Staff, not studies, needed to fix gaps in long-term care, says nurses union

If Nova Scotians value the lives of seniors, they must be prepared to pay for more staff to ensure vulnerable residents receive the care they need in nursing homes, says the longtime president of the Nova Scotia Nurses Union.

Hazelton, whose union represents some 6,900 nurses in the province, said good care is owed to aging Nova Scotians who find themselves in nursing homes after working all their lives and paying taxes.

"I'm pretty sure there's not a child at the IWK [Health Centre] that's waiting an hour, an hour and a half to get their meal," she said.

"Many, many of our seniors are not getting a hot meal because by the time the CCA [continuing care assistant] gets to them, their meal is cold. There's only so much we can do with the staff that is there."

Jane Meadus, a lawyer at the Toronto-based Advocacy Centre for the Elderly, agrees there is an indifference toward seniors in care that would be not accepted in other facilities, such as a children's hospital.

"One of the problems is the attitude. 'This is just the way it is and this is what we have to put up with,'" she said.

Hazelton said the requirements in the current Homes for Special Care Act governing long-term care staff are vague and outdated. One RN can be responsible for as many as 120 residents, LPNs care for about 30 residents each, and CCAs have between four and six residents each.

LPNs give out approximately 24,000 medications in long-term care facilities in Nova Scotia each month, something that takes up most of their day.

"They start in the morning and they pass out meds all day long until they go home," said Hazelton, who's been fighting for more staff since she became union president in 2002.

Sicker residents, same staff

Though the province has done a good job of providing services that allow and encourage aging Nova Scotians to stay in their own homes for as long as possible, Hazelton said the downside is that when seniors enter nursing homes, they are often much sicker and in need of greater care. 

"Most of our residents are incontinent, many of them cannot walk or need assistance to walk, the majority of them need help to bathe, half or more need some help feeding," she said.

"The requirement of care for those seniors has escalated and the funding hasn't changed."

When workers call in sick, Hazelton said they are not always replaced, leaving others to pick up the slack in an already overworked environment.

Staffing a constant problem

Finding enough health-care professionals to work in long-term care is difficult, said Meadus.

"The hours aren't great. Often the pressure and responsibility is probably more in an LTC [long-term care] setting than in other places. It's not seen as a desirable place to work and the wages tend to be lower," she said.

Meadus attended a public inquiry that recently wrapped into patient safety in Ontario's long-term care homes. The inquiry was launched after RN Elizabeth Wettlaufer killed eight people and harmed six others while working in nursing homes in southwestern Ontario from 2007 to 2016.

Wettlaufer is serving a life sentence after confessing to the crimes.

One of the issues that came up during the inquiry was staffing, said Meadus. Even though others noticed Wettlaufer had a poor work ethic and made frequent mistakes, she kept her job in part because it is difficult to recruit and retain RNs.

Broken Homes, a 2015 report into long-term care staffing by the Nova Scotia Nurses Union, cites research demonstrating that increasing RN staffing ratios reduces the probability of hospitalizations and associated health system costs. It also shows improved outcomes such as fewer pressure ulcers, fewer urinary tract infections, fewer falls and reduced mortality.

New legislation needed

Hazelton's union wrote a new piece of draft legislation with improved staffing levels and presented it to the Nova Scotia government this year.

"We believe in order to look after our residents safely, and make sure they have quality of care and quality of life, the government needs to address the care hours that our residents are currently funded for."

Ian Macdonald, a spokesperson for CARP NS, a national, non-partisan association that advocates for older Canadians, said the number of Nova Scotians over 65 will double in the next 10 years.

"I believe it's well past time to act," he said. "We know what the best practices are. This is a situation that has been addressed in other provinces and other countries."

'Quick actions' expected from panel

Nova Scotia Health Minister Randy Delorey told CBC News his department's first priority is the care of residents in long-term care. 

The Health Department "wants to move quickly to make improvements where we can and ensure residents and their families remain confident in the care being provided," said Tracy Barron, a spokesperson for the department.

"We believe the panel can help us with quick actions to improve the system," she said.

Hazelton said she hopes that's the case.

"Right now it's our moms and dads [in these homes]. Twenty or 30 years from now, it's us," she said. 

"So if we don't value it now, it's not going to get any better. In fact, it's going to get worse."