KJIPUKTUK (Halifax) -- Long Term Care (LTC) in Nova Scotia, understood as the manner in which we care for those unable to care for themselves, is seriously broken, according to a new report released today, January 14, 2016, by the Nova Scotia Nurses Union. And, as the number of seniors in the province is estimated to nearly double within the next twenty years, if we do not have a serious look at this issue, things will only further degenerate.
The report, which relies upon an existing literature review, as well as interviews with LTC nurses, was presented at a news conference this morning. Titled 'Broken Homes', it highlights several serious deficiencies in the Nova Scotia long-term care “crisis”.
Working conditions for nurses in LTC are highlighted in the report, as are staffing deficiencies. According to the report, one in four Nova Scotia nurses employed in LTC “experiences physical violence from residents or their families two or more times a month”, with 27% reporting having experienced “bullying and aggression at least twice a month.”
While the report does not draw a causal link, the violence directed towards LTC nurses likely goes hand in hand with a situation that suggests a crisis-level of understaffing at LTC facilities. Overworked, and unable to provide a quality level of care to the patients entrusted to them, LTC nurses become the front-line 'face' of a much larger, systemic, problem.
“You may be the only person looking after 60, even 100 patients,” says Sheri Gallivan, a registered nurse present at this morning's press conference. “The staffing numbers haven't changed. But the clientele have changed. In long-term care it is getting very difficult to meet physical needs of our patients, with the same number of staff, without even looking at mental care or holistic care.
“Today, patients are arriving in long-term care with as many as ten to fifteen diagnoses, easy. Most have a minimum of ten to twelve drugs they're trying to manage. Nurses are looking at not only disease processes, but new symptoms appearing.”
The report highlights the fact that the regulations governing long-term care in Nova Scotia were designed and implemented in an era which, in practice, no longer actually exists. It notes that staffing levels are “28.7% below what experts claim is required for safe practice.”
“We're dealing with legislation that was drafted in 1989, based on data from 1977,” says Dr. Paul Curry, lead author of 'Broken Homes'.
Indeed, at the moment, aside from the testimonies of LTC nurses and the odd incident that makes the news cycle, not much is even known, data-wise, about the overall LTC situation in Nova Scotia. Without a data-gathering system in place, incident reporting at LTC facilities is opaque at best and, says Nurses Union president Janet Hazelton, certainly not comparative to the situation of reporting at acute-care facilities.
“Across the province there is no tabulation of incidence,” says Hazelton. “With the lack of staff, we don't even know some times what has happened to a patient.”
With a Nova Scotia provincial government seemingly bent on balancing the budget through austerity-style cuts to public services, the plight of seniors entrusted to long-term care risks becoming one more symptom to add to a growing list of social woes. The report, however, does conclude with a series of recommendations towards addressing this issue.
Many of these focus on bringing provincial long-term care facilities into some level of 'across the board' industry standards. These would address data-gathering and staffing levels. Once these core issues are addressed, recruitment and retention of LTC nurses – also highlighted as a significant issue – might theoretically become easier to manage.
As for the question of how to pay for this, Hazelton notes that the potential does exist for reallocating some health care funds from acute care to long-term care. Currently, there are “over 1600” Nova Scotians waiting to get into long-term care. Many of these are already in acute care, where the average wait time, according to the report, is 198 days.
Services in acute care cost between “ten to twenty times” more than services in long-term care, according to Hazelton. Offsetting the cost of upgrading long-term care staffing, facilities and monitoring might be at least partially accomplished by increasing long-term care capacity, easing demands on the more costly acute care and then transferring funds between the two.
Despite this possibility, addressing the long-term care issue will require an influx of money.
“It's going to cost money,” says Hazelton. “We as a society have to decide are they worth it or not.
“But this would never be tolerated if this was children we were talking about.”