Hiring for long-term care homes must be priority: panel
Staffing in many long-term care homes across the province is “in crisis” and more people must be hired immediately, according to the members of an expert panel on long-term care appointed last September.
Health Minister Randy Delorey struck the panel to make recommendations around the appropriate mix of staff and how to recruit and retain people after a series of stories in The Chronicle Herald identified three deaths related to bedsores or pressure wounds. If staff are able to turn and properly position immobile residents, these injuries are preventable.
“We all feel there needs to be a greater investment in long-term care,” said Janice Keefe, the director of the Nova Scotia Centre on Aging at Mount Saint Vincent University, who headed the volunteer panel which consulted with 375 people over three months.
“Over and over we heard from family and staff who couldn’t provide appropriate care because they were ‘working short.’ But we couldn’t say to the government, ‘hire 500 continuing care assistants’ because we have a shortage of continuing care assistants and lots of unfilled vacancies in the province.”
THE RECOMMENDATIONS
Keefe said the same is true for registered nurses — too few want to work in nursing homes. Here is a short list of some of the recommendations the panel made to try and improve the quality of care within the next six months :
• Hire temporary long-term care “assistants” to help the trained front-line continuing care assistants (who earn $16- $18 an hour), who assist residents with eating, bathing, and toileting.
• Bring back a bursary program to pay the training costs and provide jobs after graduation for continuing care assistants in nursing homes and residential care facilities.
• Assign one full-time licensed practical nurse to work in residential care homes for people with intellectual and physical disabilities to ensure they do not develop bedsores or pressure injuries; these homes have no nursing staff.
• Implement all the recommendations from the Nova Scotia Long Term Care Pressure Injury Prevention Strategy (training people to identify bedsores was step 1, but collecting information about incidence and reporting the results to the public has yet to happen).
• Establish a temporary armslength committee from government to improve care and reduce the silos that include the Health Department, Nova Scotia Health Authority, and Office of the Fire Marshall.
• Develop a campaign to raise public awareness about the value of long-term care.
THE COMING YEAR
Over the next year, the panel recommends the government could ease pressure on the health system by repurposing vacant beds in residential care facilities. Instead of elderly people being cared for in hospital while they wait for a nursing home, the panel suggests allocating beds in one residential care home per region to speed up the transition.
Other recommendations include hiring more nurse practitioners to make regular visits to nursing homes and improving access to physiotherapists and other health professionals on a consistent basis. The panel is also asking the province to fund the establishment of behaviour management units — one in each four zones — for residents who lash out at staff or other residents, sometimes as a result of dementia.
Last but not least, the panel recommends modernizing the 30-year-old Homes for Special Care Act to reflect the greater needs of today’s frailer, elderly citizens. The guidelines in the Act require one nurse (licensed practical nurse or RN) for every 30 residents.
NOT RECOMMENDED
Despite that, the experts did not recommend increasing the ratio of nurses to residents or the number of hours of daily care each resident should receive. Those were fixes suggested by the Nova Scotia Nurses Union in its 2016 report called Broken Homes.
Keefe said while it is clear more staff is needed immediately, the experts can’t “pick a figure out of a hat” to quantify exactly how many additional people should be hired or what that might cost taxpayers.
“We desperately need better data to drive better decision-making,” said Keefe. “We need more staff working in long-term care, but we can’t tell you an exact ratio because the province doesn’t have the data.”
Keefe said a recent promise and request for proposals by the government to purchase software that will measure residents’ general health, staffing levels, as well as incidents such as falls and bedsores is a good first step. She estimated the interRAI (Resident Assessment Indicator) will take about three years to for all homes to set up.
She said as a gerontology researcher
she thought “it was a tragedy” that Nova Scotia did not implement the interRAI (Resident Assessment Instrument) system 15 years ago when the province first piloted it. Almost every other province has since adopted this technology to monitor long term care residents; interRAI was recommended 2 years ago by the Nova Scotia Nurses Union.