900 Nova Scotians on wait-list for home, community care support, committee told

There are some 900 Nova Scotians waiting for full-service home-care support, including Victorian Order of Nurses care, because of a staffing shortage, a standing legislative committee on health was told Tuesday.

Tracey Barbrick, deputy minister of the Seniors and Long-term Care Department, said, based on responses from a recent survey conducted with publicly funded long-term care and home-care agencies, the staffing vacancy rate in long-term care is approximately nine per cent and the vacancy rate in home care is about 12.9 per cent. The vacancy rates include full-time, part-time, and casual positions.

“It (shortage) varies by geography,” Barbrick said. “Some places are higher and some lower and it varies by profession.”

Barbrick said about half of the 900 people considered to be on the waiting list “are getting some level of care but not all the hours they have been approved for.

“A bunch of those people would be getting direct benefits where we give them some money and they might be purchasing services from We Care (home health services), a separate entity in the province, or they might be buying some service from a neighbour who is helping with housekeeping or those kind of light needs things,” Barbrick said. 

“Half of them are getting some level of service and some of them would be getting direct benefits to hold them over until they can get the service.

“The investment and focus on the continuing care sector in the last two years has been unparalleled. We have come a long way and have a distance to go.”

A full work week

A good part of the distance to be made up is providing continuing care assistants and home support workers a guaranteed work week, said Nan McFadgen, president of the Nova Scotia branch of the Canadian Union of Public Employees. 

“Many of our continuing care assistants and home support do not receive a 40-hour week of work but they need to be available in case they get a call,” McFadgen said of the 500 workers in the sector that CUPE had represented, a number than fell by 10 per cent to 450 over the past year.

“It’s a very difficult way to make a living if you have to be available for 40 hours but you may only work 24 hours or 32 hours,” McFadgen said.

“The practical effect is that people who love working in home support leave home support,” she said. “We have a 10 per cent decrease in the membership in the home-support sector and it’s attributed to the fact that they can’t really afford to work in home support.”

McFadgen said the home-care workers are battling a geography problem, having to travel considerable distances to the homes of clients while only drawing a limited car allowance.

“You live in one area and with the price of gas, it’s very difficult to travel from, say, Glace Bay to Louisbourg, and still make money at the end of that, especially if you don’t have a 40-hour paycheque.”

McFadgen said in a perfect world, home-support work would be publicly funded, publicly provided and include a guaranteed number of working hours “instead of 18 different agencies providing the service across the province with 18 different ways of doing things.”

‘It needs to be fixed’

Janet Hazelton, president of the Nova Scotia Nurses’ Union that represents the VON nurses across the province, says two workers are necessary for home visits, especially in the initial visit.

“Going into someone’s home, by yourself, not knowing what’s on the other side of that door is intimidating and it needs to be fixed,” Hazelton said.

The problem of having to go out at all hours to visit someone in their home has been somewhat ameliorated by the use of virtual care that allows VON nurses to do some troubleshooting over the phone.

But Hazelton said health-care workers in general face abuse and the risks are amplified when they are in someone’s home.

“In the community, there are dog bites, family members who get agitated, verbal abuse. There are no specific times when staff get there. If they have to wait, people get a little agitated.

Risky work

Hazelton said Workers Compensation Board statistics show that long-term care and community care providers in the province make up the highest number of injuries among health-care workers and those numbers are higher in Nova Scotia than most other provinces.

“In acute care, if I have to lift someone, you get a buddy. In community care, I have to do it by myself. Acute care nurses don’t have the risk that our nurses in the community do.”

Having two people make a call would increase safety for the worker and cut down on injuries, Hazelton said.

“The nurses I represent are either registered nurses or licensed practical nurses. Initially, it’s a registered nurse that will go in and do the assessment. That registered nurse will decide that this (case) doesn’t need a registered nurse, it could be a licensed practical nurse that could do this care or no nurse at all. We’ll come check every couple of weeks but the people Nan represents (home-support workers) can go in and do whatever has to be done.”

Barbrick said things are moving in the right direction.

“With the 4.1 hours of care in nursing homes meant an additional (500) staff on the floor in facilities,” Barbrick said. “That’s helping people to want to work in the sector because they are not working so short staffed. Everything we’ve done – free tuition, wage increases – are helping to bring people into the sector or back to the sector.”

CAPABLE program

Barbrick said the province has partnered with the Johns Hopkins nursing school to soon launch a pilot project for that school’s new CAPABLE program.

The pilot program for 300 Nova Scotia households to be run in conjunction with the VON will have an occupational therapist, a registered nurse and a handy person go intro the home together.

“They assess the needs of the person, the person identifies some of their goals and they come up with a plan,” Barbrick said. “It might include some physical adaptations to the house.”

Those adaptions would be completed with money from the government.

The guaranteed hours of work for support workers and the request for two people at every home visit are not something that will happen in the near future, she said.

Jeff Densmore, regional executive director for the North and Eastern zone, said the VON is short about 170 continued care givers out of about 700 to 800 positions and short about 100 nurses, again out of  total workforce of 700 to 800 positions.

The three areas where the wait-list for VON care is the greatest are the Annapolis Valley, Pictou and Colchester-East Hants, he said, the areas where the largest number of clients exist.

Densmore said the VON schedules overtimes among nurses.

“Sustained, it weighs on people but we have a passionate group of people, there is a reason they go into home care and they’re doing it, the sustainability is the piece we need to keep an eye on,” he said of the overtime.