Friday, October 9, 2020

Findings in CMAJ report could help NB prepare for second wave

With a second wave of COVID-19 potentially on its way, findings related to nursing homes in the Canadian Medical Association Journal (CMAJ) could help better prepare our province both in the immediate future and long-term.
The study compared how nursing homes – referred to in the study as long-term care or LTC facilities – in Ontario and British Columbia fared through the first wave of the pandemic.
As of Sept. 10, 2020, the number of resident cases in Ontario LTC homes were 5,965 and 1,817 resident deaths. Conversely, BC had 466 cases and 156 deaths in its facilities.
The authors looked for factors that caused the disparity between the two. Here are a couple of key points from the research:
• Before the pandemic, the LTC system in British Columbia exhibited a number of potential strengths relevant to pandemic preparedness compared with Ontario:
o there was better coordination between long-term care, public health and hospitals;
o greater funding of long-term care;
o more care hours for residents;
o more non-profit facility ownership; and
o quicker action in BC to implement a single-site workplace policy.
Let’s look at each finding in terms of New Brunswick.
Coordination between long-term care, public health and hospitals
Our province could achieve this in one step – move senior care back under the Department of Health and out of the Department of Social Development. After all, long-term care is part of health and the medical system.
Making this move means one entity is responsible for the coordination of care, thus streamlining the process. This is something the New Brunswick Union (NBU) and many others have been asking the province to do for quite some time.
In fact, New Brunswick is the only province or territory that doesn’t have senior care under its Health department.
Greater funding for long-term care
The average combined funding per resident per diem is higher in BC ($222) than in Ontario ($203). In New Brunswick, that number is $113, significantly lower than all other provinces with the exception of Prince Edward Island.
The argument against most spending for government is there’s no money. It’s a simplistic argument that doesn’t hold much weight when you consider governments are elected to make choices on how to spend taxpayer dollars and this is perhaps the biggest issue facing the province – senior care – given the rapidly aging population.
Also, government has means of changing things to bring in more revenue including higher taxation of ultra-wealthy, valuing new buildings at proper assessed value, such as the new Irving headquarters in Saint John, and ending corporate welfare.
More care hours for residents
Residents in BC received more daily direct hours of care (3.25) than Ontario (2.71). In New Brunswick direct care hours per day are 3.1, however, part of that calculation includes administration, so that lowers in to 2.89 according to numbers from the New Brunswick’s Coalition for Seniors and Nursing Home Residents’ Rights.
It would stand to reason that increased hours of care would lead to better resident health outcomes. Increasing hours of care is directly related to staffing which bring us to the next two points.
More non-profit facility ownership
More LTC homes are managed by for-profit operators in Ontario than BC. According to the report, “for-profit homes deliver inferior care across a variety of process and outcome measures.....several reports have documented that for-profit homes pay lower wages, have lower staffing levels, hire more part-time and casual workers and have more turnover than non-profit homes.”
The NBU has long argued that privatisation has no place in our healthcare system as it prioritizes profits over people, in this case profits over the safety and wellbeing of both residents and caregivers. We urge the province to keep nursing homes in the non-profit realm.
Option for full-time work
From the report, “Many LTC staff, in particular care aides or personal support workers, are underpaid and less likely to secure full-time positions relative to their counterparts in other sectors of the health care system. As such, staff frequently take on several part-time or casual roles at different LTC homes, which increases the risk of transmission among facilities.”
British Columbia announced a single-site policy on Mar. 26, Ontario did so about a month later on April 14. This means staff would work at just one home and receive the full time hours or the equivalent of what they were getting working at multiple sites.
In New Brunswick, the idea was discussed and the NBU was supportive. However, despite the good idea and the obvious benefits, government never went forward.
We continue to be supportive of this change as it is better for caregivers and residents so long as staff receive full-time hours or the equivalent of what they were working at multiple sites. Despite numerous inquiries as to what happened or why this has not been implemented, government has not provided an explanation.
Overall, our LTC homes fared well in the first wave of the pandemic due to the great work done by staff and residents alike. However, the low number of cases and deaths doesn’t mean improvements can’t be made.
Our Premier has spoken of making decisions based on facts and evidence, the CMAJ reports provides this and it is up to our politicians to implement practices that will help both with a potential second wave and into the future.