Nova Scotia’s Liberal government is facing a call from an expert panel to move swiftly to improve staffing at long-term care facilities to address “overstressed” homes that aren’t capable of meeting residents’ needs.
“Staff are in need of immediate support,” says the panel’s first recommendation, as its report called on the province to hire long-term care assistants to help full-time staff.
“We recommend these temporary workers be hired as soon as possible.”
Health and Wellness Minister Randy Delorey appointed the panel in September in the wake of media reports that raised questions about the quality of care in the facilities, including severe bedsores.
His move came after the death of a 40-year-old woman with an infected bedsore, followed by confirmations in June there were more than 150 nursing-home residents suffering from serious bedsores.
Panel chairwoman Janice Keefe said during a news conference on Tuesday she was comfortable using the word “crisis” to describe the state of the province’s beleaguered system for caring for some of the most vulnerable citizens.
The report calls on the province to finish putting in place a set of reforms designed to reduce the number of bedsores, including having experts available for each home.
But Keefe and co-panellists Cheryl Smith, a long-term care nurse, and Dr. Greg Archibald, head of the Department of Family Medicine at Dalhousie University, pointed to deeper, underlying shortcomings in the system.
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After speaking to over 375 people in the system, the authors of the report concluded: “We heard over and over from residents and their families that staff do not have the time to provide appropriate care because they are ‘working short.”‘
“Shortages increase staff responsibilities, with more residents to provide care for, resulting in overstressed staff, high rates of injury and sickness, and many unfilled vacancies across the system,” says the report.
The panel’s recommendations call for at least one licensed practical nurse per residential care facility and expanded access to specialists like physiotherapists or recreation directors that would be shared among facilities.
The report also recommends a return of the bursary program supporting the training of continued care workers in community colleges, a program that wasn’t renewed after the Liberals took power in 2013.
However, Keefe said one of the gravest issues is that the committee found it couldn’t even access basic figures, such as the precise nature of various complicated and chronic illnesses of residents.
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Without this information, Keefe said setting precise goals for the hours of care per resident or number of fresh workers and beds is premature.
It’s also unclear how many job vacancies there are in the system.
The province says it’s only two-thirds of the way through a “vacancy survey” to determine how many jobs are open, though Keefe said during a news conference it is in “the hundreds.”
The lack of precise figures and goals in the report drew criticisms from Gary MacLeod, the chairman of Advocates for the Care of the Elderly, and the province’s nurses union.
“The Nova Scotia Nurses’ Union is extremely disappointed … the report does not recommend a minimum staffing level for long-term care homes, something that was requested in the panel’s terms of reference,” the union said in a news release.
MacLeod described the panel’s work as a repetition of known ills, and he added that it has failed to set clear goals for improved numbers of hours of care per resident for the province’s 6,900 nursing home beds and 900 residential care beds.
MacLeod said he’s had four relatives, including his mother, pass through the system over the past 12 years and has witnessed it repeatedly fail to give sufficient care to his loved ones.
“My own mother experienced bedsores and it wasn’t because she was bedridden … it was because she wasn’t being bathed properly,” he said.
Keefe responded that the work of the panel is a “first step,” and called on the province to create an arms-length committee to monitor progress on its wide-ranging recommendations.
Delorey said in a news release his government accepts the “intent” of the recommendations and will “work toward” their implementation.
He said in a telephone interview later in the day that he will seek additional funding from cabinet for some of the measures.
“We have the recommendations put forward. I’ll be pursuing those recommendations … I’ll be pursuing the resources to make sure we’re able to do that,” he said.
The release notes the Liberals are looking at ways to increase the number of staff, access to occupational therapists and physiotherapists, and methods of increasing access to nurses.
However, the opposition says the study may simply be giving the province cover to take its time on improving funding.
Gary Burrill, the leader of the NDP, said while the report makes clear more people and care are needed, it should have called for legislated numbers of hour per care.
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Barbara Adams, the Tory critic for long-term care, said years of cuts have created the problems and the expert panel’s mandate was too limited to reverse the issues.
“The government can provide a few more workers and say, ‘We’re done,”‘ said Adams, a physiotherapist who has visited many of the province’s nursing homes.
Unions say a key underlying problem is a wage freeze, which has made it increasingly difficult to attract and retain people in continuing care work.
Nan McFadgen, the president of CUPE Nova Scotia, said many workers at the 47 nursing homes her union represents are barely making a living wage. Starting wages of continuing care workers are just over $16.38 per hour, rising to $17.68 after four years.
The report also calls for specialized teams to deal with residents who are having aggressive outbursts. In August 2017, coroner’s reports requested by The Canadian Press revealed 11 unreported deaths of Nova Scotia nursing home residents injured when they were pushed down by residents with dementia.
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