Caring For Our Frail Population
This is a critical issue - why is it not getting more attention?
Let’s talk about an aging population and health care. What happens when we need a nursing home bed? We make an application and wait six months to a year to hear from the folks who assign the beds. In the meantime if we are not able to be taken care of at home our caregivers take us to the hospital and leave us there.
Think about the person who is at home and advancing through their dementia. They may start to become combative and dangerous to their caregiver, or must be locked in a room because they wander at night and cannot be trusted in the house without supervision. This is a reality for many families!
"...Given that Nova Scotia has the highest percentage of seniors (16.5%) in the country (Statistics Canada, 2011), and a high prevalence of chronic illness, the need for home care services is presumably greater than what is currently being provided. This is corroborated by the addition of 3,230 clients to the wait list for long-term care placement in 2009-10. Of these clients, 36% were in the community with no publicly funded home care, and 27% of clients were waiting in the community with publicly funded home care (Nova Scotia Department of Health and Wellness, 2010)."1
So what are the alternatives?
- Staying at home without caregiver support (as in the scenario above) is no longer feasible although there are too many families in the province in that position.
- Home care assistance – If the family can afford to pay for assistance then that is great. If not, then there is a provincial program available. But there is a waiting list.
- That service is progressive:
- Respite care maybe one or two half days per week to give the caregiver a chance to leave the home to do the family business (groceries, banking, etc.)
- Care services every day including personal care, food preparation, housecleaning, etc.
- And in between the above, a range of services depending on assessed need and availability of service providers.
- Nursing home beds. (Long term care) - Currently in NS there are few people in nursing homes who are not heavy care. There was a time when a resident in a nursing home may still be driving their own car! I don’t think that is the case today. Today’s reality is that if you are not assessed as needing heavy care then you do not qualify for a bed.
- If the situation in point one above has become dangerous, either for the caregiver or the patient, then they will be sent to the hospital and the hospital is forced to keep them. (Hospitals are not the gateway but they are the stopgap.)
What does this cost the system:
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Cost/Day |
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$0 |
Our current situation:
Peter Vaughan, Deputy Health Minister, said that there are nearly " ...8,000 beds in the province ... (and) there are 2,126 people on the waiting list, including 1,940 waiting at home and 186 in hospital." 2
(I estimate that these numbers are low but I am not able to find current numbers to verify the correct numbers.) Vaughan goes on to say that "...there are plans to build an additional 79 beds this fiscal year..." 2 He also said that there is a long-term strategy being developed but it will not be ready until 2017. I look forward to seeing that. He also said, "That's why the department is putting more money into Home-care support." 3
The solution:
Long term care:
What I know is that when the current government was elected they immediately cancelled plans to build another 300+ nursing home beds. That was a bad thing. On the other hand they did put resources into developing the home care program. That was a good thing. Without the expansion in home care I am sure that the number of people waiting for nursing home beds would be much greater.
So we build more nursing home beds and expand home care programs to ease the problem! I do not see us as having a choice. What is the cost consequence? Well the capital cost is not an issue because most nursing homes in the province are now owned or operated by private or nonprofit organizations and if given the licenses they are more than willing to build the buildings without affecting the provincial long term debt. The real cost is in funding the beds to the tune of $120/day. If we have a dream of funding needed services without raising taxes then we, as a population, are not being realistic.
I for one do not complain about high taxes because, bottom line, I think we are getting a good deal.
Home Care:
Attached is an article published by Dr. Kenneth Rockwood, a local geriatrician. He is on the front lines dealing with these issues. As a follow up I contacted him and asked what he thought the system should look like and this is the thread of our emails.
Bottom line home care could be the magic bullet if there is one. We ( the people of NS) will have to spend a lot of money to get up to speed. The need is for a lot more people who, as Dr. Rockwood suggests, are cross trained. He looks to the model in place at John Hopkins Hospital in Baltimore where Bruce Leff, a
geriatrics
expert explains that "The Hospital
at Home
model,
wherein
we deliver acute
hospital care
to people in their homes instead of the hospital is something that
health systems can pull
off and save a lot of money in
the
process....Patient
outcomes
were
terrific,
satisfaction
was
great,
and
they
saved
about
19
percent."
(From a press release June 25, 2012)
This is not a new idea!
I suggest that we could look to St. Martha's Hospital in Antigonish for a model that may work.
"Denmark has been identified as the country that best cares for its oldest citizens'. (Margaret MacAdam, Health Policy professor University of Toronto) Maybe we should look to Denmark for help.
The Politics of it:
...our waiting list, I suspect, is back to over 2,400 people waiting to be taken care of. That is 'PEOPLE!' who need care.
Our reality is that we have the baby boomers going through the system, of which I am one. As that bubble in the demography moves through the above dire situation will only become worse.
Some will argue, what will we do with all of these facilities at the end of the bubble? A valid question for sure. Well the reality is that many of the facilities currently being used do not meet safety and practice standards required for new construction and barely meet minimum standards for care and safety. These should be taken out of service as soon as is practical but, if possible, not before the high demand described above is satisfied. If in fact any of the currently existing facilities do not meet safety standards and cannot be retrofitted at a reasonable cost then they should/must be replaced by the owner of the facility.
For now we, as a province, will have to spend more money in order to take care of ourselves; we have no choice but to pay for it. Until we have the political will to deal with some tough choices (some suggested saving opportunities are outlined in the next section) then we may/will have to pay more taxes. Let’s allow our health care professionals to come up with a workable plan and implement it.
1. An Interjurisdictional Comparison of Continuing Care Services in Canada, Prepared by the Health Association Nova Scotia, 2011, p4
2. Long-term care system unsustainable without change: N.S. deputy minister, Keith Doucette, THE CANADIAN PRESS, CTV News Atlantic, May 13, 2015.
UD May 2015