The 5 Year Action Plan – Part 2
OK, pop quiz. What’s the difference between “long term care” and “supportive living” (also known as “assisted living”)? You don’t know do you. Neither did I until I read a letter (Jan 15/11) to the Calgary Herald written by Mr Harrigan, Director of Labour Relations for the United Nurses of Alberta. Mr Harrigan points out that contrary to what the Government would have you believe these two terms are not interchangeable. “Long term care” refers to care in a nursing home or auxiliary hospital. It requires on-site nursing care by RNs and LPNs (licensed practical nurses). “Supportive living” also requires on-site care, however it is generally provided by trained aides, not regulated RNs or LPNs. The critical distinction here is that patients living in long term care facilities require significant daily nursing care because they are not as healthy as patients in supportive living facilities. Pretty straight forward, wouldn’t you say.
Remember this distinction when you read the PC’s 5 Year Action Plan. For some reason the Health Minister insists on lumping the two terms “long term care” and “supportive living” under the rubric “continuing care”. Take a look at the glowing press release describing the 5 Year Action Plan which promises to deliver “more spaces for continuing care (68% increase in the number of people moved out of a hospital bed and into a community care setting)”. This is a reference to an additional 2300 continuing care “spaces” (not beds), which it turns out, are the backbone of two of the 5 strategies in the Action Plan: the strategy to reduce ER wait times and the strategy to provide seniors with more choice in continuing care. I’ll admit that the addition of 2300 continuing care “spaces” likely will provide seniors with more choice in continuing care, however it will do absolutely nothing to reduce ER wait times. Why? Because patients who require long term care are simply not healthy enough to leave the hospital and move into “community care spaces” which in this context appears to be “assisted living” or “supportive living”. Pushing frail patients out of acute care beds in order to make room for ER patients waiting in the aisles on the first floor will simply result in these very same patients returning to those very same acute care beds, after putting in the required wait time in ER. This is not a wait time reduction strategy, it’s a revolving door strategy.
This leads me to a comment (quite a few actually) made by the Privacy Commissioner, Frank Work. Commissioner Work took the Stelmach government to task for its lack of transparency. He called it “…the difference between a culture of secrecy and a culture of openness”. An eloquent and perhaps a career limiting statement. The Commissioner’s comments were directed primarily at the access to information, however he shared his thoughts on the process of government in general and said: “People who want our votes…espouse accountability and transparency. The first of Premier Stelmach’s five priorities when he ran for election in 2006 was to govern with integrity and transparency”.
Simply put, those who promise transparency should deliver on it. Touting the addition of 2300 “continuing care” spaces (whatever that means) as a mechanism to reduce ER wait times is dishonest and misleading. Surely the people of Alberta deserve better.
Susan on the Soapbox 
Now you hit a point I can really relate to. Two years ago I went into the hospital for a radical mastectomy – it was day surgery; I was in at 6:00am and out by 6:30pm, the criteria for release was “have you passed urine yet?” It was a real mind blower for me and had it not been for the RN, my surgeon and a husband who took a week of his holidays to care for me I would have been frantic. Why day surgery well it is because of the “out care nurses program” they now have set up in BC. Good plan yes, effective no. I was to have an outcare nurse call me the next day and she did to tell me her day was overbooked and was I having any problems? temperature ok? drainage ok? I had home support (my husband) so I was punted until the next day, same story for the day after. I had one visit during the 1st 4 days, on day 8 they came to take out the stitches and one drainage tube and 3 days later the second drainage tube was removed; the hospital promised a visit every 2 days until both drainage tubes were out.
Why was I put to the bottom of the pile? I had unfortunately completed the section on the admittance form that said I had someone at home to care for me. We are working the domino effect, I had help at home – I was put to day surgery, patients in hospital beds are shoved out to “out care” so the emergency wards can push patients upstairs. This is not a system that can be referred to as “patient care”. I felt like a can of beans on a grocery shelf, as long as someone took me home they could put someone else on the shelf. Problem solved?
Your story illustrates the point that a “plan” that sounds good on paper can turn into a medical nightmare in practice. If I read your note correctly you should have had 6 visits during that time frame but in actual fact you only had 3. One wonders what it will take before our governments realize that we’re expecting them to deliver on the promises they’ve made, failing which we’ll replace them with someone who will. Thanks for sharing your story.
Hello, Susan. David Harrigan from UNA here.
I just found your blog. Thanks for the post – this is such a huge issue, I hope the word gets out!
I look forward to being a regular reader of your blog!
David, I’m glad you’ll be following my blog…please feel free to comment often. I have tremendous respect for the UNA and healthcare providers as a whole. They continue to do an outstanding job, notwithstanding the difficulties created by the government’s decision to cut funding over the last decade. We need to stay on top of this issue now more than ever.