Where is the long-term care plan?
The province knows it shouldn’t put all its eggs in one basket. But it can’t afford two.
Take care of the elderly, for example. All the eggs are going into the home-care basket because, the government will tell you, Nova Scotians have said, “overwhelmingly” that they want to grow old in their own homes.
The people’s preference is predictable. Just try to find a nominally healthy 70-something who will tell you he or she can’t wait to get into a nursing home. The food alone is enough to kill you, except it isn’t, or the problem would be less pronounced.
The problem? Unless or until home care is affordably available to people 24 hours a day, every day, a significant number of you will achieve a time in life when care at home is no longer feasible, and the health bureaucracy will go about finding you a bed in a nursing home within 100 kilometres of your first choice. (In case anyone noted the second person pronoun, I have a deal with the devil.)
Medical science has come up with an answer to almost every curve the human body naturally throws at it, except aging. As a result, the land is awash with late-80s and 90-plus-yearolds, when just a generation ago those few people were in “ripe” old age but wouldn’t be there for long.
A large elder population is a good example of a consequence of scientific progress that outpaced society’s foresight, ability or willingness to deal with it. There are a range of issues created by information technologies that fall into the same growing realm.
In Nova Scotia the response of the present government has been to build-out home care, and squeeze nursing homes. That may be the best of the bad choices available, but in many cases, it merely prolongs the inevitable. Eventually, very old people requiring a high level of care are placed in nursing homes that have been squeezed to the point where they are unable to reliably provide that level of care.
The rest is predictable, and regularly reported in the news columns of this and other journals. Families are discovering serious issues with the quality of care in some homes and those problems are most frequently the result of limited funding, staff, etc.
Upstream, hospital beds are blocked by people waiting for nursing home beds, patients waiting for admission to the hospital are stacked up in emergency rooms and ambulances are lined up outside the ER waiting to unload.
Nova Scotia is not adding new nursing home beds, and this was the first year in several the province didn’t cut back on nursing home funding.
The government has determined that Nova Scotia’s response to a growing elder population is to provide enough home care to keep as many people as possible in their homes for as long as possible, so that those who eventually wind up in a nursing home won’t be there too long.
No one in the government would admit that, and for obvious reasons. It sounds cold and heartless. It is also a logical explanation for the actions of the government.
But, while the waiting list for nursing home placement has shortened in the past four years — primarily by changing criteria to get on the list — all the beds are always full, and the boomers are not babies anymore, so demand for nursing home beds will almost certainly increase before it settles back to normal around 2060.
Meanwhile, complaints about the quality of care in nursing homes mount and the province is left to provide assurances it monitors homes to ensure they follow standards.
It’s way past time for Nova Scotia to have a strategy in place and widely understood to deal with the increasing demand for long-term care of elderly Nova Scotians. “We’re investing more every year in home care,” is not a strategy. It is a talking point that allows the province to kick the can a little farther down the road.
While we’re at it, the province has no plan to ensure Nova Scotians receive dignified end-of-life care, either.
Everybody knows these are difficult issues, but there is a place for politicians who won’t deal with the tough stuff. It’s call the opposition.