Pandemic pressure on home care exposes rift between Social Development, hospitals

Social Development Minister Dorothy Shephard says the pandemic has inflamed a pre-existing problem that impacts home care across the province: a lack of co-ordination between her department and the regional health authorities that run our hospitals.

"There might be people that cringe when I say this, but the fact is that that lack of collaboration in ensuring that…services are in place before they send someone home is often abdicated," Shephard said.

In a series this week, CBC News reported on a Moncton man whose sister has been hospitalized twice in the past month because there wasn't a home care worker available to visit her daily to make sure she was taking her medication.

Paul Ouellet's sister, Lorette, has schizophrenia and without care, she quickly spiraled into psychosis.

• Advocate for mentally ill says shortage of home-care workers landed sister in hospital - twice

• Overworked, underpaid and at the breaking point: home care worker calls for government aid

Ouellet sent a letter to Shephard on April 30, pleading with her to find a way to provide home care for those who desperately need it.

"That service allows them to remain in their place of residence and therefore prevent numerous hospital stays," he wrote in the letter.

Shephard hopes that with daycares re-opening, and a $500 per month top-up available to home care workers the situation will improve, but said the heart of the problem is a lack of collaboration with the hospitals.

Adequate home care 'major challenge'

When asked about Shephard's comments that the health authorities are abdicating their responsibilities, Vitalité President and CEO Gilles Lanteigne said "obviously I cannot be in agreement with that."

He does however agree that adequate home care has been "an ongoing challenge and a major concern."

While people like Paul Ouellet's sister are forced to go to hospital because care isn't available, Lanteigne said people end up staying in hospitals for much longer than is necessary because there is no home care available when they are ready to leave.

While hospitals are under the control of the regional health authorities, home care and long term care are the responsibility of the Dept. of Social Development.

Lanteigne said crowded hospitals are not shirking their responsibilities by sending people who need "minimal support" home before home care is available. Rather, he said, staff are forced to make tough choices when there is someone coming in with an emergency such as a heart attack and they need to free up a bed.

"If we don't have alternatives for people to go back in their communities quickly, and we have someone coming at the emergency room…we're not abdicating. Quite the contrary. We're doing what we need to do."

'Fractured system' needs structural change

Karen McGrath, president and CEO of the Horizon Health Authority, has been asking for structural change in New Brunswick for more that two years.

She said New Brunswick is the only jurisdiction in Canada where home care and long term care aren't provided by the health department.

McGrath describes the current structure, in which the responsibilities are split,  as "not optimal."

"Unfortunately that group of individuals who do require support in the community have a very fractured system as they move from hospital into community support or long term care."

There are many examples, according to McGrath, of problems that arise as a result of the structure in New Brunswick.

"I have very frustrated staff who spend long hours trying to get hold of assessors in Social Development…to come in and do assessments. Very frustrated physicians in our emergency rooms who can't get hold of Social Development when they have somebody sitting in an emergency room whose main issue is housing."

Lanteigne has proposed a system called "integrated discharge planning" that he believes would help New Brunswick departments and the health authorities work together.

"The challenge in New Brunswick is that we have to work with many silos and the silos are making it such that the process, in order to discharge patients, is very long, very slow and it creates a backlog in the hospitals. 

It's something Ouellet has also raised.

In a July, 2019 letter to Shephard, he said "bridging" was needed between Dept. of Social Development and health authority staff.

Ouellet also called for every case manager in the Dept. of Social Development to act as a "watchdog" for their clients.

Lanteigne believes the changes need to go even farther.

"We're beyond trying to integrate the services, we need to integrate the structures," he said.

Status quo not acceptable

Shephard is calling for immediate change.

"I am not going to accept that we cannot collaborate in a more progressive and streamlined way," she said.

We have to adapt the structures accordingly and make a system that is fully integrated and fully accountable- Gilles Lanteigne, Vitalité Health Authority

Lanteigne wants the same thing, and said information will only be shared effectively between health authorities and government departments if the walls between departments finally come down, and technology that spans departments is introduced.

"We have to adapt the structures accordingly and make a system that is fully integrated and fully accountable," Lanteigne said.

Lessons learned from COVID-19

McGrath hopes the pressure that's recently been put on the health care system will lead to timely change.

"Hopefully the pandemic will shine a light — it's certainly shining a light on long term care in Canada and the provision of service for our older adults. And so hopefully those issues will remain in the forefront."

Lanteigne is confident the health authorities can work with Shephard to transform and modernize the health care system so patients no longer find themselves "stuck" between two departments.

"We're all losing efficiency here. We're fully ready to collaborate."