This op-ed was originally published in the Edmonton Journal on November 3, 2010
Op-ed by Noel Somerville, Public Interest Alberta Seniors Task Force chair
In his Sept. 30 letter warning about the potential "catastrophic collapse" of emergency care in the province, Dr. Paul Parks points to the principal cause: lack of long-term care (nursing home) beds to accommodate seniors who are blocking hospital beds while awaiting placement.Parks, the president of the AMA's Section of Emergency Medicine, underlines the seriousness of the problem when he notes that more than 50 per cent of emergency beds in big-city hospitals are filled with seniors and others awaiting transfer to long-term care.
Dr. Felix Soibelman, President of the Edmonton Emergency Physicians' Association, also highlights the nature of the problem when he says the government needs to provide "the right kind of long-term care beds…places that provide ongoing nursing care."
What the government has actually been doing is precisely the opposite of what is needed. That is, it has been subsidizing the building of supportive and assisted living facilities that don't come under the Nursing Home Act and, consequently, where proper nursing care is not available. Such facilities are not part of the solution; they are part of the problem. When a resident falls, the fire department is called in to lift them because no one on staff is trained to do that. When a resident takes a turn for the worse, EMS is called to ship them off to the nearest emergency department.
The government seems simply unwilling to understand the distinction between the facilities it is providing and what is urgently needed -- properly staffed and operated nursing homes that can provide the care needed by:
- Seniors who are cognitively impaired or suffering from some other form of dementia requiring constant monitoring;
- Seniors who are chronically ill and require high levels of nursing care;
- Seniors who are profoundly frail and need help getting out of bed, bathing, toileting, dressing and who have to be taken to the dining room. Some even need to be fed when there, rather than being dismissed with, "so you are not hungry today."
Or, even worse, perhaps the government does recognize the distinction, but insists on putting such patients into assisted and supportive living facilities without sufficient and qualified staff purely for penny-pinching reasons. That certainly seemed to be the case when Ron Liepert was health minister and announced his Continuing Care Strategy, freezing the number of long-term care beds at 14,500, the same number existing for many years -- a decision the government has still not formally rescinded.
Penny-pinching seems to be the reason why most of the RN staff were stripped out of the Youville Home in St. Albert earlier this year. Operators were able to do that, and circumvent the Nursing Home Act, because the Youville had been conveniently reclassified as an Auxiliary Hospital.
Penny-pinching also seems to explain why the government has been converting existing nursing homes to assisted living facilities to save the cost of the qualified nursing staff. In Hinton, the operator of the long-term care facility was actually paid $500,000 to downgrade it to assisted living.
A further example of penny-pinching is the decision to relocate the geriatric unit from Alberta Hospital Edmonton to Villa Caritas, a facility originally planned to accommodate long-term care patients from the dilapidated General Hospital facility in Edmonton. Despite the millions spent on converting Villa Caritas, it is now clear that both the AHE patients and the General Hospital patients will be worse off than before this plan was hatched.
The sad reality is that all of this penny-pinching is false economy because, in the long run, providing proper nursing home care with sufficient numbers of properly trained staff is infinitely cheaper than having such needy seniors blocking up emergency rooms and acute care hospital beds. Hospital beds are in fact one of the worst places to put frail seniors with compromised immune systems.
While Health Minister Gene Zwozdesky is to be commended for ordering the opening of new acute-care hospital beds, this is a stop-gap measure and unfortunately, does not address the underlying problem, which is the lack of enough long-term care beds served by trained nursing staff.
It is even more distressing to note that, in the midst of this growing crisis, one of the main items on the agenda for the legislature's fall sitting is a new Alberta Health Act, a proposal that came originally from Liepert, who asked the Ministers' Advisory Committee on Health (MACH) to look into it. In September, 2009, the MACH received a submission from Stephen Duckett, chief executive of Alberta Health Services.
Duckett was very supportive of a new Alberta Health Act, partly because he saw it as a way of getting rid of what he saw as the needlessly restrictive requirements of the Nursing Home Act -- legislation designed to protect patients from inadequate care.
Until our provincial leaders can shake the notion that good quality nursing care is wasted on those who are old, sick and infirm, we will never effectively solve the horrendous wait-time problems in our health-care system. Nor will we deliver the humane treatment that all Albertans, regardless of age, deserve. Our government is headed in precisely the wrong direction on this crucial issue, and it needs to change course immediately, before the crisis worsens.