Written for Daily Hive Urbanized by Jason M. Sutherland, who is the UBC Professor of Health Services and Policy and Director of the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia.
If you have visited an emergency department in British Columbia lately, you’ve likely witnessed the hospital crisis first-hand. You see the endless waits, exhausted doctors and nurses, and the harshness of hallway medicine endured by patients and their families.
The failures of healthcare in B.C. are plainly visible in hospitals, but the root causes lie elsewhere. Our hospitals are overflowing because our long-term care system is being starved financially.
For over a decade, B.C. has relied on hospitals as an expensive and inappropriate safety net for a long-term care sector that has failed to keep pace with an aging, increasingly frail, and medically complex population. Today, 15 per cent of B.C.’s hospital beds are occupied by patients who no longer need hospital care but cannot be discharged because there is nowhere safe for them to go. Most of them are seniors.
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Keeping seniors in hospital when they no longer need specialized care is a disservice to their well-being, a risk to their health, and a wasteful use of scarce health resources. The lack of hospital beds for those who need them backs up emergency departments, causes ambulance offload delays, and drains staff morale.
Earlier this year, the provincial government abruptly cancelled projects for approved long-term care facilities in communities ranging from Squamish to Kelowna to Fort St. John. Presumably, the cost of $1.8 million per bed gave the government pause regarding the significant amounts involved.
But the waitlist for publicly funded long-term care beds in B.C. reportedly exceeds 7,000 individuals, with average waits stretching beyond 200 days. Cancelling new long-term care beds will make problems in hospitals worse.
Adding long-term care beds across the province should be a central election issue.
The demand for long-term care is coming from several directions. Advances in medical care have been successful in saving lives. This means that there are more people living longer with severe frailty and complex round-the-clock health needs. B.C. is also getting older. According to Statistics Canada, more than one in five B.C. residents is over 65.
The province’s long-term care capacity is insufficient. Thousands of new long-term care beds are needed over the next decade just to maintain current service levels.
To prevent the hospital crisis from becoming worse, the provincial government must move beyond crisis management and invest in long-term care.
First, the province must reverse its retreat from building new long-term care facilities and move more quickly to build them. Waiting five to seven years for a long-term care facility to open is not acceptable given the burden these delays place on our hospitals and their staff.
Second, we cannot neglect the buildings we already have. As health authorities diverted budgets to other priorities over the years, long-term care facilities have deferred vital maintenance. There is little value in building new facilities on expensive real estate if we allow existing ones to deteriorate. There are also older facilities that are obsolete and require complete overhauls because they don’t meet modern standards for dignity or privacy.
Third, B.C. needs more transitional care facilities. Step-down facilities bridge the gap for medically stable patients who need rehabilitation before going home or who are waiting for a long-term care bed. Renovating obsolete facilities or building new transitional care spaces frees up vital hospital space and avoids building expensive hospital beds.
Fourth, B.C. must invest in initiatives to keep people out of hospital for as long as possible. Expanding publicly funded home care, adult day programs and respite care for family caregivers will support seniors to age safely at home. Home care services also need to provide more complex medical support, including specialized dementia care to delay or avoid the need for long-term care.
None of B.C.’s long-term care infrastructure will matter unless the province also changes the demand for healthcare. The province needs to reduce the demand for intensive medical care at the end of life.
The solution is not simply to build more hospitals. The province needs to make sure people receive the right care in the right place. This means keeping people out of hospital when they do not need acute care, freeing up hospital beds for emergencies and giving older adults the dignity they deserve.
As we head to the polls, let’s make sure improved access to long-term care and hospital care is on the political agenda.
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