CEO Statement: Collaboration and system change required to streamline health care from hospitals to homes

New Brunswick is the only jurisdiction in Canada with regional health authorities (RHAs) that has long-term care under another department. In this province, it is the Department of Social Development (DSD) that oversees home care support services and long-term care, not the Department of Health.

I have advocated for a change to this system for several years now, and most recently brought this before the provincial Standing Committee on Crown Corporations in fall 2019. I requested the government consider moving long-term care and home care support services within the health department, so we, the RHAs, can provide patients with safe and quality care through their full spectrum of care.

These silos of health care affect the continuum of care for our patients, especially for those who need extra support in their home, and for Alternate Level of Care (ALC) patients.

It means their care isn’t as streamlined as it should be. It means there are issues with patients not being able to access community services when they are ready for discharge from our hospitals. New Brunswickers deserve better.  

Hospitals are designed to provide care to the most critically-ill. And it is well-known that we only have so many beds to provide this care. This means if a critically-ill patient presents at our hospital, we need to make a bed available to provide them the care they need, the care we’re designed and equipped to provide.

ALC patients do not require the level of care provided in a hospital and can be more appropriately cared for in a nursing home, special care home or in their own home. The current hospital environment is not set up to provide optimal care for these patients.

This is why we need the right supports to be available in the community – and a safe, caring and efficient process to get them there.

However, Horizon is not responsible for overseeing community support services for nursing and long-term care homes. While we can lobby for more services, doing so is not part of our mandate.

In late 2019, the government proposed changes to the long-term care assessment process, with the intent of transferring the assessment process to the Department of Health and the RHAs by April 2020. That change was put on hold and hasn’t been revisited.

The change would have not only improved co-ordination between RHAs and DSD in these patient assessments, but would have also addressed the pressure on the occupancy rate of provincial hospitals related to the number of their patients needing an alternate level of care.

However, as it is now: It is our staff – a multidisciplinary team of health care providers -who care for these patients when they wait, on average, 90 days for care at home or in the community. It is our staff who know their care needs; why shouldn’t it be our staff who assess their needs for further care?

As well, social workers from the DSD are not always in our facilities to perform these assessments when they’re needed, such as on weekends.

There needs to be a change in this system, or patients – some of the most vulnerable patients under our care – will be the ones who are impacted. I am hopeful that we will never forget to put the patient first.

Karen McGrath

President and CEO
Horizon Health Network