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“Enough Talk” is the title of a nine-page statement released Tuesday by a group representing the majority (83%) of 96 licensed nursing homes in the province. The Nursing Homes of Nova Scotia Association (NHNSA) is fed up with government inaction when it comes to long-identified issues such as chronic understaffing and shared rooms in older facilities that put seniors’ lives at risk during outbreaks of flu and COVID-19.
Nursing home operators — including both private corporations such as Shannex and Gem and non-profit, community run homes — are finally speaking up publicly after years of participating in roundtable discussions, studies, and “initiatives” with the provincial government.
“We have been politely told by government that they accept our reports only to have them sit on somebody’s desk,” said Michele Lowe, the managing director for the NHNSA. “This is the first time we have come out publicly and we felt it was absolutely critical to do so. As we worked through COVID, heads down, we heard opinions from everyone — including care advocates and unions. Well, we’re the experts. We live and breathe it every day and that’s why this report came to life now.”
Between April and June, 53 residents in long-term care at Northwood Group’s Halifax facility became infected with COVID-19 and died. A class-action lawsuit representing families of some of the deceased has been filed against the nursing home and the province alleging negligence. Here is a short description of the “actions” the people who operate nursing homes are asking the province to take; you can find the full description here.
The Nursing Homes Association is demanding a new funding model as well as money to hire more staff and increase their pay in order to recruit and retain people. Their report states:
The compensation paid to frontline staff and management positions in long term care is significantly less (30-40% in some cases) than the same or equivalent roles paid to employees of the Nova Scotia Health Authority (NSHA). This disparity in compensation has seen a continual departure of talent from long term care to acute care and other health care settings. While there have been compensation reviews over the past few years for government and NHSA employees, there has not been a compensation review of long-term care in 15 years.
Further investment to build upon our expertise in wound care management, dementia care, person centered care, palliative care, managing responsive behaviours, infection prevention and control, and specific clinical skills is critical as we face the multiple health conditions of residents who enter our long-term care homes.
The report calls on government to get working on a multi-year infrastructure program to replace shared rooms and bathrooms in older nursing homes that make infection control difficult. Coincidentally, a similar point was made yesterday in a news release by the NDP calling on government “to prioritize renovations and new construction of long-term care facilities as an important part of economic recovery in response to COVID-19.”
“We could make the investments we need now and create jobs at the same time to help Nova Scotians in the wake of the economic disruption caused by COVID-19,” said NDP health care spokesperson Susan Leblanc.
Last but certainly not least, there is that vision thing. A plan for long-term care has been promised since 2016. Nursing home operators are asking the McNeil government to introduce a plan within the next six months to make changes to the funding, staffing, and the physical configuration of long-term care facilities. Timelines established in a 2018 report with 22 recommendations from an Expert Panel have been hijacked by the pandemic.
Preparing for a “second wave”
There is currently only one active case of COVID-19 in the province. That person was identified by Public Health one week ago today and is in hospital. Despite repeated, daily inquiries by the Halifax Examiner, we have been unable to obtain any additional information about how the person became infected (community spread? contact with a traveller? unknown?) as well as any information about the age or medical status of this person. This is unusual and worrisome.
Meanwhile, Public Health has eased some of the many restrictions around visiting loved ones in long-term care. As of today, Chief Medical Officer of Health Dr. Robert Strang is allowing residents to receive one visitor at a time indoors as long as both the resident and the visitor wear masks. Hugs are discretionary. But while some nursing homes are working to reduce the social isolation endured by the elderly during the long months of the pandemic, other homes are not OK with allowing indoor visits at this time.
It all depends on whether the nursing home still has insurance coverage to prevent a manager or a member of the Board of Directors from being sued if a resident becomes sick and dies from an infectious disease such as COVID-19 or influenza. Many nursing homes in Nova Scotia (as well as other Canadian provinces) no longer have liability coverage because one underwriter of many Canadian insurance companies introduced an exclusion clause this past May denying homes that protection.
“Sorry, we can’t participate in the extension of visitation until this issue is resolved. That’s what some nursing home members are telling us,” said Michele Lowe, managing director of the Nursing Homes of Nova Scotia Association. “In British Columbia, the government has passed an order making it illegal for nursing homes to be sued. We need something similar here.”
Lowe says her group notified the Department of Health early in June they need help with this issue which will become bigger as more underwriters are expected to stop covering nursing homes for liability related to COVID-19. (Universities may face similar challenges, as St. Francis Xavier is discovering.) Lowe says the Department of Health has looped in the Department of Justice but in the meantime, some homes are asking family members visiting their loved ones to sign waivers promising not to sue. Others are not allowing indoor visits. Lowe couldn’t estimate how many homes are impacted by this change to their insurance. She says some have no issue at all.
Operators of nursing homes built 30-50 years ago face additional infection prevention and control challenges because their rooms have double or triple occupancy and shared bathrooms. Northwood in Halifax is one such facility. The Department of Health is allowing Northwood, as well as other older homes around the province, to keep more beds vacant or open in preparation for a potential second wave of the virus. This should help isolate infected from non-infected residents and it also lowers the staff-to-resident ratio, making life more manageable for employees.
Since April, the province-wide vacancy rate for beds in nursing homes has increased from 1% to 5%. That translates into 346 beds. The waiting list to be admitted to a nursing home has grown by the same amount. There are now approximately 1,450 people waiting to be admitted to a nursing home. Easing one problem has created another.
The province has sent out a team of Infection Prevention and Control experts who are visiting all homes this summer and are expected to advise them on what changes, if any, they need to make. Two experts appointed to review what happened at Northwood will report to the government in September.
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The obvious question is: why aren’t nursing homes insured by the federal system like hospitals? The answer is that they don’t fall under the Canada Health Act. Which raises another obvious question: why is this massive sector of health care *not* under the Canada Health Act? Other questions arise: what kind of profits are the owners of nursing homes making while they come hat-in-hand to the government for more funding? Will they open their books as a condition of this funding? Will they welcome a stricter inspection regime? Doesn’t for-profit care incentivize the very cost-cutting measures that have helped make these facilities into a national scandal? Doesn’t guaranteeing the profitability of this sector by provincial governments mean necessarily setting the bar for care below what is consistent with a decent quality of life for the residents and decent working conditions for the staff? Doesn’t it bleed money from a system that could be used to create higher standards?
There is no point in reporting on the complaints of the Nursing Homes Association as if they’re the innocent victims of government inaction, when much of that inaction can probably be traced to allowing the privatized, provincially-regulated (i.e. inadequately regulated) model of long term care to exist in the first place. Why not ask billionaire Joe Shannon – one of those owners represented in NHNSA’s demands for a different funding model – the if he’d support bringing nursing homes under the Canada Health Act?
Reporting on those complaints in this decontextualized way reads like apologetics for the care providers, many of them just businesses looking for profits. Some might be authentic victims of government malfeasance and wilful neglect, but others benefit from having poor regulation and inadequate standards of care. And writing that “Timelines established in a 2018 report with 22 recommendations from an Expert Panel have been hijacked by the pandemic” reads like apologetics for the government, which doesn’t need a pandemic to ignore recommendations in the public interest or the plight of the elderly and their families, something they had been doing very effectively for the past pre-pandemic decade.