Horizon implements no-refusal rule across its hospitals

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Facing a mounting shortage of acute care beds, Horizon Health Network is now implementing the no-refusal rule across all its hospitals to move alternate level of care patients into nursing homes.

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Every ALC patient is now required to accept the first available nursing home bed within a certain geographical distance on an interim basis – as opposed to having the option of waiting in hospital – until a bed opens at their preferred home.

In January, Horizon Health Network revealed the rule had come into effect at the start of the year at its Moncton hospital, although the six patients who had since been moved into interim beds had gone willingly after conversations with hospital staff.

“We are doing it now everywhere where there are beds available,” Horizon Health Network president and CEO Margaret Melanson told reporters following her appearance before a legislative committee last week.

“We had hesitated to undertake this because we recognize that patients really do want a choice with regard to the nursing home they want to move toward.”

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Under the Nursing Home Act, an ALC patient “shall” accept the first available nursing home bed that offers services in their official language of choice if the nursing home is 100 kilometres or less from the patient’s residence for interim placement.

Vitalité Health Network was first out of the gate to adopt a new approach to working closely with ALC patients to get them to accept first-available nursing home beds on an interim basis.

Over the past year, Vitalité has placed 109 patients – all willingly – in interim nursing home beds, reducing the length of stay for its ALC patients by 20 per cent and freeing up acute care beds for those most in need, according to the francophone regional health authority.

Despite this initiative, Vitalité recently had to issue a “code red” due to occupancy levels, according to Dr. France Desrosiers, the president and CEO of the regional health authority.

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Once a “code red” is issued, Vitalité speeds up the discharge of low-risk patients waiting for nursing home placement, telling organizations involved in the file that care needs to be provided for the resident in the community, Desrosiers said in French.

Over the last year, Desrosiers acknowledged that Vitalité has had to lean on provincial law at times to discharge patients.

“When we’re in a ‘code red’ with families that collaborate less or refuse help or support at home, then we’ll use the Act to force them to leave, to be discharged,” she told the public accounts committee last week.

“That’s only happened with three families in the last year.”

Melanson told reporters that no patients – outside of those who have been moved from The Moncton Hospital – have been relocated under Horizon’s new initiative.

“In the past, we were not able to do this,” she said of the initiative. “We were asked not to do this and so now we have the green light from government to utilize this practice and are obviously working with Social Development to that end, so this is new.”

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Almost 1,000 people were on New Brunswick’s nursing home waitlist as of the end of January, according to provincial data shared by the Coalition for Seniors and Nursing Home Residents’ Rights.

Surgical interruptions possible if backlog continues

During her appearance before the public accounts committee, Melanson stressed to MLAs that ALC patients aren’t receiving the quality of care they deserve while waiting in hospital for placement.

As a result of the backlog, Melanson said other patients – including those in emergency departments – are feeling the impact as well, with some waiting as long as 48 hours for an inpatient bed.

About 40 per cent of Horizon’s acute care beds are currently occupied by ALC patients, Melanson said. These patients don’t require acute level care but remain in hospital awaiting either long-term care placement or community services to return home.

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“We’re moving toward having regional nursing homes as opposed to regional acute care hospitals, and that to me is extremely concerning and should be concerning to the population of New Brunswick,” Melanson later told reporters.

If the crisis continues, the CEO warned that by this time next year, there could be surgical interruptions at Horizon hospitals because “we will not have any other places to place patients.”

The Holt government is expected to deliver a new long-term care strategy for the province this month.

Melanson told reporters that she’s open to the Holt government’s idea of shifting some hospital beds to long-term care homes – a proposal the Liberals have floated in their pre-budget consultation report.

Horizon is hopeful for the construction of more nursing homes through the upcoming strategy, but Melanson pointed out it can take up to two years for a new home to open.

She made the case to the committee for the better utilization of special care homes in the province and other options to take the pressure off hospitals.

“If government would agree to fund more hours of care for patients to return to their own homes, that could be undertaken very quickly,” Melanson later told reporters.

Brunswick News requested comment from the Department of Social Development, but it did not receive a response by deadline Tuesday.

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