Horizon safety rep warns 1 in 3 acute care beds occupied by patients waiting for nursing homes
Overuse of acute beds is a 'clear and present danger' to Horizon operations, says Dr. Stephen Bolton
The outgoing chair of Horizon Health Network's patient safety committee used his last public address to warn about the impact a shortage of long-term care beds is having on the ability to deliver safe and timely acute care.
The number of hospital beds occupied by people awaiting long-term care represents "a clear and present danger to our clinical operations in Horizon and is likely to do so in the immediate future," Dr. Stephen Bolton said at Tuesday's board meeting in Saint John.
A total of 571 of these so-called alternate level of care, or ALC, patients were waiting for a nursing home bed or access to services to be able to return home, as of May 31, the latest quarterly report shows. That's a third of all of the regional health authority's hospital beds.
And the projections are "frightening," given the growing, aging population, said Bolton, a retired physician who has been outspoken during his two-year term, which expired and "has not been renewed by the minister."
Bolton contends Horizon is slated to get only a "handful more" of long-term care beds this year under Social Development's "two-year-late, five-year plan," and none next year.
"You're all smart people," he told the board. "You know what's going to happen with respect to our ALC levels. And I invite you to reflect upon our ability to continue to deliver acute care in a safe, timely fashion in that situation."
The long-standing problem has added to costs and wait times, and caused emergency room backlogs due to a reduced ability to admit new patients.
Social Development spokesperson René Doucette said a 60-bed nursing home is scheduled to open in Oromocto, about 20 kilometres southeast of Fredericton, in December. It will be the town's first.
Another approximately 120 new beds are planned "in other parts of the province" in 2026, he said. Doucette did not indicate where.
Horizon president and CEO Margaret Melanson told reporters after the meeting the Oromocto nursing home is currently the one planned within the health authority's region.
CEO 'very concerned'
Melanson, who previously suggested "multiple" nursing homes are required as soon as possible, said she, too, is "very concerned."
Having a large number of hospital beds occupied by people who do not require acute care "places pressure everywhere in our system — from the emergency department, to surgical services, to all the other medical areas," she said.
It creates "a fragility."
"I would say we are in a position where we do require action on these individuals who, due to no fault of their own, remain within our facilities," said Melanson.
Horizon has been trying to assess ALC patients faster to determine whether they can go home with support services or need a nursing home, so they can get on the wait list sooner, she said.
It's also in ongoing discussions with the province to try to come up with new strategies to address the problem, she said.
But more long-term beds are needed, said Melanson. "There just simply are not enough."
Long-term care co-ordinator pilot
New Brunswick has 78 licensed nursing homes providing 5,272 beds, according to the Social Development spokesperson.
A total of 620 nursing home beds have been awarded across the province since 2021 under the 2018-2023 Nursing Home Plan, said Doucette.
To date, 460 of those beds have opened, while another 180 are under construction, he said.
Meanwhile, the department is working to streamline the ALC assessment process. "This is a complex issue, as wait times can be influenced by several factors, including increasing demand, the time individuals need to make informed decisions, and the availability of financial or care-related information needed to complete the assessment," Doucette said in an emailed statement late Wednesday afternoon.
The department is also piloting the introduction of long-term care co-ordinators to "improve service access, care navigation, and ensure social workers can focus on responsibilities aligned with their scope of practice," he said. Doucette did not provide any further details.
Could have been 'far, far worse'
Bolton, who worked in New Brunswick intensive care units, emergency departments and urgent care centres for decades before he retired, said the ALC situation would be "far, far worse" today, if not for the efforts of Horizon.
He noted that while the number and percentage of ALC patients is roughly the same as when he joined the board two years ago, people should not interpret that as a failure.
It took "a significant degree of work" to maintain that level, he said, crediting Melanson and her staff with doing "everything human in their power to mitigate the natural increase" that comes with a growing, aging population.
Urges study by health council
Following a presentation by members of the New Brunswick Health Council, Bolton urged the Crown corporation, whose mandate is to report publicly on the performance of the provincial health system, to focus its "laser attention" on Social Development and "its responsibility to provide long-term care beds — and perhaps bring about some accountability."
Having a third of Horizon hospital beds occupied by ALC patients is already having a negative impact on acute care and with no additional long-term care beds planned for its region next year, it's bound to get worse, he argued.
"Population dynamics is not an esoteric science. We know the number of old people we're going to have. We can anticipate the number of long-term care beds we need. This is not rocket science," he said.
"This is a fertile opportunity for you to provide New Brunswickers with some much-needed statistical analysis."
"I accept your invitation wholeheartedly," replied health council CEO Stéphane Robichaud.
He noted about nine per cent of people referred from hospital to long-term care across Canada should actually be going home, not into a long-term care facility. In New Brunswick, it's about 14 per cent, or 50 per cent higher, he said.
"It's more than just straight math and assuming people should end up in a long-term care facility," he said.
Adding to that complexity, different hospitals and different regions use ALC beds differently, said Robichaud, nodding to a patchwork system of public, non-profit and for-profit care homes across the province.
"It's surprising how we don't have a clear understanding of the numbers," he said. "So what we need to do is improve … the knowledge of those realities."
Bolton pointed to the "fragmentation" of health care in New Brunswick, with long-term care being under Social Development instead of the Department of Health.
"My final comment is, this board recognizes the danger and they're not going to stop making this a priority. Neither is Margaret and her management team.
"This simply has to be addressed. Period. Full stop."