Overhaul governance of long-term-care sector, advocate recommends
Kelly Lamrock says local, regional authorities can provide better patient-centred care
New Brunswick's child, youth and seniors' advocate is calling for a new governance system for the province's struggling long-term-care sector.
Kelly Lamrock says putting nursing and special care homes under smaller, local authorities — while still ensuring provincial funding and standards — would make it easier to match patients with the care they need.
A range of challenges plague the system now, from scarce staffing resources to inadequate funding to provide the needed hours of care, he said in a 198-page report released Wednesday.
At the same time, hundreds of people, mostly seniors, are getting care in hospitals while they wait for long-term care accommodation, even though hospital care is far more expensive and less tailored to their needs.
Creating long-term care authorities that are "integrated, nimble, community-based, and administratively flexible" would make it easier for local managers to communicate with hospital staff about patients, the report says.
"Currently, communication occurs between two large, centralized bureaucracies with highly distinct subunits," Lamrock wrote.
"The long-term-care authority can develop a structured framework that outlines the roles, responsibilities, and mobility between types of care and would define how they work together to create an integrated approach to care."
The Higgs government has adopted a more centralized, provincial-level planning approach to health care, arguing there needs to be better co-ordination of scarce resources between different parts of the province.
Lamrock rejected the idea that decentralizing long-term care might not make sense given that philosophy.
Currently, patients moving from one level of care to another need an entirely new, time-consuming assessment from a social worker, which he said could be eliminated by a local authority.
"It's not about more administration. It's about administration that is flexible and integrated and close to the patient," he told reporters at a news conference.
In a statement, a spokesperson for Social Development Minister Jill Green said the government "will be taking the necessary time to review this sizable report and once finished will be able to comment further."
The two opposition party leaders in the legislature agreed with the idea of decentralization though they did not commit to implementing Lamrock's exact proposal.
Liberal Leader Susan Holt said the system needs to be more responsive to individual patient needs, and "that flexibility can come with a more decentralized model."
Green Leader David Coon said the proposal was interesting "as long as these don't become bureaucratic entities, but really nimble."
The report examined pressures on nursing homes and special care homes, as well as home-care programs and the situation of patients now in hospitals who are waiting for long-term care and receiving what is called an "alternative level of care."
Lamrock used an anecdote about a banana to illustrate the flaws he found in the system.
A tearful senior waiting in hospital for a long-term-care space told a nursing student she'd been trying for a week to get her regular morning banana included with her breakfast.
"It sounds minor. I mean why am I starting a report on a $3-billion health-care system with a banana?" Lamrock said.
"It captures the urgency for me very well, that helplessness.
"If we're too helpless to get our own banana, we need somebody to care about what it means to us. We need somebody to understand that it's more than just a banana, that somebody sees us and knows who we are."
The report recommends new service standards for people in alternative level care — so-called ALC patients — in hospitals and the tabling in the legislature of a costed plan with "hard targets" for reducing those numbers.
The report was praised by people working in the sector.
"I was trying to keep myself in my seat. I wanted to stand up and applaud, actually," said Jan Seely, president of the New Brunswick Special Care Home Association.
Many of the problems Lamrock identified, including the silos in the system that have spread resources "all over the map," sounded familiar to her, she said.
"I've heard it echoed in the halls of many meetings we've had with our key partners. … It seemed like he was speaking our language," she said.
Ken Pike, the director of social policy with Inclusion New Brunswick, said he was happy Lamrock identified that there are almost 2,000 adults with disabilities living in special care homes, some of whom could live and work in their communities if they had proper support.
The report recommends modernizing services and financial support for people with disabilities.
"Those are the things we wanted to see reflected in the report and we're very pleased that they were," said Pike.
The report also recommends other measures, including more support for home modifications, and flexible benefits so that people have more incentives and ability to stay in their homes.
ABOUT THE AUTHOR
