The new model will be beneficial to some areas of health care in this province. It has the potential to speed up treatment time in hospital wait rooms and decrease surgery wait times and even simple procedures like ultra sound. It provides incentives for health care providers to ensure quality care. Pay for performance is another name for this payment model as it rewards physicians, hospitals, medical groups, and other health care providers for meeting certain performance measures for quality and efficiency. The quality and efficiency are rated on turn over and turn over times. The idea is that doctors and health service providers will see more patients because the more they see and the more they treat than more funding is available to them.
This funding model works well for long-term facilities that operate to rehabilitate an individual. 70% of the long-term facilities in Alberta are for the care of our senior citizens. Roughly 40,000 of those seniors have dementia. Dementia is a progressive disease, with no cure. Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living and lasts more than 6 months. Dementia is a terminal illness. Allison Redford, our premiere, knows what dementia is. Ron Casey, our local MLA, knows what dementia is. Fred Horne, the minister of health in Alberta, surely must know what dementia is and I'm sure, George VanderBurg, the associate minister for seniors, knows what dementia is. Yet, I have to wonder if they do, because they have applied this new funding model to long care facilities across the province knowing that 70% of those facilities are for seniors and knowing that 40,000 tax-paying Albertans have some form of dementia. Long-term care facilities and especially those that cater to seniors with dementia, don't have turn over, so the funding that they have been receiving in the past is now gone and they can't possibly qualify for additional funding with the new model. The name long-term care says it all. Long-term is self explanatory it means a patient is at the facility for a long term.
I have sent emails to all of those involved in the changes to the funding model. They have a standard answer written by the communications officer. It states 'the service provider at the facility where your mother resides, was made aware of the forthcoming changes in 2009. They have had 3 years in which to adjust their budgeting, costing and expense requirements accordingly. Therefore your concerns should be addressed to them'. Passing the buck, the one thing all politicians are good at. It isn't the service providers fault that the government is applying such a funding model to facilities that can't possibly rehabilitate those that reside there.
To manage the loss in funding, the society that runs my mom's facility did lay-offs from the top to the bottom. The loss of an executive position has no relevance in the care of my mother but the loss of a nurse or an LPN or a health care worker certainly does and everyone has noticed the difference. The staff that still have jobs are already tired and burning out. There are two workers and one nurse on a wing with 26 residents. The nurse is usually very busy giving medications and checking everything from minor to major complaints. In addition, the government, in their infinite wisdom now requires a tracking system for each individual patient that must be recorded daily and then input into a government database. It can take almost an hour to record and input the data required for 1 PATIENT, yes for 1 patient. The nurses work 8 hour shifts, there are 24 hours in a day there are 26 patients so everyday they are already behind. Then they fall further behind because there is only 1 nurse on the midnight shift for 3 wings that have 78 long-term care patients and she must input every report that hasn't been entered and make adjustments if there is any incident that happens in any of the three wings overnight. If you think that people with dementia actually sleep at night then you are wrong. The reports are sent to the government every two weeks and if any report is late or missing then there is no money given to the facility for that period. If a computer glitches up and the reports are not submitted then there is no money given to the facility for that period.. If a resident is rehabilitated and moves out of the facility during that period, then the government does give money to the facility and even more money. But in a 'dementia' wing, the only way out is by death and death doesn't meet the funding criteria so if a resident dies during that reporting period, then no money is given to the facility.
The nurses are busy but the government expects them to properly adhere to the medication requirements in a timely manner and do the residents reports and help with the basic day to day care of the facility residents. They don't have the time so the onus for the basic care of course falls on the tired shoulders of the health care workers. It takes anywhere from 20 to 45 minutes to wake, wash and dress a dementia resident. That is providing that the resident is agreeable, aware and in good spirits. The health care workers start waking residents up at 7:00 am. People with dementia sometimes get aggressive and it's near impossible to wash or dress them if they don't want to. They are like toddlers but in adult bodies and one person can't do it alone. People with dementia are confused and scared and don't remember faces and don't want someone that they view as a stranger touching them or helping them. Dementia patients are often very weak and feeble and can't help in any way. Needless to say, by noon some of the residents are having breakfast while others are getting lunch.
Most people with dementia either require to be fed or they are a choking risk and must be watched. Some will put too much food into their mouths because they have lost the ability to eat normally. Others won't eat and need encouragement and others might pocket the food in their mouths and could aspirate on it later and cause aspiration pneumonia. Again, there are 26 residents and 2 workers at breakfast, lunch and dinner. Any family or volunteer that comes during meal times to assist their loved one is so greatly appreciated. Some of residents that do require feeding are unfortunately getting cold food or have fallen asleep by the time a worker is able to get to them and they won't wake up. I know from experience that it takes a minimal of 30 minutes to feed a person who requires meal assistance.
In addition, most people with dementia are incontinent and require toileting. An adult diaper is changed in the same way that a babies diaper is. They are laid down, the dirty diaper is removed, they are cleaned, a fresh diaper is put on and they are redressed. With a baby it is actually quite easy, but not so easy with an adult. It is time consuming and often requires two workers and a mechanical lift to get the resident safely from their chair, to the bed and back again. Many dementia patients do use the toilet but they still require assistance and often it requires two workers to get them safely to, on and back from the toilet and change the adult pull-up if needed.
Then, again with their infinite wisdom the government has assured, under an act no less, that all residents of long-term care facilities will receive two assisted bathes or showers per week. To accommodate this there is a floater. The floater is assigned to do all the bathing or showering AND help with meals, toileting, lifting, portering AND covers breaks. There is one floater who works an 8 hour day/7 days a week. That is 56 hours and there are 78 residents that require bathing and as they are to get two bathes or showers a week, that is 156 bathes and showers. I take hour long bathes on a regular basis and even in a rush, I'll take a 20 minute shower and that's just my wet time and not including getting naked, towelling dry and getting dressed again. It takes close to an hour to properly bathe or shower a person with dementia. Again, not enough hours in the day or days in the week.
Forrest Gump said it best "Stupid is as stupid does". The new funding model is just about as stupid as stupid can get. I always took that line to mean that your character is defined by your actions, so our government representatives have very questionable characters. I am not impressed, in fact I am pissed off, really fucking pissed off. Those that know me, know I must be pissed off because I used the f-bomb. And I am really fucking pissed off. I'm pissed off because our seniors deserve better. I'm pissed off because a simple bladder infection can mean the end for a dementia patient and because they no longer can get toileted or changed regularly they are going to get infections. I'm pissed off because my mom needs assistance to get to the toilet and if she can't get a worker to help her she will go on her own and she might fall and break a hip or get a concussion, or something. I'm pissed off because our seniors might choke on a boiled egg. I'm pissed off because sometimes all a dementia patient needs is someone to hold their hand and no one has the time to hold their hand anymore. I'm pissed off because my mom has dementia. I'm pissed off because my dad is a senior. I'm pissed off because I too will be a senior someday. I'm really pissed off because right now, in some ER in the city, some bimbo is getting top notch medical care because she has a little infection from a botched manicure and my mom is anxiously awaiting for a worker to help her get dressed and into bed because she's tired. I'm pissed off because my mom has paid more taxes in her life time then the bimbo with a bad hang nail at the Foothills emergency room right now. Yep, I'm just pissed off.
That's why we organized the rally against cutbacks. I hope that you reading this will do the same where ever you live. The pay for performance funding system is prevalent in the US, the UK and Europe. More and more countries are moving towards this model of health care funding. That means more and more seniors will not get the quality of care that they not only deserve but that they earned. We have to do something and if we don't then we are stupider than the politicians. I'm not stupid, my mother didn't raise a fool.
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