New Brunswick is confronting a deepening problem over how the province cares for its seniors as it balances the competing demands of an aging population and the deteriorating state of its nursing home infrastructure against its worsening financial outlook.
A seniors' advocate says the condition of existing nursing homes is "alarming," and the scarcity of nursing home spaces is set to become an even larger concern in the future.
There are 4,140 residents in the province’s 65 nursing homes. But there are more than 700 seniors occupying hospital beds because there are no beds available in nursing homes.
There were also 719 seniors on waiting lists for nursing homes on March 31, 2010, and those lists are expected to grow longer every year.
Quick facts of N.B.'s nursing home crisis
Number of nursing homes: 65
Number of nursing home residents: 4,140
Number of female residents: 2,909 (65%)
Number of male residents: 1,231 (35%)
Percentage of residents under 65: 9.6%
Percentage of residents between 65 and 84: 40.8%
Percentage of residents older than 85: 49.6%
Average length of stay in 2010: 2.37 years
Average length of stay in 2008: 1.9 years
Number of nursing homes with less than 30 beds: 2
Number of nursing homes with 30-49 beds: 23
Number of nursing homes with 50-99 beds: 26
Number of nursing homes with 100-149 beds: 7
Number of nursing homes with 150 or more beds: 5
Nursing home waiting list as of March 31, 2010: 719
Nursing home waiting list in 2008: 518
Estimate of seniors in hospital beds waiting for a nursing home bed: 700
Source: Department of Social Development
Cecile Cassista, executive director for the Coalition of Seniors and Nursing Home Residents' Rights, said the combination of an aging population and the condition of the existing nursing homes is "devastating" and "alarming."
Cassista said the provincial government is not moving swiftly enough in addressing the well-known problem of worn-down nursing homes.
"I think that we have reached that plateau now and it is going to get worse," she said.
"They are not moving forward fast enough. We are in a crisis, there is no question about it."
New Brunswick is not the only province that must face the financial challenges that will be brought on by an aging population. But the Maritime province will be among those hardest hit by the demographic shift
New Brunswick has 119,000 citizens aged 65 or older. Statistics Canada has estimated that by 2011, New Brunswick residents aged 65 and older would represent 15.7 per cent of the total population, the second highest percentage in Canada.
Statistics Canada also estimates the number of seniors will hit 188,300, or 25.7 per cent of the total population, by 2026. The Department of Social Development expects the number of seniors will fully double within the next 20 years.
The provincial government's statistics also show the length of stay at nursing homes is getting longer and the average age of residents is getting older.
The cash-strapped province is reviewing a five-year, $400-million infrastructure plan that would have replaced and renovated the stock of nursing homes.
Under that plan, which was announced by the former Liberal government in 2009, New Brunswick would have created 700 new nursing home spots. The plan recommended the provincial government build two new nursing homes, replace 11 nursing homes with new facilities and renovate 31 buildings.
When Premier David Alward’s Progressive Conservative government was elected in 2010, the long-term plan for nursing home infrastructure found itself in political limbo. The Tories immediately started preaching fiscal austerity and ratcheted back spending across all departments.Even nursing home projects that were already approved were reviewed to search for any possible cost savings and the remainder of the plan has been subjected to the internal review.
That internal review has been completed and has been delivered to the provincial cabinet for approval. Social Development Minister Sue Stultz is expected to release the report closer to Nov. 23, when the legislative assembly resumes sitting.
Stultz, who declined an interview, said in October that some savings were found by re-examining the sizes of rooms and the types of materials used to build the roofs, for example.
Growing infrastructure challenges
The infrastructure challenges being faced by the province's nursing homes are not new. The Department of Social Development's statistics show there were 73 infractions found during nursing home inspections in 2008. That number fell to 63 in 2010.But the declining state of New Brunswick’s nursing homes burst into the open earlier this year when two facilities were forced to cope with mould outbreaks.
The 40-year-old Grand Manan Nursing Home, which has battled mould problems for a decade, restricted some residents to eating and bathing in their own rooms in June.
A section of the the 71-bed Mill Cove home, which is about 70 kilometres east of Fredericton, has been closed since last fall because of a toxic outbreak in the storage area that spread through the walls of an adjoining wing.
When the long-term nursing home strategy was announced, Mill Cove was on the list for an immediate replacement. Its management hired an architect to begin some design work and got ready to issue construction tenders.
Not long after the architect was hired, the provincial government's review started and the brakes were put on plans for a new building, said Jason Dickson, the nursing home’s chief executive officer.
Mill Cove is like many other nursing homes in New Brunswick. It was constructed in the 1960s and it received a series of additions in the last 50 years to meet growing demands.
The patchwork of upgrades has led to some of its current problems.
Dickson said the original foundation and the foundations of the additions do not line up perfectly, allowing water to get into the basement. There are similar problems on the roof.
When any water gets into the building, Dickson said, that stokes fears over new mould problems. The facility’s staff must be on guard constantly for any "odd odours or smells" that could be an early warning for more mould.
The costs of those ongoing battles to maintain the aging infrastructure, buy new equipment to improve the quality of life for residents and meet the standards of patient care are all adding up.
"We are seeing the costs to maintain the facility go up each year," Dickson said.
'It is a not a 'nice to have,' it is a 'must have' for us right now.' — Jason Dickson, CEO of the Mill Cove Nursing Home
"I’ve always equated it to an older car. You keep putting money into it, but at some point, you realize you have to turn it over and buy a new one. It puts a lot of pressure financially on us."
The costs of living in the outdated building are not the only concern for Dickson. The early signs of the looming demographic challenge are also appearing in Mill Cove.
In the past, seniors from other areas would look to Mill Cove as a possible nursing home destination because it had empty beds. Now it is the latest New Brunswick nursing home to begin managing a waiting list.
Roughly five people are on a waiting list for admission into the enhanced care area of the building, which cares for special needs adults, and another seven are waiting for a bed in the nursing home.
The facility’s chief executive officer said the myriad problems facing the nursing home prove a replacement building is not a luxury in an otherwise austere time.
"It is a not a 'nice to have,' it is a 'must have' for us right now," Dickson said.
The demands from nursing home administrators and advocates for new buildings and expensive upgrades come as the Alward government is preparing for its second budget.
Early indications point to another lean financial plan. Finance Minister Blaine Higgs had promised to whittle down the province’s deficit to $448 million in 2011-12 but the Department of Finance’s second quarter report shows the estimate has ballooned to $545.7 million.
The larger deficit forecast is on pace to push the province's debt to more than $10 billion by the end of the current fiscal year.
The Tories have promised to balance the $8.1-billion budget by the end of their first mandate.
Last year, Higgs pared down the capital construction budget to $592.9 million from $940.4 million. The provincial government releases its capital budgets in December ahead of its regular budget in March.
Liberal MLA Donald Arseneault, the opposition’s finance critic, said he understands the province's fiscal challenges.
But he said any attempt to save money in the short-term by postponing needed improvements to nursing home infrastructure will only cost more in future years.
"I can’t stress it enough, our biggest challenge is a demographic challenge," he said.
"Our population is getting older and older. We have one of the highest senior populations in the country. They need a place to go."
Arseneault said he worries that seniors living in rural areas could be forced to move to nursing homes in larger centres unless new nursing homes are built or existing facilities are improved.
'They are not building, renovating or refurbishing nursing homes fast enough. The plan is broken and they need to fix it quickly.' — Cecile Cassista, Coalition of Seniors and Nursing Home Residents' Rights
"You cannot centralize everybody into the three cities in New Brunswick," he said.
"We have to be responsible in how we [pay for new buildings]
, but if you do cut back on some of these projects, seniors will be asked to move further from their families.'
The former Liberal government hired the ADI Group to design its long-term nursing home strategy. The consultant's report outlined what nursing homes should be replaced or improved and where new facilities should be built.
Arseneault said he believes that plan is still worthwhile and should be implemented.
Cassista is nervous as she waits for the Progressive Conservative government's review of that plan to be revealed and says she believes it "is utterly nonsense" to stall the plan considering the declining state of the province’s nursing home infrastructure.
She said any new plan must actually include "a vision" for addressing the infrastructure challenges and a firm timeline.
"They are not building, renovating or refurbishing nursing homes fast enough. The plan is broken and they need to fix it quickly."