The homecare system that allows senior citizens and disabled adults to remain in their homes is in the process of being re-designed to give clients more control over who provides the service.
“It’s about increasing choice and flexibility across the system,” said Vicki Lopez-Elliott, senior executive director of Continuing Care for the Department of Health. Lopez-Elliott and the deputy Health Minister were witnesses before the Public Accounts Committee today, which delved into issues first identified in an auditor-general’s report back in 2017.
The auditor-general was concerned the province had not set clear performance standards or accountability procedures for some 20 agencies contracted by the province to deliver personal care, housekeeping, and meal support to people living at home. Today Deputy Health Minister Dr. Kevin Orrell acknowledged work is underway to follow through on that recommendation but it still has not been completed.
“The pandemic has presented challenges to maintain service to people in their homes,” noted Orrell. During the first wave of the pandemic in the spring, many residents refused to allow caregivers into their homes and many employees were unwilling to take that risk. COVID made it hard for the Department of Health to calculate how many hours of assistance clients were receiving or that caregivers were working, in part because the province was also subsidizing wages to make sure staff didn’t leave the field.
Demands keep growing
More than 17,000 Nova Scotians rely on homecare supports that are delivered by 20 agencies contracted by the Nova Scotia Health Authority. The province spends about $260 million a year and the wait list for service is growing as the population gets older and nursing home space is at a premium.
One reason the province is overhauling the home-care system is because it can’t keep up with the demand for service as it is presently configured.
Elliott-Lopez told the committee over the past five years, the Department of Health has authorized a 23% increase in the number of hours it is paying for.
Dartmouth North MLA Susan Leblanc asked what is the current “wait time” by region for people requesting homecare. Orrell said that data is available internally but he would not commit to sharing it publicly without further consultation. He did acknowledge that compared to January of last year (2020), Nova Scotians are waiting about 35% longer to receive homecare services.
COVID led to changes
Staffing problems are a key part of that — during these COVID times agencies try to “bubble” a small group of care-providers with a small group of clients to reduce the risk of transmission. That may have meant fewer people were served but those who were should have noticed an improvement in consistency.
Orrell outlined a list of changes the Department of Health has made since COVID to help homecare recipients cope with cutbacks in the hours of service they may have received. That includes more one-on-one adult daycare programming and the hiring of home support aides who help with meals and housework freeing up Continuing Care Assistants to focus on personal care.
But the sea-change the government is considering is giving people receiving homecare services a set amount of money to spend as they choose, whether it is for nursing care, showers, foot care, meals, or housekeeping help.
“We are looking at redesign of homecare and HANS (Health Association of Nova Scotia) has been given money to come up with a plan,” said Orrell. “The ability to reduce wait times will be similar to what we have initiated during COVID to try and keep people at home. We want to create a system that is more flexible than it is now, it would be client-centred. Funding would be direct and allow people to seek some of the services themselves, so this would open up homecare to competition and increase the number of providers.”
Lopez-Elliott noted clients could be given a pre-approved list of suppliers to choose from and agencies which provide homecare services are already permitted to sub-contract. Exciting as this sounds, neither Elliott-Lopez nor Orrell were able to provide any estimated time-line for when a new-and-improved homecare system might be ready. Hopefully it will happen faster than changes to long-term care which have been discussed for more than 10 years. By 2030, one quarter of the people in Nova Scotia will be age 65 and over.
Nursing home footnote
People who need a lot of care while waiting for a nursing home bed to open up have also been receiving more support, according to Lopez-Elliott. She said the province has been providing families with up to $5,000 a month to pay for overnight respite care provided by the VON. She said people on the waiting list for long-time care (more than 1500) may qualify for up to $2,000 a month to cover additional nursing or housekeeping support to keep them at home while they wait.
We also learned that some of the new 236 long-term care beds promised for Central Zone may be divvied up among private and non-profit nursing home operators. Orrell said that’s because the licensing and regulations governing long-term care homes are the same in this province regardless of who runs them.
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Thanks very much for this coverage. Obviously, this announcement and the recent announcement on Long-term Care improvements may be linked to a possible provincial election call. It is worth noting that while such announcements are needed, the province still lacks a comprehensive, multi-year strategic plan for the Continuing Care sector (which includes both home care and long-term care). Such a plan should base forward planning and budgeting on up-to-date population and labour force projections, and contain auditable benchmarks and performance standards for the sector overall. Accountability and follow-up are crucial. We have suffered from a piecemeal approach to this sector for too long, in spite of the fact that it uses roughly 20% of our annual health budget.
Aging in place is something that we should all aspire to. Is it good for people and supporting it makes good use of public funds when considering alternatives. Especially for palliative care services, which are made more difficult to access by the hospital-centered model that NS uses. Home palliative care allows family physicians to provide this vital service while being covered by community nursing for the majority of care, drug administration and other support.
We all hope to grow old. Let’s hope we can do it with dignity.
If this site had a like button, I would like your comment. Without that button (and I fully support keeping this site like button free), I will just say that I agree with your comment.
My father, almost 82, supported my mother in her wish to die at home with dignity (which she did in 2007); his second wife supports his wish for the same. I plan to follow their example and will do what I can to help others age in place. We should all be able to grow old (and yes, eventually, die) with dignity.