ALC patients are biggest obstacle to safe, timely care: Horizon

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ALC patients are biggest obstacle to safe, timely care: Horizon

Horizon Health Network working on solutions for patients waiting for surgeries, nursing home beds

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The Horizon Health Network’s chair of patient safety and quality improvement is urging action on “alternate level of care” patients, who occupy hospital beds whilst awaiting placement in a nursing or special care home.

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“We have to find solutions to this,” said Dr. Stephen Bolton at the health authority’s quarterly board meeting on Thursday. He described the issue of ALC patients as the single factor most impacting Horizon’s ability to safely and timely deliver clinical services.

“We are putting people in danger and delivering a lower standard of care,” he said, noting that ALC patients taking up acute care beds can cause bottlenecks in emergency rooms and surgery delays.

Horizon CEO Margaret Melanson said there are 607 patients in Horizon facilities waiting for a bed in a long-term care facility, and about 35 per cent of acute care beds are occupied by ALC patients.

Melanson pointed out there was a successful initiative piloted at the Dr. Everett Chalmers Regional Hospital in Fredericton where the hospital’s social workers and discharge planners were able to perform the long-term care assessments for ALC patients, which allowed them to have expedited access to a long-term care bed.

Horizon’s quarterly report shows since the shift to Horizon-led long-term care assessments, the percentage of ALC patients in hospital awaiting an assessment dropped from 42 per cent in May 2024 to 18 per cent by October 2024, and resulted in an average 11-day reduction in length of stay.

Currently, there are no patients waiting at the Chalmers for a long-term care assessment because of the initiative, said Melanson.

She said the health authority has submitted a request to the province for funding to expand the pilot to other Horizon locations, and is waiting to see if the request is approved.

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Brunswick News had reported that 82 new acute care hospital beds, which the province authorized for Horizon to alleviate pressure on the health system over the winter, will be permanently kept at a cost of about $17 million a year. Those beds are in Saint John, Fredericton, and Miramichi.

Melanson told Brunswick News on Thursday another 18 to 20 acute care beds will be added in Moncton in the next couple of months.

Bolton said during the meeting that the number of nursing home beds and community programs to keep people in their homes longer “are simply not keeping pace with the aging population.”

Department of Social Development spokesperson Kate Wright said in an email this week that to date, 380 beds have opened with another 240 beds under construction as part of the province’s 2018-2023 nursing home plan.

Wright said Social Development also continues to work with nursing homes on strategies to address staffing shortages and open vacant beds. The department has participated in international recruitment missions in the Philippines, Belgium, France, Tunisia and Morocco.

She said that since 2023, those efforts have resulted in 514 job offers. She did not say how many offers were accepted.

The province is also helping seniors age with dignity, on their terms, through the expansion of the Nursing Home Without Walls program, which now includes 22 locations across the province, and has served more than 2,400 participants to date.

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Initiatives optimizing operating room time

Horizon officials say the health authority is seeing success in better access to surgery.

The quarterly report states surgical teams achieved a 14 per cent increase in completed surgeries, and increased surgical capacity in Moncton, Fredericton and Saint John. Completed surgeries increased for all surgical services – except plastic surgery – by 19 per cent, with hip and knee completed surgeries increasing by 77 per cent compared to last year.

Last year, Horizon announced the health authority had eliminated its “long waiter” list of patients who had been waiting a year or more for hip and knee replacements.

Amy McCavour, Horizon’s co-leader of surgical services, said that although their wait list for hip and knee surgery is growing, the health authority has been able to keep on top of it.

“We’re always going to have wait lists. We’re never going to eliminate it, so we need to know that sweet spot,” she said.

McCavour and her other co-lead Dr. Trish Bryden said there continues to be challenges in the surgical field, such as temporary replacements for operating room staff on leave, anesthesiologist shortages, and succession planning for retiring operating room staff.

In addition to ongoing recruitment, McCavour and Bryden said there are other initiatives aimed at improving access to surgery, such as new cataract clinics in Saint John and Moncton. McCavour noted the largest proponent of the long waiter list are in ophthalmology.

McCavour said Horizon is also looking at which procedures can be done outside of an operating room, and how to maximize the use of operating room time, such as weekends, evenings and extended hours.

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