Horizon Health facing geriatrician shortage in Saint John

The Horizon Health Network's geriatric medicine department "has experienced significant changes in (its) manpower resources" in Saint John, which will increase wait times at its geriatric assessment and memory clinics by up to several months, CBC News has learned.

The staff shortage is expected to "continue into 2017," according to an internal email sent to all medical faculty on March 23.

Ken McGeorge, the acting chief executive officer of the Alzheimer Society of New Brunswick, and co-chair of the provincial government's new Council on Aging, calls the news "disturbing."

"Even before there was any talk of shortage, the wait times … to get seen and diagnosed and into treatment have been unacceptably long," said McGeorge.

"So if there is going to be a further erosion in staffing, which is going to cause further backups … boy, this is cause for alarm."

Wait times for patients to be seen in the geriatric medicine clinic will lengthen to over 10 months. Urgent cases will be seen within one month.- Internal Horizon email to all medical faculty

McGeorge said delayed access to diagnosis and treatment, combined with the province's aging population, could result in more patients being admitting to hospital while they wait for a nursing home bed to become available.

New Brunswick already has a higher percentage of hospital beds occupied by so-called alternate level of care (ALC) patients with dementia than any other province, he said.

It was Dr. Donna MacNeil, clinical academic head of the geriatrics department, who sent the internal email, advising of the changes in "manpower resources."

"As a result we are unable to maintain our previous level of service," the email states.

"Wait times for patients to be seen in the geriatric medicine clinic will lengthen to over 10 months. Urgent cases will be seen within one month," she said.

"The number of patients followed in the memory clinic will be curtailed."

"We will endeavour to continue to see the majority of inpatients referred to our consult service within three days."

3 positions affected

Horizon declined an interview request about the issue and failed to answer a list of questions from CBC News.

But MacNeil confirmed in an emailed statement that the Saint John area lost one geriatrician last fall, "due to family responsibilities in Ontario."

"Horizon Health Network is currently recruiting for this position," she said.

CBC News has learned, however, that another geriatrician has reduced her practice to part-time, while another is scheduled to move to Saskatchewan this summer.

Horizon is recruiting for "two full-time positions" in Saint John, according to its website.

The positions, based at St. Joseph's Hospital, were posted on Feb. 29 and the job competitions will remain open "until filled," it states.

Current wait for 'routine' service 6-7 months

MacNeil told CBC News the only geriatric services that will be "unable to maintain" their "previous timely level of service" are the two outpatient clinics at St. Joseph's Hospital.

The geriatric assessment clinic offers diagnostic and treatment plans for patients who are referred by a physician.

The memory clinic offers ongoing support and management of patients who have already been diagnosed with dementia and continue to live in the community.

"We anticipate the wait times will increase to approximately 10 months from the current wait time which is six to seven months for routine service. Urgent cases will be seen within one month," MacNeil's statement said.

"The memory clinic will not refuse any patient, however, it will become more selective regarding long-term follow-up," she said.

Horizon literature says the memory clinic, opened in 2005, has "seen steady growth … with a tremendous need for this type of clinical care."

It's unclear how many patients the clinic currently serves.

Wait adds to stress for caregivers

George Allen's wife, Joan, is among them.

The 79-year-old was diagnosed with Alzheimer's about three years ago and has had follow-up care at the memory clinic every six months, including physical check ups, memory testing, and referrals to a social worker, physiotherapist, and occupational therapist, he said.

Last fall, Allen says he was told his wife's follow-up appointments would now be yearly. "Whether that had anything to do with [losing] the doctor, I can't say. They just told me it was the normal procedure," he said.

Allen, who plans to keep his wife living at home as long as possible, considers himself fortunate to have had timely access to the services.

"Just being a caregiver for your spouse, or parent, or whatever, that's stressful enough because … you're gradually losing them," as they lose their memory, said Allen, who grew up living nextdoor to his wife, became her high school sweetheart and husband of 57 years.

If you don't get the help quickly … you're just adding to the stress of the day-to-day stress you're feeling.- George Allen, caregiver

"It's difficult. And if you don't get the help quickly … you're just adding to the stress of the day-to-day stress you're feeling," said the father of two, whose children and grandchildren all live in Ontario.

In addition, "the sooner people are diagnosed, the sooner they can get medication or treatment of some sort," said Allen, noting his wife was immediately put on a medication designed to improve the function of nerve cells in the brain by preventing the breakdown of a chemical that's important for the processes of memory, thinking and reasoning.

"So I would hate to see … delays for other people coming along," he said.

'Absolutely appalling'

An estimated 3,000 new cases of dementia are diagnosed in New Brunswick each year, according to the Alzheimer Society. About 15,000 people in the province are currently living with dementia.

New Brunswick also has the oldest population in Canada with 19 per cent aged 65 and older, according to the latest figures from Statistics Canada.

Cecile Cassista, executive director of the Coalition for Seniors and Nursing Home Residents' Rights, says any additional delay in accessing geriatric services is "absolutely appalling."

She contends all patients waiting for a diagnosis of dementia should be treated as urgent — not only for the sake of the patients and their families, but the entire health care system.

"When a doctor refers you for your testing, it's an urgent matter. The doctor obviously has detected some concern," said Cassista.

"What's going to happen is people are not going to be detected at an early stage and it's going to be beyond control," forcing more people into hospital beds as they wait for nursing home beds, she said.

Other services currently provided by geriatricians in the Saint John region include: ambulatory clinics, consultation to the Saint John Regional Hospital, community visits to patient homes and nursing homes, and inpatient hospital care at St Joseph's Hospital.

The inpatient care consists of a 21-bed geriatric evaluation and management unit, 21-bed restorative care unit, 20-bed cognitive assessment and management unit and two 21-bed transitional care units.  

The salaries being offered for the two vacant positions range from $243,204 to $268,788 per annum, depending on a geriatrician's qualifications and licensure.