Idle ambulances and long-term care
Provincial demographics indicate that Nova Scotia is headed for a catastrophe
Perhaps this is what “continuum of care” now means.
An ambulance pulls up to the emergency room and, with its prone passenger, idles away hours because there’s no room in the room. ER beds are occupied by patients awaiting hospital admission and there are no inpatient beds available. Many of those are occupied by elderly folk waiting on a place in a nursing home.
When someone dies in a nursing home, the available bed goes to one of the people waiting in the hospital. A patient in the ER then moves up to the now-empty in-patient bed, and the ambulance disgorges its passenger into the ER, before loading the elderly, former hospital resident for the trip to the nursing home.
A continuum is defined (Merriam-Webster) as a coherent whole characterized as a collection, sequence, or progression of values or elements varying by degrees. Other than the requirement for coherence, in the logical sense, the above scenario describes a continuum playing out in Nova Scotia.
Unless the province loosens its moratorium on nursing home beds, Nova Scotia is going to need more ambulances.
Buying ambulances to address the shortage of nursing home beds isn’t all that much more absurd than the only response the government has on offer. That comes in two words – home care.
There is no argument that staying at home, with the required care, is preferable to living in a nursing home. But, to many lives comes the agonizing realization that there is no option. That realization has arrived for about 7,000 Nova Scotians now in nursing homes and, in the last year, 2,000 who were in the hospital waiting out one of the 7,000.
There is a temptation to characterize long-term care as a crisis contributing to the calamity cascading through the health system. It’s a temptation best resisted for more than the alliteration. In a very few years, the descriptors will need to be fresh and unsullied by premature hyperbole.
A glance at the provincial demography will tell anyone with the plunk to look that if there is a crisis today, Nova Scotia is headed for a catastrophe.
Two years ago, the census revealed 21,645 Nova Scotians were 85-years of age and over. Another 21,915 were between 80 and 85, and 75,550 more were in their 70s. Next comes the bulge of the baby boom and 133,670 Nova Scotians in their 60s, followed by 152,180 over 50. By comparison, there were just 109,885 Nova Scotians in their 20s.
In a rare moment of candor, a member of the provincial government or, more likely, a senior civil servant will allow that more longterm care beds are required now, but peak demand is still some years off.
True enough, but the numbers don’t lie, and it is self-evident that with each passing year demand for non-existent beds is increasing and will do so dramatically over the next two to three decades.
It’s cold reality that a predictable number of old people will be unable to stay at home, absent around-the-clock nursing care, which none but a select few can afford. The number increases with age. For example, in Canada almost one in three women over 85 now lives in a nursing home. At 90, the number increases to about half and seven in 10 centurions require nursing home care.
Home care is an assisted living program. The province limits uncomplicated care to roughly four hours a day and adds up to two more hours of nursing care, on an as needed basis. Like nursing homes, how much people pay for home care depends on their income.
Right across the health system costs are controlled on the supply side, by limiting access. Health managers know that if you add a bed in a nursing home or hospital, it will be filled, and the costs will rise. That’s why Nova Scotia doesn’t have enough nursing home beds to meet current demand.
But within a decade, that demand will more than double, and Nova Scotia has no plan to add anything like 10,000 nursing home beds. The 7,000 we have now cost taxpayers about $575 million annually.
Which begs the question: What is the plan?
“In Canada almost one in three women over 85 now lives in a nursing home. At 90, the number increases to about half and seven in 10 centurions require nursing home care.”