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The challenge in caring for seniors with often chronic and complex needs is finding the right blend of staffing. Health advocates say more creativity is needed in the approach, as well as more supports to help people age at home. Right now, a shortage of long-term care spaces is sending some people to hospital who don't need to be there.
There’s a will — is there a way?
From emergency rooms to long-term care facilities, bottlenecks in the system are keeping people from where they need to be for optimum care.
Nova Scotia’s Health Minister Randy Delorey said it will take time to come up with a detailed plan on staffing and primary care before the recommendations of the Expert Advisory Panel on Long Term Care can be implemented.
“Before increasing staffing, (we need to) better understand the care needs, which can vary from facility to facility, and complement the needs of residents in the facility,” Delorey said in a recent interview. “That work is ongoing to understand the model of care that’s being provided and that will influence the staffing changing that might come in the future, but we’re certainly continuing down that path.”
The minister couldn’t say when the plan would be ready, saying the priority is “ensuring we do the work right rather than setting a specific deadline.”
The Liberal government has come under fire for not adding any nursing home beds since coming into power in 2013. But Delorey said his department has spent $40 million on expanding home care, reducing wait lists for existing nursing beds and other initiatives.
“So that was the early stage and phase. We’re now at the point where we’re seeing those benefits and we’ve announced the addition of beds as part of the (Cape Breton) redevelopment project,” said Delorey, referring to the 120 new beds that will be opened in new facilities in New Waterford and North Sydney.
MORE THAN 375
The number of people consulted by the Expert Advisory Panel on Long Term Care, to understand the challenges facing the long-term care system, including residents and their families, staff, service delivery personnel, sector organizations, health authorities and representatives of the provincial government.
— Source: Expert Advisory Panel on Long Term Care
NDP Leader Gary Burrill has hammered the Liberals on its handling of long-term-care for years.
“I think it has been a defining failure of the present Nova Scotia government that in the five and a half years that they first came into power, they haven’t opened a single new nursing home bed, and this in the midst of the greatest tsunami of aging they’ve we’ve known in our history,” Burrill said in an interview.
That has not only affected seniors and their families as they wait for a bed, it’s had a cascading impact on the health system in general, he said.
“A fifth of our hospital beds in the province occupied at the moment by people who are not hospital patients. They call them alternate level of care patients. That means that there’s no reason for them to be hospitalized at all. Other than the fact that they need long-term care and there’s no place for them in a (long-term care) facility.
“People working on the frontlines in ER care all over the province under a wide variety of authorities and health-care policy have all pointed out the negative impact this has on the whole operation of the hospital, beginning in our emergency rooms. Emergency rooms are unable to transfer care of their patients into their general population of the hospital when it is clinically time to do that because there’s no room in the hospital for them to transfer those patients into.”
By living longer and living at home longer, seniors are arriving at care homes at a later stage in their condition with more complex health issues and more physically frail than ever before.
— Source: Canadian Association for Long-Term Care
Health consultant Mary Jane Hampton said the focus should be on boosting staffing support for the long-term-care system we have now, before adding a great number of new beds.
“I think there is plenty of evidence that we need to look at the staffing ratio for the level of complexity of care that’s provided in a nursing home,” she said in a recent interview. “We need to do much more to actually train more of those providers to be actually ready to take those jobs.”
She also said we have to change our mindset on finding solutions to the long-term-care crunch and focus on how to keep seniors in their own homes as long as possible.
She credited the Nova Scotia’s home care program, which is among the most extensive in Canada, but said more must be done to support older people, particularly financially.
“We need to unpack the reasons why some people are actually forced into a long-term care option that may be able to extend their years of independent living with some more innovative government support. …
“For example, we know a great number of seniors can’t live independently in their homes anymore because they can’t afford the heat, the electrical bill, because of a whole bunch of issues that make independent living impossible, but all those things can be solved.”
While the long-term-care panel emphasized the need for the immediate hiring of nursing home assistants, the president of the Nova Scotia Nurses Union has said that’s not the route we should be going.
Perhaps not surprisingly, Janet Hazelton said the role of VON home-care specialists, nurse practitioners and licensed practical nurses should be expanded.
“We see we could hire a nurse practitioner for the northern region and she could go from facility to facility to help make sure that those seniors (are OK),” Hazelton said at a recent news conference in Dartmouth.
“Quite frankly, many go to Emerg departments and they wait there for hours on a stretcher, and that creates all kinds of issues as well. When they could have been seen (by) a nurse practitioner that’s on circuit.”
BY THE NUMBERS
Atlantic Canada has the highest proportion of seniors in Canada – with approximately 21,850 residents in 479 long-term care facilities.
— Dalhousie University’s Atlantic Long Term Care Network
Staying at home? Plan ahead.
For those seniors who decide to stay in their own homes, they would be wise to plan ahead about where they are going to find the supports they need when they need them. But they would still be wise to think that the time may come when they will need to move. And it is better if the move is planned ahead, rather than in the middle of a crisis. - Source: Seniors NL
FEELING THE CRUNCH
In New Brunswick, the 2016 Auditor General’s Report revealed that nursing homes are operating at 98% capacity and that demand is growing at a concerning rate.
— The Creeping Privatization of Health Care in New Brunswick, NB Health Coalition, 2017
Lack of primary care across region 'particularly hard' on seniors
As chairwoman of a provincial advisory panel last year, Janice Keefe experienced first-hand the state of long-term care in Nova Scotia.
The Mount Saint Vincent University professor and director of the Nova Scotia Centre on Aging visited nursing homes and rehabilitation centres across the province. She came away with a sense of the enormous challenges society faces in taking care of people as they age and admiration for the majority of frontline staff who are dedicated to that task.
“It’s really complex,” Keefe said in a recent interview. “There’s a lot of really good things that happen in nursing homes. So often all we hear is the negative. It’s really important to shine a light on when things are wrong but there’s also places where people are quite happy and they improve. They have a better quality of life. Most of the staff are there because they want to be there.”
But as Keefe’s advisory panel pointed out in its final report, comprehensive change is needed to tackle the challenges in long-term care. These include long waits for beds and insufficient staffing and training.
“There’s a lot of work to be done,” Keefe said. “It’s an area that’s been underserved and underfunded for a while. … (We need) new approaches. The people who work in this sector are extremely dedicated. The challenge is, you know, there’s a lot of variability within the sectors.”
Although the panel focused on the situation in Nova Scotia, Keefe said the same problems can be found across the country, particularly in the Atlantic region with its aging population.
These include a lack of continuing care assistants, also known as personal care workers or personal care attendants.
“We wanted them to really look at hiring temporary long-term-care assistants because we’re very short in continuing care assistance,” Keefe said. “They’re the people who do the personal care, get people up, that sort of stuff.”
The lack of primary care that afflicts much of the province is particularly hard on seniors, she added.
“We really need to have the nursing homes to be able to have access to a primary care provider 24/7, whether that’s (a nurse practitioner) that’s assigned to a facility or whether it’s a physician. … I think it’s pretty critical, as well, given the health authority, about a month ago, they sent a letter to all the nursing homes: don’t send your people to us. You know, everyone has the right to health care, right? It’s not fair, fundamentally it’s ageism.”
A BIG NEED
“There’s a big need, and with an aging population we need support. You need appropriate places for long-term care, instead of occupying acute care beds and acute care staff who are needed to deal with other issues.”
— Gander, N.L. Mayor Percy Farwell, quoted in The Northern Pen, June 2018
Nursing home officials say creativity is needed in long-term care
When you run a nursing home, one word will take up a lot of your time: staffing.
“You get to a point where finally you breathe a sigh of relief and then the next day you’re back into it,” said Debra Boudreau, who manages Tideview Terrace in Digby.
“So yeah, absolutely, it is challenging to get the right people, the people who we are looking for as an organization, you know, who show the model of care that we subscribe to and that we practise.”
“What we would like is a skilled individual who's really great with clients who have dementia and can really provide that level of support on a one-on-one basis when they are having an acute episode.”
- Michele Lowe
In an interview with Michele Lowe, managing director of the Nursing Homes of Nova Scotia Association, Boudreau said she agreed with an advisory panel last year that emphasized the need for more staffing support.
The panel didn’t go so far as to prescribe staff-to-residents ratios, and while some residents advocacy groups weren’t happy about that, the nursing home association said flexibility is more important.
“When licensing comes around every year to do their audit, and we’re not meeting that ratio, then you know we’re getting our fingers slapped,” Lowe said.
“We know that we need to have perhaps more funding to support some of the acuity (of residents’ health) but what we want is the flexibility to be able to say, we don't need necessarily a (continuing care assistant) or we don't necessarily need an RN. What we would like is a skilled individual who's really great with clients who have dementia and can really provide that level of support on a one-on-one basis when they are having an acute episode.”
Nursing homes have come under fire in recent years in the wake of deaths related to neglect of residents, particularly when it comes to bedsores, known as pressure wounds. Both women said tarring the whole industry as negligent is unfair.
“When you dive deep, the numbers that were reported to the province back in in June of 2018 showed a two per cent rate for wounds in the sector,” Boudreau said. “That’s fabulous. Like, nobody’s celebrated that. There were certainly some very complex cases that had an awful outcome, but it's also without looking at the hundreds of successful cases that are happening on a daily basis.
A LOT AT STAKE
“Only with government investments in better infrastructure, data and human resources planning can seniors receive the care they need now and into the future.”
— Source: Jodi Hall, executive director, New Brunswick Association of Nursing Homes
“Yes, we definitely want to avoid those adverse reactions and those complex cases, but at the same time that’s only a small glimpse of what is truly happening in the sector and it is not all doom and gloom.”
The problems that have taken the spotlight lately haven’t deterred people from signing up for nursing home beds in Atlantic Canada. In Nova Scotia, for example, there were about 1,040 people on the waiting list for long-term care as of March 2019.
“In terms of waitlist, we often are somewhat removed from that because we don’t know who’s on the waitlist,” Lowe said. “We only declare a bed when we have a vacancy to the health authority, and then through their systems and their processes, they then fill that bed for us. There’s obviously work that’s done together to ensure that we have all the information on that resident coming in and that we can support them fully once they come into our home. But it’s no surprise … lots of people have been feeling under pressure.
“This isn’t an anomaly by any stretch,” Lowe added, referring to the nursing bed crunch that’s being felt across the country.
Canada will need an additional 199,000 long-term care beds by 2035, nearly doubling current long-term care capacity, according to the Conference Board of Canada.
“We need to completely shift our minds around how we deliver long-term care and we need to be willing to be creative and get out of these restrictive parameters that we've had in place for decades that are no longer meeting the current clients that we’re serving,” Lowe said.
BEFORE YOU DECIDE
Key questions to ask before choosing a long-term care facility:
If I become ill and have to go to the hospital, how long will my bed be kept for me?
How many people live here?
Can a couple share a room even if they need different levels of care?
— Source: Community Legal Information Association of P.E.I.
Suggestions for helping the people dealing with a system in dire need of improvement.