Earlier this month, immediately following its budget, the New Brunswick government notified nursing homes that financial pressures dictate they must reduce the number of licensed nurses on staff.
The decision set off alarm bells for nursing home operators in New Brunswick and has the nurses’ union in Nova Scotia concerned similar cuts might happen here.
“What worries me is whether the government here will look at Long Term Care as the way it is going to save money in the upcoming budget, on the backs of seniors,” says Janet Hazelton, president of the Nova Scotia Nurses Union, which represents all registered and licensed practical nurses in nursing homes.
“Over the next three years, we will lose 392 nurses and Licensed Practical Nurses from our nursing homes,” said Michael Keating, executive-director of the New Brunswick Association of Nursing Homes. “We are very concerned our residents are not going to receive the same level of care. We weren’t properly consulted by government. This was a pre-determined decision to save money.”
New Brunswick nursing homes have been told to replace more expensive Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) with cheaper Resident Attendants (RAs) for whom certification isn’t required and no standards apply.
Repeated calls to the New Brunswick Department of Health were not returned. Unofficially, the New Brunswick Nursing Homes Association has been told that once 25 per cent of nursing jobs are eliminated and the percentage of Resident Attendants jumps from 40 per cent to 65 per cent, the government could save in the range of $5 million to $6 million a year.
In Nova Scotia, paying for health care chews up 46 per cent of the provincial budget, at more than $4-billion. After hospitals, the combined $800 million bill for Home Care and Long Term Care is now the Health Department’s second highest expense, eclipsing doctors’ salaries, which are currently being negotiated.
The Nova Scotia Department of Health says it has “no plans“ to follow the New Brunswick government’s decision to cut hundreds of nursing positions from nursing homes.
“We see the value in having professional nurses in long term care,” said Ruby Knowles, executive-director of Continuing Care for Nova Scotia’s Department of Health & Wellness.
Whew. But just how many nurses continues to be a matter of great debate.
Last January, the Nova Scotia Nurses Union released its report called “Broken Homes,” aimed at shaming the Province into hiring more nurses and nurse practitioners to care for elderly patients.
“We need more nurses and LPNs in long term care in Nova Scotia,” says Hazelton, admitting many will see that statement as self-serving. “We need people with the training who can properly assess whether a patient needs an IV and who can identify symptoms of dehydration or if a bladder infection is starting. We need CCAs (Continuing Care Assistants), too, but they don’t have the same training to assess patients.”
In New Brunswick, the government pays for three hours of care per nursing home patient a day. Here, the government pays for four hours per patient a day. In both provinces, the bulk of a patient’s daily needs — feeding, toileting, hygiene — are handled by a growing roster of either CCAs (graduates from NS Community Colleges) or employees New Brunswick calls Resident Attendants.
The Broken Homes report was critical of the Department of Health for failing to monitor whether nursing home patients actually receive the four hours a day that taxpayers are paying for.
The Nova Scotia Nurses Union paid for an independent survey last fall in which more than 200 nurses in long-term care participated. Based on the nurses’ workplace experience, the survey estimated most patients received about 3.6 hours of care each day. That happens because nursing homes often run “short” when people scheduled to work can’t come in and there’s no one available to “back fill” – “a situation that would never be tolerated at a Children’s Hospital,” points out Hazelton.
In his 2007 annual report, Nova Scotia’s Auditor General raised a similar concern about staffing in nursing homes (4.40, page 76):
- Many of the requirements detailed in the regulations, such as sufficient staffing levels, do not appear to be addressed as part of the inspection process.
- There is no review and analysis of actual resident care staffing levels in comparison to the numbers of staff funded.
Ruby Knowles, with the Continuing Care branch of the Department of Health, says steps have been taken to address concerns around staffing. Inspectors now visit each nursing home twice a year (once unannounced) and require the owner to supply actual time sheets for the hours staff worked compared with the hours staff were scheduled.
Knowles acknowledges many facilities have difficulty finding enough staff, and rather than close them, she says inspectors will sometimes issue “short term licences for three months” to give nursing homes time to comply.
The NS Health Department is also reviewing another recommendation in “Broken Homes” that calls for hiring more RNs — at the same time the province next door is preparing to amputate a portion of its professional staff.
The Nurses Union wants the Province to update 1978 regulations that still require only one RN be on duty at homes where there are 30 or more residents. Using Freedom of Information legislation, CBC News recently reported that since 2013, a total of 15 nursing homes in rural areas have told the Department of Health of instances when they couldn’t find a RN to meet that minimum staffing requirement. No sanctions were levied.
Knowles says “it’s too early” to say whether staffing ratios will be included in changes to the Act for Special Care Homes. She says it is likely to form part of a review of the Continuing Care strategy ordered by the Province that’s about to get underway and must be completed in 2017.
Whether that’s soon enough to prevent elderly residents from being short-changed on care — or nurses from leaving homes to work in hospitals where patient ratios are much better — is anybody’s guess. Discussions about staffing between the Nurses’ Union and Department of Health are planned for next month.
See related article: “People are living too long in nursing homes.”
I’m very glad that you are keeping a close eye on this important issue. Thank you, Jennifer Henderson.
I think it’s really unfortunate that these nursing homes can admit to understaffing or absent-staffing these people –which as you pointed out is a violation of minimum staffing standards– and not be punished in some manner. It’s as if a cat is tearing up your chesterfield: if you don’t punish the behaviour, it’s going to continue to happen. There are a lot of things Long Term Care places, and adult-inpatient care centres are getting away with. However, being a nurse in adult-inpatient care, I find other nurses typically don’t swap over from the Long Term Care system into inpatient systems. The nurse:patient ratios may be better on paper in the hospital setting, but you give much more of yourself in the hospital. When you’re getting close to or in your retirement, nurses typically swap over to Long Term Care. However, the way hospitals are being managed in this province, and the ever increasing acuity of the population of this province –and the Atlantic Provinces for that matter– is requiring all nurses to give over 100% of themselves when they’re in their prime. By the time retirement rolls around, having spent years burning out both mentally and physically in the hospital environment means the culture of switching to a nursing home or assisted living facility when you’re an older nurse just isn’t happening anymore. Nothing left in the tank and seniors end up taking the brunt.
The Herald never had articles of this length and depth.