Social workers tell it like it is

The two weakest links in the health system chain went under the microscope in Nova Scotia this week, and what appeared depended on who was looking.

Long-term care, or nursing homes, and mental health and addictions are without much doubt — although not without some dispute — the two poor country cousins of the provincial health system.

At two legislative committee meetings, politicians, senior bureaucrats and health workers’ unions wrestled with the myriad of problems that beset nursing homes and mental health services but, lo and behold, it took the province’s social workers, who weren’t at either committee, to get to the heart of the matter.

If we want healthy people and healthy communities — and let’s assume we do — the social workers said we need to ensure folks have adequate incomes, preferably from secure jobs, to lift them out of poverty; affordable, decent housing and nutritious food, along with easy-to-access mental health services, shaped by community consultation and collaboration.

The Nova Scotia College of Social Workers released a 244-page report specifically about the failures of the mental health and addictions machinery, but their prescription, which also stresses equity and social justice, would go a long way towards solving the broader “wicked problem,” as Dr. John Ross characterizes the health system in general.

Ross isn’t alone among doctors who advocate a fundamental shift — a reimagining — of health and social programs, but he may be the most persistent.

He’s publicly and repeatedly said that governments have to acknowledge and deeply understand the social determinants of health — most of which are provided above, thanks to the social workers — and how failures there make the long line for most every health service a whole lot longer.

Mental health and addiction services, like nursing homes, are woefully underfunded and have been for years.

The senior bureaucrats can’t admit that because such bold honesty could reflect poorly on their political bosses, the government-ofthe-day.

Two numerical standards are central to the discussion — 10 per cent and 4.1 hours.

The College of Social Workers, and most every other mental health advocate in Canada and beyond, say 10 per cent of the total health budget should be earmarked for mental health and addiction services.

In Nova Scotia, it’s about 6.7 per cent, and achieving 10 per cent would require the addition of well over $200 million-a-year.

The officials at the public accounts committee meeting, including Sydney native and deputy health minister Kevin Orrell, wondered where that money would come from and noted that if it was from other areas of the health system, it would only create problems there.

As for the nursing homes — the focus of the health committee this week — everyone in attendance, except government MLAS and bureaucrats, advocated that Nova Scotia adopt the widely-accepted standard of care for residents. That’s 4.1 hours daily, as opposed to the roughly 2.4 hours of care residents can expect now.

While the health bureaucrats agree that change is needed in the continuing care sector — home care and nursing homes — they don’t buy into the 4.1-hour standard, which also comes with a price tag running close or into the hundreds of millions, depending on pay levels for longterm care workers.

The sad reality is that nursing homes and mental health will remain underfunded as long as they survive on whatever crumbs are left on the table after the government has satisfied the nearly insatiable appetite of the acute care system.

In the minds of many folks, acute care is the real health system — the hospitals, the advanced technologies, the highly-trained specialists and other talented professionals that all combine to heal the sick and repair the physically injured.

We need all of that, but the health budget is fast approaching half the total provincial budget and there’s no sign that rising costs will abate, driven as they are by the ever-increasing cost of acute care.

The path to a health system we can afford and sustain isn’t austerity, but rather a fundamental shift in emphasis — and money — towards keeping people well, which brings us back to those social determinants of health.

The evidence is irrefutable and long-standing that meaningful action to address and alleviate the social factors that almost inevitably lead to poor health — poverty tops the list — will pay dividends down the road, in better health, less stress and cost in the health system and — and this ought to be the first consideration — a better quality of life for thousands of Nova Scotians and millions of Canadians.

But the required shift also requires a government, or governments, with the political courage to either reallocate spending or increase revenues — taxes — to the level necessary to actually lift people out of poverty.

That’s not going to happen. Instead governments will build big new, shiny hospitals and the kids that are growing up in poverty and depravation today will need them sooner and more often than those who aren’t.

Meanwhile, the residents of nursing homes and those who suffer from debilitating mental health problems and/ or addictions, will receive whatever care is affordable after the acute care system is satisfied and the shiny new monuments to myopia are paid for.