1/3 of hospital patients are waiting for long-term care, Horizon CEO says
Wait times have risen to 'critical' level, with big impact on emergency departments
The head of Horizon Health Network says they're making progress to improve wait times at their four emergency departments, but there's much work yet to be done, particularly when it comes to people waiting in hospital for long-term care.
A total of 542 people are currently waiting in Horizon hospitals for nursing home or special care home beds, said interim president and CEO Margaret Melanson.
This is more than previous years, according to Melanson, and represents 33 per cent of Horizon's total inpatient beds, or one in three.
Horizon's four regional hospitals have an average overall occupancy level of 106 per cent, she said. The national benchmark is 85 per cent.
"This creates an entire pressure on our system down to and including the emergency department in terms of our overall hospital capacity to care for newly admitted acute care patients," Melanson told reporters during a media update via Zoom Friday, following complaints of filthy and overflowing ERs over the holidays and diverted ambulances earlier this week.
Patients who are treated in the emergency 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 issues.
While this is always an extra-busy time of year because of the rise in respiratory illnesses, this year has been "especially trying," said Melanson, noting about 10,000 staff worked more than 350,000 hours over the holidays, many of those in the ERs.
Wait times for Level 3 patients, those with "urgent" medical needs who may need to be admitted, are stabilizing to pre-holidays levels, she said. But staff and physicians "remain extremely busy caring for a high volume of sick patients."
Strategies implemented
Some of the steps Horizon has taken to improve wait times and capacity at its hospitals include:
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At the Dr. Everett Chalmers Regional Hospital in Fredericton, which continues to see up to 20 patient admissions a day from the ER, largely due to respiratory illnesses, 12 beds have been added by moving some ambulatory care clinics to Oromocto Public Hospital, and by moving maternity outpatient clinics to another location within Chalmers, said Melanson. Horizon also plans to add an extra day at the Fredericton Urgent Treatment Centre in early February.
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At the Moncton Hospital, 24 new beds have been opened. "These beds are being placed wherever we can find space, including non-traditional care settings in the hospital," Horizon spokesperson Kris McDavid told CBC. He declined to provide examples, but Horizon has previously used supply rooms at other hospitals. In addition, some patients who come to the ER with influenza-like-illness symptoms have been redirected to an outside clinic for care.
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At Saint John Regional Hospital, the discharge of some patients has been accelerated or admission has been avoided "by identifying and providing appropriate and timely services," Melanson said. She did not elaborate.
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At Miramichi Regional Hospital, the opening of new nursing home beds in the community has helped with the discharge of some patients, she said.
"In short, we are doing everything in our power in collaboration with a number of our partners to help improve the performance and functionality of our provincial system."
'Truly a critical level'
Horizon is also encouraged by initial work on collaborative initiatives with the departments of Health and Social Development as well as the extramural program that will prioritize moving patients from hospitals to nursing and special care homes and increasing the availability of community resources, said Melanson.
She acknowledged to CBC that the waiting time in hospital for long-term care beds has been a longstanding issue, but contends it has now reached "what is truly a critical level.
"I believe that that has now been brought to the attention of our Department of Health and Social Development. And I believe that they recognize now more than ever that action needs to be taken as expeditiously as possible."
"Up until the last several months, we have been coping as a system. And I would say now our ability to continue to do that is reducing because of the greater needs of the acute care system. And I believe that's been prompting now a level of action and focus that perhaps was not there previously."
935 on nursing home wait list
According to the Department of Social Development, 935 people were waiting for a nursing home placement across the province, as of Jan. 1.
Of those, 463 were waiting in Horizon or Vitalité hospitals and 472 were waiting in the community, either at home or in special care homes.
That number is down from Dec. 1, which saw the provincial total at 949, said department spokesperson Rebecca Howland, noting more than 150 New Brunswickers find a nursing home placement each month.
"Although it is important to remember the wait-list is constantly changing, government acknowledges that the wait times spent waiting in hospital for placement in a long-term care facility must be addressed," Howland said in an emailed statement.
The department is "working hard to assist the Regional Health Authorities (RHAs) to improve New Brunswick hospitals," she added.
Can't force patients to accept placements
Melanson did not say what the initiatives being worked on include, but did confirm Horizon does not have the same powers it did in the early months of the pandemic to move people to a nursing home or special care home bed outside of their home communities.
"We cannot at this time force the patient to accept a long-term care placement."
Instead, Horizon "encourages" people to accept the first bed that becomes available and explains they can always transfer later to their first choice once a bed becomes available.
It also "emphasizes" to patients and their families that an acute-care hospital is not designed to care for those individuals who require long-term care, and cannot provide the same support or quality of life, she said.
Primary care plans 'forthcoming'
Horizon and Vitalité have both been working on a primary care strategy, which should also help improve hospital overcrowding and wait times, said Melanson.
"There are plans forthcoming" to address the growing number of physicians leaving their practice or retiring, as well as the growing population, which is adding strain on the system, she said.
"We are looking very forward to funding — hopefully to be available this year — for us to embark on improved collaborative care clinics," or the "medical home model," she said, where allied health professionals work with physicians and nurse practitioners.
These are considered best practice in Canada and New Brunswick needs to move in that direction, said Melanson, adding they should also help with recruitment efforts.
Meanwhile, some of the factors that led to ER problems over the holidays "will continue in the near future," Melanson advised. She cited as examples a "major surge of patients" because of respiratory illnesses, such as COVID-19, the flu and RSV, a significant number of whom were "very ill," staff shortages created by vacancies and illness, and a slow down in discharging patients waiting for community supports or long-term care placement.
While emergency departments "always care for critical care and trauma patients," patients with non-urgent medical issues may see long wait times and are encouraged to visit SoWhyWait.ca to help them choose another option, such as visiting a pharmacist, primary health-care provider, after-hours clinic, virtual care, such as eVisitNB.ca, or calling Tele-Care 811.