Horizon wants patients at 4 Fredericton-region hospitals fast-tracked for nursing homes

Horizon Health Network has asked Social Development Minister Jill Green to grant "critical state" status to four more of its hospitals, all in the Fredericton region, to fast-track their patients on the nursing home waitlist.

Horizon requested giving temporary priority for alternative care to patients waiting at the Dr. Everett Chalmers Regional Hospital in Fredericton, the Oromocto Public Hospital, the Upper River Valley Hospital in Waterville, and Hotel-Dieu of St. Joseph in Perth-Andover, over other New Brunswickers for available nursing home beds, confirmed Greg Doiron, vice-president of clinical operations.

The province calls these people "ALC patients."

Horizon's request, made Jan. 8 under a new protocol used to address a lack of capacity in hospitals, remains under review, as of late Thursday, Doiron said.

"Where many of our hospitals are currently overcapacity, this would also allow us to free up more acute care beds for patients requiring admission and improve emergency department wait times," he said in an emailed statement.

Meanwhile, Green was expected to determine "next steps" Thursday for the two Saint John hospitals she granted "critical state" status to earlier this month. She was to re-evaluate giving priority patients waiting at the Saint John Regional Hospital and St. Joseph's Hospital for a nursing home bed.

Department spokesperson Rebecca Howland did not provide any update by the end of the day.

9 Saint John patients moved to nursing homes

What the possible next steps could include and what information Green was considering remain unclear. Howland has not answered CBC requests for information since Monday.

But nine patients from the Saint John Regional Hospital have been discharged to nursing homes so far under the new protocol, and none from St. Joseph's, Doiron said Wednesday.

He did not say whether the patients were admitted to their preferred nursing home but did note that "alternate level of care" patients — people who have been medically discharged but are waiting in hospital for placement in a nursing home or other long-term care setting — "spend a long time" waiting.

"When a space becomes available, Horizon works closely with the Department of Social Development, patients, and their families to ensure patients are safely and compassionately transitioned to an appropriate setting, where their needs for socialization, recreation, and other therapeutic services would be best met," Doiron said.

Normally, nursing home admission is done chronologically.

As of Jan. 1, 935 people were waiting for a nursing home placement across the province, 463 of them in hospitals, according to the department.

Green authorized giving priority to ALC patients at the Saint John Regional on Jan. 4 at Horizon's request because of the "exceptional circumstances" there, the department spokesperson told CBC on Jan. 12.

No details about those circumstances have been released, but according to the Nursing Homes Act "critical state admission prioritization" regulation, this change in priority can be enacted for up to 30 days at a time when:

• The hospital's emergency room is over capacity and there are prolonged off-loading delays from ambulance bays.
• Acute care units are over capacity.
• There is cancellation of critical surgeries due to a lack of available hospital beds.

On Jan. 8, Horizon amended its Jan. 2 request to also prioritize patients waiting at St. Joseph's Hospital, which Green approved, Doiron confirmed.

4 regional Horizon hospitals over capacity

Horizon's four regional hospitals have remained over capacity as of Friday, following a surge of emergency room visits over the holidays because of a rise in respiratory illnesses, staff shortages, and a slowdown in discharging patients waiting for long-term care.

The Saint John Regional Hospital, Dr. Everett Chalmers Regional Hospital in Fredericton, The Moncton Hospital and the Miramichi Regional Hospital had an average occupancy level of 106 per cent. The national benchmark is 85 per cent.

About one-third of Horizon's inpatient beds are occupied by patients who have been medically discharged from hospital, but are awaiting long-term care placement, interim president and CEO Margaret Melanson said.

With these patients tying up inpatient beds, patients who are treated in the emergency department and require admission for acute care services must remain in the ER until an inpatient bed is available, which means longer wait times for people with non-urgent medical problems, she said.

Seniors scared of getting bumped down on list, says Liberal critic

Robert Gauvin, Liberal critic for Social Development and seniors' affairs, said he understands the need for the new protocol.

But he worries about the impact on people waiting at home for a nursing home bed.

He wonders, for example, what would happen to a senior who is currently No. 2 on the waitlist and can no longer safely live alone.

"If they fast-track four or five patients from the hospital into a long-term care facility, your grandfather or grandmother will go — instead of number 2,  will now be number 7 or number 8 on the list," said Gauvin.

"It's a safety issue for that person. It puts extra burden on their families to try to take care of them, and maybe they can't. So what do we do with them?"

Gauvin said he has heard from citizens and seniors' representatives who are scared by the prospect of being bumped down on the waitlist.

Staffing is key

He acknowledges there are no easy answers, but contends the government needs to focus more on recruitment and retention of workers in both acute care and long-term care.

At least 245 nursing home beds are vacant in New Brunswick because the homes don't have enough employees to take care of more residents, Sharon Teare, president of the New Brunswick Council of Nursing Home Unions, has said.

"It always comes down to staffing," said Gauvin. "We have to take [better] care of staff. They're not leaving for fun. They're leaving because they can't take it anymore."

He said he spoke to one long-term care worker in Saint John who told him she had to get a second job. "Imagine that," said Gauvin. "She cannot make ends meet and she takes care of seniors — probably one of the most noble things there is to do, take care of vulnerable people.

"I talked to another one, she's been in there for 40 years. She got a raise of $9 in 40 years. So people are leaving because this is not a job, this is a vocation."

He suggests the government start by improving communication with the nurses it has, and asking what it would take for them to stay. If the province can't hold onto the nurses it has, it will have a harder time convincing any new nurses to come and there won't be enough experienced nurses left to mentor any new recruits, Gauvin said.

"It's a question of safety, a question of respect, question of human beings. It's a question of taking care of people we should be taking care of.

"And I know it's important to have [a] balanced budget, I get that. But at the end of the day, we'll be judged by the way we treat our seniors."

285 Saint John hospital beds occupied by 'ALC' patients

About 226 beds at the Saint John Regional Hospital — the largest tertiary care hospital in the province and the primary referral centre for all New Bruswickers for major trauma and cardiac care — are still occupied by patients who require an alternative level of care and are awaiting placements in a nursing home, special care home or community setting, said Doiron.

"Horizon regularly transfers less acute patients and patients no longer requiring medical care from SJRH to St. Joe's as a means of freeing up much-needed acute care bed space and enhancing patient flow at the regional hospital," Doiron said in an emailed statement.

"There are currently 59 patients at St. Joe's awaiting placement in a long-term care facility, which has a direct impact on the flow of patients at SJRH and can lead to overcrowding in the emergency department and on our inpatient units."

Horizon is working with Social Development to prioritize assessments for inpatients to determine the level of care required when they are discharged from the hospital, said Doiron.

"Once they have been assessed and a nursing home or special care home has been chosen, we work closely with the patient and their family to help ready them for their discharge," he said.

"This, along with our other initiatives to help increase patient flow, will help alleviate wait times for other patients seeking care in Saint John."