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No senior should have to live in a hospital

We believe no senior in New Brunswick should have to call a hospital “home.”

This is one of three major issues we hear from our patients. The other two are the need for more family doctors and emergency room wait times

On any given day in New Brunswick, over 300 seniors are stuck in a hospital. Trust us, they don’t want to be there, but there’s no safe place to go. We call them “Alternate Level of Care” patients, and most of them have arrived at the hospital because of a health crisis – they’ve fallen or they are in a state of delirium, for example. They landed in the emergency room, were admitted, and now need to go somewhere else.

While some of these patients can go home with the right supports, or even to special care homes, the fact is that you’ve got to be pretty sick to get admitted to a hospital bed in New Brunswick these days. Most of these seniors who are stuck in the hospital have a number of health conditions, and the best place for them to go is a nursing home. But with one of the ‘oldest’ populations in the country and demand for nursing home beds at an all-time high, wait lists for nursing homes are very long.

Why is this important?

Nobody wants to be in a hospital if they don’t want to be there. For seniors, it’s even worse: infections like C.Diff and MRSA can be lethal, and patient health sometimes worsens due to lack of social and physical activity. Hospitals are designed for people who get very sick and need to truly recover, not for people who are waiting. Beds being used for ALC patients also can’t be used for others who really need them, like the many people stuck in emergency rooms (see our other fact sheet). This is incredibly expensive, especially when you consider that 25% of all beds in the province are occupied by ALC patients, and that we have one of the oldest populations in the entire country.

The current challenges

It’s not a grandmother’s fault that they’re stuck in a hospital. To call them a “bed blocker” is nonsensical – it’s our processes and resources that form bottlenecks in our system. We’re the blockage, not them.

  • Some patients could easily be described as living in the hospital. Some having been waiting for nursing home placement for over a year. In some of our hospitals, the average number of 118 days waiting for placement in a nursing home actually becomes an average of 4 months.  
  • These beds are the most expensive way to deal with this problem. Government reports say we could save $37-51 million annually by reducing our ALC length-of-stay.
  • Our processes are dysfunctional. Even getting the assessment for a senior’s needs after discharge is tough. The wait now stands at 54 days – again, just to get the assessment.

Grandparents shouldn’t live in hospitals. Our seniors deserve better in the twilight of their lives.

Ensuring seniors have access to the right care is a complex problem that requires the Regional Health Authorities, the Departments of Health and Social Development, and care providers to work together. To get our grandparents and parents out of the hospital, we need concrete action to:

  • Eliminate redundant processes and bureaucratic delays between the Department of Health and the Department of Social Development.
  • Expand the reach of New Brunswick’s incredible Extra Mural Hospital program to ensure seniors are supported to live safely and happily in their homes as long as they are able.
  • Implement the Drug Information System to help providers avoid the dangers of polypharmacy and associated drug interactions.

There are good things happening which need political support.

The recently-published Home First Strategy contains a number of good ideas and focuses on the group of seniors in hospitals who could go home with increased supports. It also tries to prevent seniors from being admitted to the hospital in the first place. Those are good steps, but doctors know they deal with a tiny proportion of ALC patients. Most ALC patients are too sick to go home, even with help.

The government has also handed out more licenses for special care homes and is renovating and expanding a number of nursing homes.

Our signature priority to fix the rest of the problem is this: the best way to get seniors with complex health needs out of hospital is to give them somewhere better to go. While some can be diverted from long-term care, the plan and simple truth is that we need more nursing home beds in New Brunswick.

Not all nursing home beds are the same. Special care home beds are quite valuable for a certain segment of the population, and there has been a lot of attention on them in recent years. But for many patients, nursing home beds are the best fit.

We are far behind the national average on the number of nursing home beds we have. Our population over 75 to nursing home bed ratio is between 79 and 81.  To get to the recent national average of 94 would require 800 new nursing home beds. 

To address this shortage, the province is already building 350 beds, which is a good start.

We continue to ask politicians and health system leaders to adopt a priority of building 120 new nursing home beds annually until the end of 2018. This would take care of the current wait list for nursing home beds across the province – though every year as our population ages, demand will grow.

We expect this improve the lives of seniors across the province and would end the problems associated with ALC pressures in our hospitals.

To build these beds across the province, there is a considerable capital investment required – but would also save tens of millions of dollars annually in the hospital system. To build a 60-bed nursing home costs approximately $15 million. An annual capital investment would be $30 million for each of the four years, and additional operating expenditures would cost $28 million annually.

The return is generated through savings in the hospital sector. By simply reducing our ALC rates in Regional Health Authorities to the Canadian average, the Department of Health’s own report found that they could save $37 million annually. This would more than make up for the additional operating expenditure in the nursing home sector.