Long-term care plan framework already exists and has for years

In response to the advocacy that has presented the acute need for modernization of long-term care in New Brunswick for nearly 20 years, the current government has assured the public we will have a plan. Many months ago, they announced “the plan” would be created with the assistance of a committee that apparently includes the Minister of Social Development, Minister of Seniors, deputy minister and at least one assistant deputy, the CEO of the Coalition for Seniors and Nursing Home Resident’s Rights, the four members of the Long-Term Care Alliance. This committee is apparently supported by several of the civil service support staff and directors along with some consultants.

We have not yet heard when “the plan” will be approved and released. Meanwhile, in response to the continuing crisis created by the huge volume of alternate level of care patients, the health authorities continue to struggle to find short-term “fixes”.

This all seems very odd. When presented with an issue of this importance and significance, and with the volumes of good information submitted to government by various groups over more than a decade, getting a serious plan should not be rocket science! Nor should it require months and months to create.

Given the situation, what would a plan look like and what should its key elements be?

Before anything is the clear, convictional, motivating and inspiring statement of vision… what kind of long-term care system is the dream for New Brunswick? That would be a first amongst the many plans created for long-term care and published in our province.

Then always start with the facts: what do we know? Volumes have been written by respected agencies on the issue of the demographics, the current and projected case volumes for long-term care. The NB Health Council has a ton of data; national bodies including the National Institute on Aging also have much data. A good researcher could tell us all we need to know in days as to service need now and over the next two decades.

That is followed by a careful analysis and inventory of services currently available in all the elements of long-term care. What is the volume of service available by service level requirement? With work already done or in progress, that should not take more than a few days. This needs to include a realistic examination of home care issues, level 2 issues, level 3 issues, and level 4. With all that has been written and submitted previously, that should not take months. A few weeks, maybe?

Then you go to a careful analysis of current systems and structures that contribute to service: assessment processes, primary care level of support, all the sources of pre-institutional care accessed by seniors and persons with chronic diseases. That is not months of work.

At this point we should have clear insight into current and forecast gaps in essential services. If done correctly, it should open serious review and discussion of service options, service efficiency, productivity.

Having done that, we would turn attention to strategies to fill the gaps. Conventional thinking likely would result in “build more nursing homes” but the process must not fall into that trap. Nursing homes are the most expensive of all long-term care options and, as the National Institute on Aging advocates, we need to put huge energy into making it possible for persons to remain at home with efficient access to the supports they need to do so. This is not rocket science and should not consume months of pondering.

By this time, it will become very clear as to what should be the content of a Long-Term Care Act and that needs to be fasttracked. While the legislative framework for long-term care has been flawed for decades, it took on new importance with the Lamrock Report in 2023. Apparently, there has been progress but it does not yet seem to have hit the Legislature Order Paper.

A serious, fact-based assessment of the processes that enable persons and their families to access services is decades overdue but must be done. That is not rocket science, either, but requires new skills at the table. The debate on “system navigation” has gone on for decades and despite assurances and attempts to improve, it does not get better. Try something new, innovative.

Any plan that fails to deal realistically with human resources issues is doomed at the outset and New Brunswick has had a spotty track record in that area. If this is to be useful, it will explore the various strategies to encourage careers in health and long-term care in addition to developing serious standards of management of health human resources. Again, there has been so much written and submitted on this for years that strategies should not evade the planners for more than a minute. This must be done carefully and thoroughly with all the facts on the table this time. There are some key elements that have not been part of previous “reviews and pronouncements."

Having worked through these steps, the issues should become clear but only if there is a discipline to deal with facts as opposed to perceptions. Getting to this point, it should be getting clear what can/should be done immediately to provide a measure of relief for the ALC cohort. The immediate growth curve for ALC’s must change rapidly and it is possible but not without some change. It has always amazed me to see what happens when you get seasoned, experienced people and regulators around the same table with a common goal. The missing link has always been “the common goal.” Government staff have their needs and agenda, service providers come with an agenda that is seen to be different, although it really isn’t. That communication gap needs fixing before any of this can work much less result in improvement.

I hope and pray government can do this. But please do not continue to use the “it’s going to cost a fortune; we already have a big deficit” blinder. If done properly this could result in more efficient and effective use of resources and we will never know until we decide to fish more than we cut bait!

Ken McGeorge, BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or www. kenmcgeorge.com.