By Emily Stonehouse and Vivian Collings
The Minden emergency room doors will be closing permanently on June 1, 2023.
As of that date, all emergency services will be operating out of the Haliburton Hospital. “This is really related to our health human resource crisis,” said Carolyn Plummer, President and CEO of Haliburton Highlands Health Services (HHHS). “It is a global health human resource crisis, it’s been ongoing for quite some time, and it has meant a shortage of both nursing and medical staff.”
Plummer emphasized that this closure is based solely on staffing rather than funding; recruitment is the persistent struggle looming over most rural communities.
She said that throughout this crisis, it’s been incredibly difficult to maintain both emergency facilities in the county. “In order to preserve health services and continue to offer high quality health services in this community, we need to consider the well-being of our staff,” Plummer shared in a media press conference.
Plummer noted that by creating a space where staff feel supported, she believes that the environment will entice others to join the HHHS team.
While shutting down the emergency location in Minden, HHHS staff demands will be alleviated, but not entirely solved. “Even with this change, we are going to need to continue focusing on hiring new staff,” she said, “we will still be recruiting for nurses and other physicians as well.”
Plummer acknowledged that this major shift will be a difficult transition period for the residents of Minden Hills who rely on the emergency department facility, noting that the decision to close was difficult. “We’ve been talking about this and looking at options for quite some time,” she said, “but this was the decision that we needed to make in order to continue to provide health services in the county and to make sure everyone in the county has access to those services.”
Plummer described the amalgamated emergency facility as significantly more “robust”, and highlighted that the combined staffing would suit the growing needs of the county as a whole.
During the press conference, it was noted that the Minden emergency room actually has a higher intake than that of Haliburton. Plummer clarified that while the numbers may be higher, an emergency department must be attached to in-patient beds. Currently there are 15 in-patient beds at the Haliburton Hospital.
HHHS dove into the feasibility of adding an in-patient component to the Minden Hospital, yet identified that it would take significant renovations and finances, and would entail a lengthy approval process that would likely take years to complete.
Plummer also noted that even if the renovations did take place, they would likely not be able to match what Haliburton currently has for in-patient support.
Beyond the in-patient beds, Plummer was transparent in stating that the Haliburton emergency facility is significantly more central to the county as a whole, which aided in the decision to keep the Haliburton ER doors open.
To accommodate the incoming emergency room volume from Minden emerge, the Haliburton facility will be making some minor alterations to make “more efficient use of the space that we do have, without any major capital investment needed, and no ministry approval needed” said Plummer.
These modifications would include waiting room space, parking, and alterations for patient-incoming flow.
With closing one facility down, it was noted that the Haliburton emerg would be facing significant growth in volume to their site. Yet Plummer reiterated once again that the primary incentive for the closure lies solely with staffing. “If you add up all the minimum staffing requirements that are needed at the two individual sites, it is more than we need to manage the volume that we have,” she said. “But, it’s the staff we need to meet minimum staffing requirements. It is going to mean that we don’t need as many people overall to fill the gaps.”
Yet, even with this conglomeration of the sites, Plummer shared that the facility would require at least five to six additional nurses to get their team up to par.
In terms of the Minden site, Plummer did not have a straightforward answer as to what would happen with the freshly-emptied emergency room. “We are looking at a variety of different options,” said Plummer. “We certainly haven’t landed on anything yet, but there’s a lot of possibilities and we’re going to explore those possibilities.”
Dr. Norm Bottum is the acting chief of staff for HHHS. He noted that while the news may be surprising to some, the act of consolidating health services isn’t something new to the region. “If we go back to the beginning of the Haliburton Health Services, it was actually started as a result of St. Joe’s and Peterborough Civic Hospital amalgamating, giving us the opportunity to start our own services,” he said.
Bottum clarified that this amalgamation gave Peterborough the opportunity to expand their services when all staff were working from the same site, and the facility became an appealing destination for interested physicians.
He noted that the board has worked incredibly hard to keep both the Haliburton and the Minden sites open, but with the ongoing staffing shortages, emergency departments seem to be shutting down across Ontario. “Things have gotten worse over the last year rather than better, so I think the hospital has been basically backed into a corner to make this decision, but in my mind, it’s actually something we anticipated would happen a lot sooner.”
Bottum said he believes the amalgamation of emergency rooms will help with recruitment of much-needed staff. A “progressive medical community” with new equipment and the potential for mentoring will be a lure to new doctors.
“Having a consolidated emergency department with hopefully improved staffing and maybe opportunities for improved equipment … so especially for junior doctors to actually be able to work a day shift alongside another emerg doc, there’s no rule that says you can only have one emerg doc, and lots of other communities have two,” Bottum said.
He added that a struggling medical community likely pushes new doctors to find employment elsewhere. Many new doctors are looking for a more active emergency department.
“Having a higher-volume emergency department would be very helpful in retracting,” Bottum said.
Plummer addressed HHHS’ anticipated $3 million deficit for this year and said although it will reduce their need to hire agency nurses, money was not a factor in the decision to close Minden emerg. Staff well-being and ensuring efficient ER operations are their main priorities.
HHHS is hoping for a smooth transition, having anticipated the closure of either the Minden or Haliburton ER for the past 18 months.
“We’ve done an awful lot of work to prepare for even potential temporary closures of an emergency department. So, lots of planning has already taken place to look at what would need to happen if one emerg was closed while the other stayed open,” said the HHHS president.
When asked about the limited parking at the Haliburton hospital, Plummer said, “We’re looking at alternatives there, as well.” They plan to have ample signage at the Minden emerg to inform visitors of the change. They will also have a staff member on-site initially to redirect anyone attempting to visit the Minden emergency room once it has closed.
“There’s going to be a shift in our communication focus to making sure that the community at large is very, very well aware of this change and the date and what to expect, so that come June 1, our hope is that everybody is very, very well-aware,” Plummer said.
Although the COVID-19 pandemic isn’t necessarily to blame for the closure, it didn’t help already-present issues, said Plummer.
“Certainly the COVID pandemic did exacerbate our resource challenges. It’s historically been a challenge to recruit, it’s not unique to Haliburton, it’s a challenge to recruit health professionals to rural communities in the province, and not limited to even the province.”
She noted that the COVID-19 pandemic caused some staff members to leave healthcare altogether.
Haliburton County Paramedic Services were taken into consideration when deciding which emergency room to keep open.
“Some ambulances now, instead of coming to Minden, are going to be going to Bracebridge and Lindsay,” Bottum said, while the rest in the county will head to Haliburton.