Horizon calls for tougher nursing home placement rules

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Horizon Health Network recently suggested that the province tighten up the refusal rules around nursing home placements, including “obligating” patients to accept any offers within 50 kilometres of their home, but the idea apparently hasn’t convinced the government.

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That news was revealed on Thursday by Horizon president and CEO Margaret Melanson, who appeared before a legislative committee in Fredericton to discuss the health authority’s 2023-2024 and 2024-2025 annual reports.

But the ongoing hospital overcrowding crisis, which Melanson said was primarily because of the huge number of alternate level of care (ALC) patients occupying Horizon’s beds – she estimated it’s between 37 and 40 per cent of all beds, and costing taxpayers about $557,000 a day – quickly overtook proceedings, and was the focus of media questions afterwards.

That’s when Melanson revealed Horizon’s recent request to the government.

“I would say the potential that (New Brunswick) patients can remain in hospital if they are refusing nursing home choices is something that does not occur in every province in Canada,” Melanson said.

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“In other provinces in Canada, patients are obligated to accept the nursing home option provided to them and move to that nursing home while they are potentially waiting a transfer to the preferred nursing home. That would be the policy that we would prefer to see within Horizon. We’re hopeful that perhaps New Brunswick can eventually move to that particular policy.”

If hospitals were able to get back under their operating capacity, Horizon would happily surrender the cost of housing ALC patients in hospitals from its budget. Housing those patients in hospitals cost taxpayers about $17 million in the 2024-2025 fiscal year, she added, noting that “we do have the trajectories now to indicate, unless there is a robust action undertaken, we can only expect these numbers to accelerate in the coming years.”

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Melanson also noted that New Brunswick does have a system in place to financially penalize ALC patients in hospital who keep refusing nursing home placements – namely, by charging them the “full” daily hospital rate. She didn’t say what that cost was, but did explain why it often doesn’t work.

“That is not necessarily a great incentive for individuals to move to a nursing home, because at this point in time, we really do not have a robust way for us to collect that money, and so despite people being billed for these larger amounts, that doesn’t necessarily translate into us receiving that money. That’s often the case,” Melanson said.

Brunswick News also quizzed Melanson about recent changes to the Nursing Home Act, which were announced late last Friday by the province. Those changes give ALC patients waiting in hospital rather than at home vastly more choices for nursing homes, and the benefit of never being kicked off the wait list no matter how many times they reject a particular facility.

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That’s led New Brunswick Association of Nursing Homes chief executive officer Richard Losier, a former Liberal MLA, to worry that the government’s rule changes will lead to more ALC patients winding up in hospital, not fewer.

While Melanson said that “any change is taking us in a positive direction” and that the network welcomes “any type of intervention that has been introduced,” she quickly added that “unfortunately, (the changes to the Act) will not achieve a large number of medically discharged patients leaving our facilities.”

She then reiterated her hope that the government will adopt Horizon’s idea.

Asked whether Horizon was consulted about the Nursing Home Act changes before they were announced, Melanson said an opportunity to “provide feedback” was offered, and accepted.

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“The feedback we provided is (that) this is a step, hopefully, in the right direction,” she said. “However, it is not taking us far enough.

“And we were very clear about the recommendations we made around that more robust approach toward within a particular geography, and our recommendation was within perhaps a 50-kilometre range, a patient would be obligated to accept a nursing home offer, and as I mentioned, have the potential to move to their home of choice.

“Well, the government … took those recommendations under advisement,” she said, later adding that Horizon wasn’t given any other information.

Brunswick News asked Social Development Minister Cindy Miles for an interview, but she didn’t respond. But in an interview before Melanson made her comments, Lyne Chantal Boudreau, the Minister responsible for seniors, rejected the idea that the changes to the Act could lead to more ALC patients and their families choosing a hospital over their home while they wait for placement in a long-term care facility.

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“For me, if you are someone taking care of your father or a senior around you, do you think it’s really fair to bring that person in the hospital if they don’t really need … hospital services?” Boudreau asked.

The “main thing,” she added, is that seniors and their families “need help, need something other than going to the hospital.”

“And the professionals who are in the hospital right now, they will ask some questions. They will check that person, just to make sure … because we know hospital is not the place where we can put all seniors for many, many reasons.”

Brunswick News also asked whether there have been any procedural changes to the screening of ALC patients before they’re admitted to hospital.

“Social Development is not aware of any changes to admissions processes in hospitals,” spokesperson Kate Wright said in an email, suggesting Horizon and Vitalité health networks might have more to say.

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Opposition reacts

Progressive Conservative health critic Bill Hogan described the 50-kilometre idea as “not an unrealistic ask,” provided the patients and their families are consulted, and their individual situations examined.

“For my family, travelling 50 kilometres may not be a big deal. For other families, it may be impossible. So I think that that needs to be taken into consideration.”

Green party Leader David Coon said the former Higgs government had long-term care legislation “almost ready to go,” but the Liberals apparently weren’t interested in quickly adopting it when they took power.

“I thought, ‘Well, there’ll be a few tweaks (to the legislation), and then we’ll see it,’ but we’re not going to see it until some time next year,” Coon said. “So this is a big problem.

“It is a key element to solving the problem: to take an integrated approach to managing special care homes, nursing homes and home care, so that it’s kind of seamless in the way people can access the right place for themselves and deal with the financial issues that separate special care homes from nursing homes – (it’s) sometimes difficult to get into a special care home financially, so that needs to be levelled.

“And that’s what this legislation would do, and we’re still waiting for it.”

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