Long-term care patients in hospitals partly blamed for Horizon deficit as well as bed shortage

Patients who should be in long-term care but are instead taking up hospital beds were a major topic of Horizon Health's board meeting Thursday and were blamed in part for the network's projected deficit of more than $64 million this year.

Board chair Susan Harley said New Brunswick's rapid population growth and the province's aging population continue to put extreme pressure on the health-care system with "inadequate" placement options for long-term care patients.

"In some hospitals, we're seeing levels of over 35 per cent of hospital beds occupied by elderly patients who do not require acute hospital care," Harley told the board.

With so many of these patients, known as alternate level of care, or ALC, patients, in hospital, the number of people who can be admitted through emergency departments is drastically reduced, she said.

Greg Doiron, vice-president of clinical operations, said the goal is to reduce ALC numbers to below 330, or 20 per cent of total hospital beds, by January 2026. 

But the province needs to accelerate growth in nursing homes, he said.

A graph provided by Horizon has 652 acute care beds in network hospitals now being used by ALC patients, or 39 per cent of the total. The numbers have shown "substantive and consecutive" increases since the pandemic, Doiron said.

The number of people aged 65 or older New Brunswick increased 78 per cent between 2004 and 2022, he said, but new nursing home beds only increased 21 per cent in the same period.

"As you creep beyond 20 per cent, you start to really have meaningful impact on our ability to provide acute care," he said. 

The nursing home waiting list has also grown and now stands at more than 1,000 people, "because there's no new capacity."

And the longer that ALC patients stay in hospitals, the worse off they become, he said.

"What we see is a decompensation of these patients due to the lack of those resources, which actually makes their situation worse, makes their ability to be placed more challenging, and ultimately leads to a longer and longer stay in hospitals."

Stephen Bolton, chair of patient safety and quality improvement, said a solution to the bed shortage created by ALC patients is challenging because nursing homes fall under the Department of Social Development, not Health.

"We look after people from when they're in cradle until they need long-term care, and then that responsibility is given to someone else," Bolton said.