When law enforcement agencies confront a potentially dangerous situation which they need to defuse quickly, they send in a Special Weapons And Tactics (SWAT) team. When governments face a potentially damaging political issue they create a panel.
After the deaths of three former nursing home residents linked to badly infected bedsores, months of mounting complaints through the Protection of Persons in Care Act, and published news stories from family members alleging nursing home staff are overworked and residents’ care is often neglected, Health and Wellness Minister Randy Delorey has announced the hiring of an expert advisory panel to recommend how to improve the quality of care residents receive in nursing homes and residential care facilities.
The government’s SWAT team will be chaired by Janice Keefe, director of Mount Saint Vincent University’s Nova Scotia Centre on Aging. The panel will be rounded out by Greg Archibald, wound care expert and head of Dalhousie University’s Department of Family Medicine, and Cheryl Smith, a nurse practitioner focusing on polypharmacy and dementia.
Delorey’s decision comes after the Province hired six specially-trained nurses this summer to go into nursing homes and work with staff to improve wound care. On Wednesday, the minister said the new panel will provide his department with “advice from experts on effective, evidence-based solutions to improve quality of care in Long Term Care. In reviewing quality issues, there will be a focus on matters such as proper wound care, resident and worker safety, appropriate care and protection of vulnerable persons.”
Specifically, the Health Department is tasking the three experts to do the following:
• Identify evidence-based solutions to improve quality of care in Long Term Care facilities;
• Make recommendations regarding appropriate staffing of Long Term Care facilities, staff complement, skill mix etc.;
• Advise regarding the recruitment and retention of appropriate Long Term Care staff.
The panel’s mandate from the Health Department ends with the following caveat or caution: “Recommendations should be feasible and sustainable, authentic to the realities and complexities of long term care in Nova Scotia.” Translation: don’t make any changes that are radical or would cost a lot of money.
The current budget to care for the approximately 11,000 frail elderly or disabled people living in nursing homes and residences is just over half a billion dollars a year at $573,152,000. The total health care budget exceeds four billion dollars.
And just as law enforcement officials expect quick results from a SWAT team, the panel must report back to government on this politically charged file in just three months — by November 30.
The previous day, NDP leader Gary Burrill had announced his party would introduce legislation to mandate minimum staffing levels in nursing homes and improve accountability by making the inspection reports of nursing homes easily available. In response to the announced creation of the panel, Burrill said, “We expect to see recommendations for increased staffing at nursing homes in our province and hope that the McNeil Liberals will move quickly to make improvements once they have recommendations from this panel.”
But an advocacy group for the elderly which has been meeting with government officials and demanding change for more than a decade was not impressed by Delorey’s decision to undertake more study.
“The crisis in long-term care is real and cries out for action today,” said Gary MacLeod, chair of Advocates for the Care of the Elderly (ACE). “Residents, front-line workers, and families should not have to wait until after November 30, when the panel will be reporting back to the Minister. What we need is a firm commitment for action with precise time frames and adequate resources.”
While the government has hired an expert panel to provide clear direction, here’s some of the information from previous reports available to it right now.
- In 2007, and again in 2011, the province’s auditor general recommended updating the staffing regulations in the Homes for Special Care Act (1989).
- In 2016, the Nova Scotia Nurses’ Union published a research report that recommended the Province hire more people (primarily Continuing Care Assistants) to improve the quality of patient care and help retain nurses, two thirds of whom told a survey they were considering quitting.
- In 2002, a report from a Task Force that included health care unions, nursing home employers and Health Department officials noted there was no human resources plan for the Long Term Care sector.
Among the Task Force recommendations were implementing a software program called a Resident Assessment Instrument (RAI) to measure staffing levels and incidents such as falls and bedsores. Most provinces use it and although many Shannex homes in Nova Scotia have implemented it, in 2018 that recommendation is still on the table waiting for Cabinet ministers to approve or reject.
The 2002 Task Force report also recommended the Department of Health establish a multi-disciplinary monitoring committee to ensure that residents receive safe and adequate care.
With hindsight, implementing that one recommendation might have saved a lot of time, money, and heartache. And at least the work and cost of one more government panel.