for days? Where I live many able-bodied people couldn’t get out of their homes or yards for four and five days. How do frail and fragile people in rural areas who need home care cope? They can’t clear paths and drives. The isolation must make many fearful.

One home care worker I met told me of his fear of winter driving. Of the challenge his night blindness presents. And having to shovel his way into homes. That takes away from the time he has to deliver care.

The health conversation is about keeping people in their homes. But it is a misdirected conversation? Are those in their homes really committed to that particular house or do they see it as their only option for avoiding an institution? Maybe their real desire is to stay in their home community, which is familiar, and where they have family and friends?

In rural Nova Scotia there isn’t a lot of rental accommodation. What there is is usually a large house. But drive the province and it’s obvious we have a lot of vacant and/or surplus public buildings, like schools. I’ve proposed this before, why can’t these buildings be converted into senior housing?

As I drive the Walton shore I see a low, abandoned, flat-roofed, brick school building. It looks like it was built in the 1960s or 70s. It’s boarded up. It is not used. If the walls and floors are solid, why can’t it be gutted and classrooms converted into self-contained apartments for seniors. As a former school it would have wide halls and is on one level, so it would work for those with mobility issues. The land around the school is level, so in spring, summer and fall it would provide an opportunity to get outside. It would provide social options so residents aren’t isolated. The chance for socialization and some movement might add to overall health. And a cluster of seniors would make delivery of care more convenient. Each resident could pay a modest rent to cover building operations. It might even become a type of social hub or modest economic contributor to the community.

Why not employ some of these buildings as a pilot project as a new alternative for rural seniors and senior care? Cost would be marginal. What have we to lose? Given how we are burning people out, we have to be innovative.

No doubt there is a small army of experts in Halifax to say why this can’t work, but these same experts haven’t faced caregivers or the people receiving care. I doubt they have even driven the province. The experts rely on spreadsheets, not real people and real situations.

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What’s the storm plan?

The Maritime Weather Agency’s graphic is amusing and prophetic.

While the province is basically closed, health care soldiers on. Hospitals can’t close, though16711783_1550745341621672_96955325820078773_n non-emergency treatments are postponed.

There’s a history of the Nova Scotia Jeep Club’s Severe Assistance Team generously providing transportation assistance to essential personnel so they can get to their shifts at the various Halifax hospitals.

While doctors and nurses get the attention, support staff in Halifax and around the province still need to get to work. In addition to the medical personnel there are those who cook, clean, sterilize equipment and perform the other support services that keep a facility functioning.

Another group who need help doing their job are the thousands of caregivers who travel to provide care and support to people who are sick, infirmed and in recovery at home. There are thousands of such people around the province who receive care at home and not in a hospital or long-term facility. How do these caregivers make their calls? What contingency plans have the Nova Scotia Health Authority for poor weather situations like today?

There has to be a way to safely deliver caregivers to their appointments. But is there a set plan and resources in place or do we operate on an ad-hoc basis? We can’t expect volunteers to step in to provide a service to the thousands of caregivers who may be on the roads in such miserable conditions. Days like this have to be stressful for the person who receives care, for their families and for the caregiver. If anyone knows anyone who receives care, it’s important to check on them so they don’t feel abandoned.

Additionally, families who are in discussions about long-term care for themselves or a loved one should specifically ask how care is delivered on storm days.

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