Sundre's mayor got a long but detailed answer from an Alberta Health Services official after asking about the reason behind the closure of the local hospital's 15 long-term care (LTC) beds.
"Regarding the closure of the long-term care beds, do you have the rationale for that?" said Terry Leslie during council's April 18 meeting, addressing Cathy McDonald, AHS senior operating officer for South, Central Zone, who had come to provide town officials with a clearer picture of the hospital's use by presenting a breakdown on its statistics.
"When we look at our capacity needs in long-term care, there's some key stakeholders that are involved in that, and Alberta Health Services is just one," began McDonald's response.
"In the past, a group of different government departments has developed what's called the Continuing Care Capacity Plan, and that's work done by Alberta Health, Alberta Seniors, Alberta Infrastructure, Alberta Municipal Affairs, and Alberta Health Services."
These groups have looked at needs for continuing care up to 2036. They consider a region's current population and adjust future requirements based on anticipated growth, she said.
"That's always a hard one, because we can look at growth patterns, but we know that there's a lot of things that can influence growth in a community. We look at the age of a population and we look at disease prevalence. Knowing the disease profile of a community really does indicate the future use of certain services within the community."
Also factored into future planning are wait lists, utilization rates and adjustments for increasing home care support, she said.
"One of the things the capacity plan does have in it is not only the anticipated need for continuing care within facility living but also living in the home, because more and more studies or work that's being done does tell us that seniors want to stay in their homes and be independent for as long as possible."
Over the course of the next 20 years, the number of needed facility living spaces is expected to double, while home care resources will need to quadruple, she said.
"We feel that more and more into the future, people are going to be wanting to remain in their own homes. I'm one of those baby boomer generation folks ó it's certainly the life plan I have for myself in my older years."
Taking into consideration that the type of care that will be delivered over the next number of years will change also has to be factored in when talking about the "tsunami of people aging." The delivery of care has changed over the last 20 years, and it will continue to evolve in the years to come, she said.
But "it's very difficult to look at any one rural community in isolation. We look at groups of communities together and then try to project where we might need to increase this service."
Matching a community's exact needs is an elusive goal, "but we try to look at it over a larger service area so that you can get it right for the population," she said.
However, the idea is not to go too far out, as there are already "natural synergies" among communities like Sundre and Olds as well Innisfail, Rocky Mountain House and Didsbury "because there seems to be some natural connection between those communities where physicians work together."
In terms of considering future needs for long-term care, supportive living (SL4) and supportive living for patients with dementia (SL4-D), "we're still grappling with that," she said.
Supportive living is a relatively new model of care delivery in the central zone dating back less than 10 years, she said.
There are differences between the patient profile for SL4 and LTC, "but they are very subtle," she said.
The Continuing Care Capacity Plan is reviewed once a year so operational staff can reconsider and decide where and when new capacity should be built or factored in, she said.
"So when you ask where do these decisions, or how are those decisions made, this is the kind of data that's looked at. When we look at specifically for Sundre and Olds, if we look at maintaining all of the long-term care beds that we have in both communities, even when we go out to 2034-35, we would have too many long-term care beds in those communities."
Long-term care requires a more constant presence of a registered nurse while supportive living has professional nursing provided by a licensed practical nurse. That presents an operational "conundrum" as long-term care is an expensive model of service delivery, she said.
"Even given the long-term care beds that we have right now, I could not look any one of you in the face and say we could meet the needs of every long-term patient that might be out there ó there's just some folks that need more specialized care."
Still, efforts are made to keep the majority of people who don't need such a high level of care in their hometown, she said, adding "every community is concerned about keeping people in their community."
Coun. Myron Thompson said it's a mistake to leave local front-line workers out of such a decision-making process. He recalled his time as MP, when he would invite for discussions people in front-line positions ó educators, health professionals, correctional services ó only to be told they're not supposed to talk.
"Whose voices are being heard?" he asked.
"I think it's administrative voices from above who constantly draw up regulations and make decisions on our behalf because we're too stupid to do it ó that's how I feel as an old boy of this town."
But McDonald said she has "just been blown away" by the work done by the local workers, and that a local team does make decisions about how to spend budgeted dollars. Additionally, since the creation of AHS, "we've been able to save the people of Alberta about $750 million in administrative costs."
There are approximately 100,000 employees in AHS, of which only about 3,200 are managers, many of whom are also on the front line, such as Larry Gratton, the Sundre hospital's site manager, she said.
AHS has the lowest number of administrators of any health-care system in Canada, and "we work hard at helping support the work front-line employees do. Could we do more with less? I guess we're always trying."
However, with the economy as it has been, budget increases have been basically non-existent, she said.
"So it is a constant struggle and we rely on our front-line people to do that problem solving."
The mayor thanked her for the presentation, and McDonald expressed an interest in being included on council's agenda twice a year to keep the lines of communication open.
Heidi Overguard, a community member with the Sundre Hospital Futures Committee who attended the meeting with several others from the committee, said AHS had met with the group.
"We're working in the right direction," she said.
"We're starting a public consultation process, although we wish it had started sooner, but we are starting one."
The committee's stance is to continue pushing to keep the hospital's long-term care beds, she said.
"That's not something we are changing on. However, we are willing to work with Alberta Health Services to find out what plan would be the best one."
