Ken McGeorge: How bad must it be before real strategic direction?

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Don’t be put off by reading more about the Lamrock report! If you feel enough is enough, that is ok, but the key problems in health and long-term care do not get resolved in New Brunswick without some visionaries being very persistent. The public has to say “enough is enough”! No more tinkering with technology or solutions that give great photo ops and sound bytes. Particularly in an election year, beware of solutions intended to placate or offset public expression of concern.

Media exposes some of the issues that impact long-term care with those issues often disguised in other forms. Nothing in health and long-term care is simple, nor do simplistic solutions tend to yield sustained, satisfactory results.

The Lamrock report represents the opportunity for public policy in this very significant area to be put on the table and brought into line with current needs, issues, trends, and demographics. Lamrock makes the point more eloquently than has been done in the recent past: long-term care is a hodgepodge of services organized in a manner that does not encourage integration, consistent quality, consistent financing, nor many of the other relevant public policy goals. The Nursing Homes Act was originally proclaimed in 1982 with a financing mechanism that has not been systematically brought up to date since that time. The Family Services Act, under which the majority of long-term care services are regulated, was proclaimed in 1980 for a purpose other than long-term adult care.

It is embarrassing, if not very frustrating, to listen to families and informed operators and care givers in conversation about issues ranging from how to get appropriate care levels of service, funding, and ever so much more. But what is more embarrassing, and government should be highly embarrassed, is the number of persons occupying expensive acute care beds in hospitals when there is vacant capacity in long-term care facilities. What is dreadfully embarrassing is there is no plan in place of which the parties are aware that will bring order to what honestly is sub-standard public policy.

The tragedy is this: 40 years ago, experts in key medical schools and health economics programs knew that by now the system would be at a major crisis point. So, getting prepared for all the issues that an aging population presents should be no last-minute solution but could have had strategic attention many years ago. That is the key reason the hospital reforms of 1992 were adopted as the first stage in preparing for the future.

So, right now, we need to refrain from finger pointing and casting blame; there is enough blame to go around to governments, unions, academic institutions and more. Please: just focus on the issues then come to the table to sincerely create solutions.

Focusing on the issues has been, in New Brunswick, very difficult. Most people from whom I hear and interact have a good sense of symptoms of system malfunction: staff shortage (symptom), staff recruitment issues (symptom), long wait times for assessment (symptom), vacant long-term care capacity (symptom), silos in government (symptom), over-medication of the elderly (symptom), staff morale (symptom), high absenteeism (symptom), mother is not getting care she needs (symptom).

Lamrock’s researchers heard from hundreds of people, both the public, advocacy groups, service providers and more. I have not seen all the submissions per se but his report starts with the now famous banana story. That would be nearly humorous if not so sad. Speak with families who have had loved ones in care in hospitals or some other facilities and you will get variations on those stories very often (I have had many brought to my attention).

It is not enough for government to give a report of this importance to staff to review and recommend solutions. That input is necessary but that alone cannot possibly represent the totality of government response. And the typical government pre-budget consultation process, if used here, would gain nothing productive.

For decades, service provider organizations have been sending signals of the need for new directions which government seems not to have recognized nor acted upon. The difference between symptoms and real issues requires informed, experienced, mature people, with no agenda, to employ a diagnostic process not unlike the diagnosis of illness. Start with presenting symptoms (pain in the abdomen), which part of the abdomen, what about temperature and blood pressure, what do lab results suggest; then many more questions, perhaps abdominal x-ray or ultrasound and observations to determine some gallstones that can be removed in a few minutes in the operating room.

The same principle must be applied to this very important area of public policy if we are to make a dent in the long waits in the emergency departments and the increasing numbers of alternate level of care patients occupying acute care beds. No simple solutions will fix and no simple solutions should be tolerated. The issues are far too important.

Take the over-crowding of emergency departments and long-waits, for instance. The classic blame-game would be to blame nurses, blame doctors, blame all those patients who should be seeing their family doctor. That is classic New Brunswick, scapegoating.

The vast changes in public demand and in clinical practice explain much of what is simplistically referred to as “over-crowding.” In a serious analysis, one finds the growing issues of mental health service seem to be a major factor. Then the growing issues of illicit drug use with overdoses is another. Then with the population age profile, perhaps more persons in the heart attack and stroke age contributing to volume. That is all before you get to the critical issues of trauma, sexual violence and more. Then, as the New England Journal of Medicine outlined, you add the growing numbers of frail elders in crisis, many of whom cannot be discharged back home.

A careful analysis will show the fundamental purpose of the emergency department is often compromised due to volume that is brought to the department stemming from inadequate social and public policy.

Look at the headlines in the last 20 years. Those topics have been central to many an article describing many a crisis in the urban areas of New Brunswick. That is why the Lamrock report must not only get a response from government but must be accompanied by a plan of action that contributes to improving public confidence. These issues have been growing and simmering for so long there is, based on feedback I get from across the province, a sense of “what’s the use? Nothing ever happens.”

We have some of the greatest physicians, nurses, technological staff, rehab professionals, social workers and much more. Simply recruiting more of them is no solution. Diagnose and fix the brokenness first, make serving in health and long-term care something to be proud of, inspire the people. That is not done with promises but with action that they see to be relevant.

Ken McGeorge, BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or www.kenmcgeorge.com