Wait for long-term beds hurting patients and health-care system alike, says internal review

A lack of long-term care capacity is harming Prince Edward Island seniors and hurting the province's overall health-care system, according to an internal review from the Department of Health and Wellness.

And while the report concludes the government needs to increase the number of long-term care beds, it also says P.E.I. relies too much on institutionalizing seniors and needs to provide more support to keep them in their own homes while they age.

The report also says an ongoing staffing shortage has meant some new long-term care beds cannot be used because there is no one to care for the people who would occupy them.

Earlier this week, Health PEI said 85 of the province's more than 1,200 long-term care beds aren't currently in use because of a lack of staff.

The agency also said there are 200 people waiting to be placed into long-term care.

The internal review says almost a quarter of overnight hospital stays in P.E.I. in the 2020-21 fiscal year involved patients who'd already been discharged but were awaiting placement at a long-term care facility.

They are referred to as alternate level of care (ALC) patients.

"Waiting for a long-term care bed in a hospital has adverse consequences for older adults and the overall health system," the report warns.

Stuck in hospitals 

Having seniors wait in a hospital setting results in a loss of mobility, an increased risk of illness, and "negative social impacts" for patients stuck in facilities "that are not designed to support their activities of daily living."

As well, tying up hospital beds with people who've already been medically discharged "reduces the health system's capacity to admit [and to] accept transfers from the emergency department." It also prevents hospitals from transferring inpatients to the units where they should be.

The report calls for more long-term care beds to meet the needs of the province's aging population, saying a 35 per cent increase in capacity is needed by 2025 to maintain the status quo.

However, the report concludes the status quo on P.E.I. "is heavily skewed toward institutionalizing older adults without considering other measures" — such as home care, health promotion and restorative care.

"Without a shift to increase funding for home and community-based care and support, the health system will not be able to meet quality standards or system sustainability," it says. 

No concrete staffing solutions

While the report acknowledges challenges in recruiting and retaining staff within both public and privately operated long-term care facilities, it proposes no concrete measures to address those challenges.

"Health human resource shortages will require action in the short-term and on-going attention. Progress on these new challenges may best be achieved through collaboration across the sector."

Another document, the province's Seniors Health Services Plan, calls for an increase in training spaces and sponsorships for students training to become health care workers.

This year the province announced it would pay tuition fees for students training on P.E.I. to become resident care workers.

Holland College and UPEI have announced expansions of their nurse training programs, and UPEI is developing a faculty of medicine to operate as a satellite of Memorial University.

On Wednesday representatives of three different health-care unions appeared before the province's Standing Committee on Health and Social Development, collectively painting a stark picture of the human resources situation in long-term care.

"Long-term care is in crisis," declared Barbara Brookins, head of the P.E.I. Nurses' Union.

Workers have struggled with mental fatigue, stress, and lack of opportunities for restorative time from work.- Internal review of long-term care on P.E.I.

The COVID-19 pandemic took a tenuous situation with understaffing in long-term care due to staff vacancies, and pushed existing workers to the breaking point. 

"Workers have struggled with mental fatigue, stress, and lack of opportunities for restorative time from work," the government's review notes.

Private versus public

The report also points to significant differences in the operation of government-owned versus private long-term care facilities on P.E.I. Facilities in the province are almost equally split between the public and private sector.

"Public and private long-term care homes operate in markedly different ways," the report states, "which may result in different access to services, care experiences for residents and work-life experiences for staff members."

Among the differences:

• Limited access in private facilities to allied health professionals, such as occupational and physiotherapists. Meanwhile, public facilities had limited access to a pharmacist.
• Specialized beds to support dementia patients or those with complex needs are more likely to be included in public facilities.
• The report noted differences in data collection and reporting between private and public facilities as a factor limiting analysis.
• Private facilities are inspected at least once per year by the Department of Health; public facilities are not. Instead, they take part in an accreditation process every few years.
• Workers in the public system are paid more, at least in some cases. The report notes care workers in public facilities earn $21 to $22 per hour. In private facilities, the report says the average wage is $16 to $19 an hour with some facilities offering as little as $12 to $16 an hour.

"Efforts to align quality and safety measures between public and private long-term care homes will ensure that Islanders receive comparable care across the sector," the report states.