'Some may have surprises': Reviews of homes for disabled adults lead in unexpected directions

As the Nova Scotia government plans to transition care for adults with disabilities to the community, reviews of the eight large adult residential care facilities are an important way to get the "lay of the land," says the chair of Diverse Abilities Nova Scotia. 

"I think government needs to know what's going on, how we're programming and what we're doing," Joyce d'Entremont, the chair of the association that advocates for all eight facilities, said in a recent interview.

"We are the service providers and we have lots of flexibility with what we do. But I do feel that the government, [Department of Community Service], is moving to a completely new way of doing business."  

The province has announced its intention to close the eight facilities in favour of small options homes or apartment assisted living. 

"I think it's good for them to know the lay of the land before that happens on a bigger scale," d'Entremont said.

A CBC investigation this week revealed the governance and financial review of Riverview Enhanced Living, which is a home for 58 people just outside Bridgewater, turned up some major concerns in early 2021. 

The review prompted the minister of community services to suspend the home's licence and place it under the care of an interim administrator. 

"The reviews … maybe some may have surprises," d'Entremont acknowledged in a nod to the findings at Riverview. 

"I'm not expecting any from my organization." 

Changes made

Since the review, Riverview Enhanced Living has made changes, has a new CEO, reports regularly to the Department of Community Services, and had its licence reissued to its governing board. 

Riverview is just one of eight licensed and funded adult residential care facilities for adults with a disability. All are under review.

The Department of Community Services may make the reviews a regular practice, but that hasn't been decided.

"That may very well be the outcome that we may set up a regular schedule," said Maria Medioli, the executive director of the disability support program with DCS. 

"We're still getting through the eight facilities. So I think we'll reassess when they're all done," she said. 

Medioli said in early July that the department decided to do reviews proactively.

"Regularly reviewing your operations is best practice to see where your strengths are, where improvements can be made," Medioli said. 

In an email, the department later said it was started as part of the move to transition disabled adults from large institutions to community living. The department wasn't sure when the last such review was done. 

Reviews have also been completed for Harbourside Lodge in Yarmouth and the Breton Ability Centre in Sydney River.

Two homes have reviews underway and three homes haven't yet been scheduled for review. 

Each review varies in cost and scope, but DCS says the costs have ranged between $30,000 and $70,000.

Planning for the future

Cyndi Carruthers says the process is worthwhile. Carruthers is the executive director of People First, a coalition of advocates for people with a mental disability.

"They should have been doing it 10 years ago," said Carruthers, "but it's nice that they're doing it now, because they're planning to close these institutions." 

Carruthers has been advocating for the closure of large institutions and for the department's transition to care in the community. 

To make the transition successful will take planning and analysis, Carruthers said. She said that the institutions have not traditionally had a lot of oversight or consistency from the department, and she doesn't believe that the department has had a good grasp on how they operate. 

However, she's hopeful that understanding is "dawning" and the transition to integrate adults with disabilities more into the community is progressing. 

Harbourside closure sprang from review

D'Entremont oversees Harbourside Lodge. She said she has worked with the third-party reviewers to examine how that home is run.

To her knowledge, these kinds of reviews had never been done before in the sector.

"It was governance, it was financial, it was the building, it was the day-to-day operations. It was the full-meal deal," she said. 

She said the review made recommendations, including capital improvements and the privacy of residents, and then it was her responsibility to develop a plan for the Department of Community Services on how to proceed. 

"When we looked at the bigger plan, my team said, 'You know what, let's just propose we close it down and that we build small options and that we be the first out of the gate to transition the participants to community living,'" she said. 

That led to an announcement in October. 2020 that Harbourside's 27 residents would move to small options homes.

The move has taken longer than the 12-18 months initially announced, but d'Entremont said she expects Harbourside to close by the end of 2022. 

Care in the community

Kathleen Bell, the CEO of Riverview Enhanced Living, said her organization is still aiming to transition to more small options and assisted living. 

She said an important takeaway from the review is that Riverview may make a case to DCS that more funding for staff is needed, particularly as staff navigate the transition to caring for residents in a community setting.

Dylan Robar, who is a resident at Riverview Enhanced Living, was concerned to learn of management problems at the home. But he said he has confidence in the new management and he's pleased with what the CEO told him. 

"She is looking to the future, the future of small options, and apartment assisted living," he said. 

"I think that's great because they're looking at the clients. She wants to make this company better, and not to be down the path that we were before." 

Leta Jarvis, a member of People First Nova Scotia, said her younger brother, Paul, lives in Kings Regional Rehabilitation Centre in Waterville, but is on a wait-list to move to the community.

Jarvis, who lives in Truro, said she and her brother talk on the phone each night about their hopes for him to live closer to her. 

"I would like him to move into an option home or a group home where there would be staff there that can give him his pills and help him to get by," she said.

"I'll be able to phone them and tell them I want to take my brother out for a day or an overnight pass or stuff like that." 

Jarvis said her brother has an intellectual disability, while she herself has a learning disability and gets a bit of assistance from other members of People First in her daily life. 

Jarvis, 71, said she lived in various institutions from age seven until she was in her 20s or 30s, when she was able to move to independent apartment living. 

"I can pay my rent, I can pay bills with the help of Cyndi [Carruthers]," she said. 

"I can come and go when I want to, I don't have to have anybody tell me you can't do this or you can't go here." 

Medioli said there isn't a direct connection between the reviews and the move to community, but more information could make the change easier. 

"If [the eight homes] have strong financial management and governance practices, that prepares them better for that transition to support participants, to move to community and to change their service delivery model as well," she said.