'We are putting people in danger,' official says about Horizon's long-term care patients
Patients awaiting nursing home beds are biggest obstacle to safe, timely care, says patient safety official
A shortage of nursing home beds in New Brunswick is endangering the lives of hospital patients, warns the chair of Horizon Health Network's patient safety and quality improvement committee.
Dr. Stephen Bolton made the statement Thursday at a Horizon board meeting, after hearing that about 35 per cent of Horizon's acute-care beds are currently occupied by people awaiting long-term care placements.
That's more than 600 people, known as alternate level of care patients, president and CEO Margaret Melanson advised the board in her quarterly update, covering Oct. 1 to Dec. 31.
Meanwhile, Horizon hospitals are operating at 105 per cent occupancy, despite the recent addition of 82 acute-care beds in Saint John, Fredericton and Miramichi, Melanson said.
The number of alternate level of care patients — also referred to as ALC patients — is a long-standing problem, one flagged by hospital officials many times over the years for its impact on operations, including emergency department backlogs and a reduced capacity to admit patients.
Affects safe, timely service, board told
But Bolton, who worked in New Brunswick intensive care units, emergency departments and urgent care centres for decades before he retired, took it a step further.
"We are putting people in danger and delivering a lower standard of care than we otherwise could be," he said.
Bolton described the ALC problem as the single factor that most negatively impacts Horizon's ability to "safely and timely" deliver clinical-care services.
"You go into a hospital waiting room and find it's full? It's because the staff there have about three or four empty spaces — on a good day — to get those patients out of the waiting room and into a treatment bed for assessment," he said.
"All those other beds are occupied by patients waiting for an inpatient bed, and they're not getting those because they're occupied by long-term care patients."
Similarly, ALC patients occupy post-op beds "and so surgeries get delayed," Bolton said.
We have to do better.- Stephen Bolton, chair of Horizon patient safety committee
The number of nursing home beds and services to help keep people in their homes longer are "simply not keeping pace with the aging population," he said.
"I can't stress enough how important it is we find solutions. We have to do better."
The government is working on it, said Department of Social Development spokesperson Kate Wright.
A total of 620 additional nursing home beds have been awarded since 2021. To date, 380 beds have opened and the rest are under construction, she said in an emailed statement.
A working group with members from Social Development, the Department of Health, Horizon, Vitalité and Extra-Mural has also been struck to "develop and implement actions to further reduce pressure on the system," said Wright.
In addition, Social Development continues to work with individual nursing homes on various strategies to address staffing shortages and open vacant beds, and continues to expand the Nursing Homes Without Walls program, which now includes 22 locations across the province that have served about 2,400 people, she said.
The Department of Health did not respond to a request for comment.
Pilot sees faster assessments, frees up beds
Melanson could not say how many more nursing home beds are needed to alleviate the pressure in Horizon hospitals.
"I've heard the number of 1,000 beds. I'm not sure whether that actually is what is required," she told CBC News.
But she did say "multiple" nursing homes are required as soon as possible, along with increased hours of home-care services and funding to help people make their homes accessible "to be able to provide the quality of care that seniors really need and deserve."
In the meantime, Melanson said, Horizon has seen some encouraging results with a long-term care assessment pilot project at the Dr. Everett Chalmers Regional Hospital in Fredericton.
Hospital nurses, social workers and discharge planners now conduct the assessments for ALC patients, rather than Social Development employees, she said. This has shortened the wait time for an assessment and provided the patients with faster access to a long-term care bed, if one is available.
According to the quarterly report, since the shift to Horizon-led assessments, the percentage of ALC patients in hospital awaiting an assessment has dropped to 18 per cent as of October, from 42 per cent in May, and resulted in an average 11-day reduction in length of stay.
No patients at the Chalmers are currently waiting for an assessment, noted Melanson.
In addition, she said hospital staff, who have interacted with patients during their stay and gotten to know them, as well as their families, are "best-suited" to conduct these assessments.
Seeks $1M to expand pilot
As a result, Horizon has requested "just over $1 million" a year from the provincial government to continue the initiative at the Chalmers and extend it to other Horizon hospitals, she said.
This new assessment process in the Fredericton region is "currently being evaluated," according to the Social Development spokesperson.
According to Wright, it includes not only long-term care assessments, but also "arrangement of interim home support services, and coordinates support services for patients transitioning back to the community, or into long-term care facilities."
Later this year, Horizon plans to open 30 new beds at the Mount St. Joseph Nursing Home in Miramichi for ALC patients and those seeking nursing home placements, providing additional capacity at Miramichi Regional Hospital, according to the report.
Moncton is to get about 18 additional acute care beds.
"This is a short-term fix — and an expensive one — to care for our aging patients without an ongoing need for acute care," board chair Susan Harley said.
"We must do better together to serve this population of our province."