'Critical state' hospital protocol could make nursing home situation worse, says union rep

A new protocol that gives priority for nursing home beds to people waiting for them in a "critical state" hospital may only be shifting the problem instead of fixing it and could actually make things worse, says an advocate for staff.

If people get moved into nursing homes that are understaffed, it "potentially could put them in more harm's way," said Sharon Teare, president of the New Brunswick Council of Nursing Home Unions.

In addition, the new protocol could become an incentive for people to try to get their loved one into a hospital to "jump the queue" and get them into a nursing home sooner, she said.

This would create more pressure on hospitals, and take beds away from people waiting at home but still in "dire need."

Teare thinks the province should focus more on recruitment and retention in both acute care and long-term care.

Meanwhile, seniors advocate Cecile Cassista says she's keeping a close eye on how the new protocol unfolds but would like to see the government do more to help people stay in their own homes longer.

The Department of Social Development confirmed Friday that patients who are waiting at the Saint John Regional Hospital for a nursing home bed are being fast-tracked.

The department implemented temporary admission prioritization for these so-called alternate level of care patients  — people who have been medically discharged but are awaiting long-term care placement — on Jan. 4 because of  the "exceptional circumstances" at the hospital, department spokesperson Rebecca Howland said.

Normally, nursing home admission is done chronologically. But when patients waiting for another level of care are tying up hospital inpatient beds, it can cause a negative domino effect.

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.

The "critical state admission prioritization" may be enacted by the minister of Social Development at the request of a regional health authority for up to 30 days when:

• A hospital's emergency room is over capacity and there are prolonged off-loading delays from ambulance bays.
• Acute care units are over capacity.
• Critical surgeries are cancelled because of a a lack of hospital beds.

The department will re-evaluate the Saint John Regional Hospital's prioritization on Thursday.

Wait hours to go to bathroom, weeks for a bath

Teare and Cassista both said they understand the reasoning behind the new protocol and would prefer to see seniors in the home-like environment of nursing homes than languishing in a hospital bed.

"But we do know that nursing homes are facing their own challenges in being chronically short-staffed, so therefore it does compromise the quality of life that these seniors deserve," said Teare, a resident attendant at a Saint John home.

Seniors might wait hours for someone to take them to the washroom, and up to three weeks for a bath, she said.

An activity that's important to either their physical mobility or cognitive ability might get dropped, their meal times might be rushed, or they could receive less emotional care and attention.

"And most importantly, our seniors sometimes notice the short staff [situation]," Teare said. "As much as you try to hide it from them, you know, they see the rushing and it actually makes them feel bad.

"And by times they may not acknowledge any type of, you know, pain or distress that they're in and it could actually trigger a worsening health condition."

Hundreds of beds vacant

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, according to Teare, who represents 51 of the province's 73 nursing homes.

That number of beds sitting vacant is based only on the 24 homes she heard back from as of Monday afternoon. 

"It's a major staffing crisis throughout the province."

A total of 935 people were waiting for a nursing home placement as of Jan. 1, according to Social Development. Of these, 463 were waiting in hospital and 472 were waiting either at home or in special care homes.

Stop working in silos

Teare contends acute care and long-term care have to stop "working in silos" and start working together to find short- and long-term staffing solutions.

"We've got to fix the problem and not shift the problem."

One idea she proposes is that if a particular region has more empty nursing home beds than others, then long-term care employees who are willing could be relocated to that region to enable those beds to be opened up. 

"I do believe that a major focus on retention and recruitment and adequately compensating those in the sector would actually bring the human sources and human resources, so we can get these beds open and so that we can assure that our valuable and vulnerable population of seniors are actually provided a life with dignity and respect of which they deserve," said Teare.

Choice is important

Cecile Cassista, executive director of the Coalition for Seniors and Nursing Home Residents' Rights, said the faster  seniors can be moved out of hospitals and into nursing homes, the better. They deteriorate in hospitals, she said, and place a heavy burden on the health-care system.

But she wants to ensure the province doesn't dictate where they have to go.

It's important seniors and their families have input, she said, noting it's not an easy decision to place a loved one in a care home.

While it's a concern some people may try to "play the system" and get their loved one into a hospital now, Cassista hopes the fact they must be admitted by medical professionals will help prevent that.

"I'm watching it very carefully," she said, and so far, it appears it's "being done in a fair and just way."

More in-home supports, subsidies needed

Still, Cassista would like to see the province provide more services and support to enable seniors to continue to live at home.

"Why are we placing them in an institution? That's the piece that I struggle with. I really believe that the government needs to focus in on that part."

Cassista also wants the province to increase subsidies for special home care. It now provides up to $77 a day for Level 1 and Level 2 care and $83 a day for memory care, she said.

That "isn't a lot of money when you're paying four or five thousand a month."

Her group has advocated a scaled subsidy, based on income.

In addition, special care home fees should be regulated, as nursing homes are, she said.

Julie Weir, CEO of the New Brunswick Association of Nursing Homes, said she hasn't heard any concerns from homes about the critical state prioritization protocol. She declined further comment on any pros or cons of it.

"The wait list belongs to Social Development and so [the nursing home association] is not included in these discussions or decisions," she said in an email.