Nova Scotia spends $11 million on health care every day — that’s $131 every second.

Chances are someone in your family is one of 6,900 people receiving care in a Nova Scotia nursing home right now. Or perhaps you know one of 1,463 people waiting to be admitted — a wait list that has dropped 40 per cent since this last time last year, according to figures obtained from the Department of Health.

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The Health Department says part of that improvement is due to policy changes a year ago that forced people on the waitlist either to accept a nursing home bed no matter where it’s located in the province or to re-apply later. A further (and arguably overdue) change now being considered could reduce what is still a stubbornly long waitlist, if the government approves and implements it later this year.

Get ready for it. Instead of admitting people on a first-come, first-served basis, future nursing home admissions could be based on “a balance between how long a person has been waiting and the urgency of their needs,” says Ruby Knowles, executive director of Continuing Care for the Department of Health.

This is hardly revolutionary, considering these are the criteria already used by most other provinces. In Nova Scotia, only a relatively small number of cases get fast-tracked: those involving adults in need of protection because of neglect or abuse, and people who are married to each other. Everybody else gets processed chronologically.

Meanwhile, the province isn’t planning on building new nursing homes anytime soon. Instead, it will tackle the nursing home wait list by continuing to expand the amount of money spent on Home Care services to keep seniors in their homes longer and (perhaps) shorten the length of nursing home stays.

Nova Scotia not only has the highest percentage of seniors — 19 per cent of the population — but seniors in this province actually live longer in nursing homes than in other provinces – three years on average.

“If we could reduce that nursing home stay from three years to two years, it would free up an additional 1,100 beds and serve about 1,500 more people,” said Susan Stevens, senior director for continuing care with the NS Heath Authority.

If that sounds slightly ghoulish, think about trying to make that happen when nearly three-quarters of nursing home residents are now 85 years and older. Yet Stevens told a small audience at the Silver Economy Summit for Seniors in New Glasgow last week that when it comes to dealing with the challenge of rapidly aging population, “it’s not all doom and gloom.”

Department of Health & Wellness figures presented by Stevens link the recent decline in the number of people waiting for nursing homes primarily to putting millions more into Home Care. Keeping more people home longer is a trend she predicts will ensure only the frailest and most vulnerable will get admitted to nursing homes in the future — a cohort unlikely to live as long as the folks occupying the beds today.

Faster turnover could save the province millions of dollars each year.

The province now spends $567 million a year on nursing homes caring for 6,900 people.  That cost continues to rise, but not as quickly as Home Care, whose budget has doubled in the past decade and now stands at $240 million.

Last year, 12,000 people received Home Care visits. According to figures from the Department of Health & Wellness, the cost to care for someone at home is at least $1,000 a month less than in a nursing home. And that saving is usually greater since most Home Care recipients don’t require the maximum support of 100 visits a month.

But guess what?  There is also a steady and significant line-up for Home Care. Last month, 618 people were waiting for 3,824 hours of home support. That compares with 612 people lined up for 7,416 hours in July 2015.

The demand for home care is rising, according to Stevens, because the Department of Health & Wellness is increasingly directing hospitals to send people home instead of transferring patients to nursing homes.

That directive is to prevent someone who needs full-time nursing home care less urgently than someone else from “jumping the line” by checking into hospital first.  (The number of people occupying hospital beds waiting for a nursing home admission remains constant at about 250 at any given time, according to the Nova Scotia Health Authority.)

The good news is that the wait list for a nursing home bed is much shorter than it was a year ago.  The bad news is that 1,463 people are still on it.

And over the next decade, 34 more Nova Scotians will turn 65 every day.

See related article, “Nova Scotia still failing to meet nursing home standards.”

Jennifer Henderson is a freelance journalist and retired CBC News reporter.

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  1. I’d like to see a lot more being done to improve and maintain health of the whole population, including, of course, the elderly. Keep us healthy longer and we’ll stay out of nursing homes maybe forever! But it means putting funding into services like physiotherapy, nutrition, hearing, eye care, dentistry, etc, as well as making sure the old are not isolated as they “age in place’. Most older people want to be in communities where they can interact with others, (and no, I don’t mean “nursing homes”).

  2. Thank you for this story. Many good points raised. One of the ways that the waiting list for nursing home beds was “reduced” was by taking out the names of individuals who are waiting to be transferred from one facility to another, say if they were placed to first available bed in 100 km or to a second or third choice and are waiting to move to their preferred faciltiy. A big concern is that while the total funding for home support is increasing, the amount available to individuals is being capped. It is not 100 visits, but 100 hours, which is just over 3 hours/day. With management approval, up to 150 hrs may be authorized. Not much time for someone who may need 24 hour care. Home care agencies are in competition with nursing homes and hospitals for CCAs, and staffing shortages occur daily with clients missing visits. Not exactly an equal substitute for nursing home level of care, but as per the companion article, staffing in facilities is not exactly desirable. The comment from jlevack is very true – the philosophy seems to be shifting from being facilites being for long-term care to facilites for short term end of life care

  3. Great research. A couple points though: the province currently conducts a needs assessment for everyone who requests continuing care and then people are prioritized beds based on a number of factors (including if they’re coming from a hospital, medical conditions, support at home/community).

    Also, patients are required to take a bed in a nursing home within 100km of them, not anywhere in the province. For more info see Facility Placement Policy, 5.2-5.4: http://novascotia.ca/dhw/ccs/policies/policyManual/Facility_Placement_Policy.pdf

    Also, an important element of the conversation is the fact that the Liberals are focusing on home care, while simultaneously trying to cut its spending. Besides trying to privatize it in 2015, they are offering greater incentives to informal caregivers and looking at direct funding models (Self Directed Care Program) that enable patients to purchase services directly. The result? Less governmental spending on infrastructure and health workers, and greater strain on family members (mostly women).Not to mention an expansion of market based care.
    See the recent update to the continuing care strategy for more information.

  4. Not mentioned here is the small but significant population of young people (by DHW standards that means anyone under 65) who are forced to live in nursing homes because home care cannot meet their physical needs. Sometimes, in fact, home care is more of a prison than a nursing home – you are completely captive to their schedules. Getting ready for work or school is largely impossible, and if you want to say, go to bed when you feel like it, you can’t (because again you are dependent on their schedules).

    There is a very real need for young people with disabilities to have somewhere to live where their physical needs can be met and where they can live with a modicum of independence. My 25 yo daughter lives in a nursing home because it is – alas – the best of a bad lot, as far as choices go. You think people are living too long in them? Try the rest of her life! She is truly one of the only authentically “long term care” residents there are. The nursing home allows her to be independent in that she can come and go, the care she needs for all of her activities of daily living are met, and she is then able to go to university, to the clubs with her friends, and to volunteer in her community. The only issue of course is that she lives with very old, sometimes very ill people.