Shiny budget surpluses versus investing in long-term care

Our long-term current crisis in long-term care, now in the spotlight because of COVID019, is the result of lots of choices governments have made. We need a public inquiry to hold them accountable, and to make share our long-term care future is better than its past.

Choices?

  • Crushing health care unions versus investing in long-term care?
  • Slashing $8 million from the provincial budget for grants to long-term health care facilities versus investing in long-term care?
  • Boasting about shiny budget surpluses versus investing in long-term care?
  • Cutting taxes for corporations versus investing in long-term care?
  • Not opening a single new long-term care facility in seven years versus investing in long-term care?
  • Spending close to $80 million to subsidize a ferry that isn’t versus investing in long-term care?

No wonder Premier Stephen McNeil chooses to change the subject — “First of all, let me say thank you to all long-term care workers across our province” — whenever anyone has the temerity to ask if he will call a public inquiry into why so many Nova Scotians have died in long-term care facilities, especially in Northwood, during the current COVID-19 pandemic.

The scorecard, in case you’re keeping score, looks like this. As of Saturday, May 30:

  • 246 residents at Northwood have been diagnosed with the virus. (The facility has 485 beds, but 85 of them are currently vacant. It’s not clear what percentage of residents actually tested positive, but it appears to be about 50 per cent.)
  • The number of positive tests at Northwood represents close to one-quarter of all the COVID-19 cases in Nova Scotia.
  • Fifty-three of Nova Scotia’s 60 deaths occurred at Northwood.
  • An additional 99 employees have tested positive, though none have died.

Do we need to have a public inquiry? Are there questions we need to answer? Are there changes we need to make?

During his May 5th briefing, as the Examiner’s Zane Woodford reported:

Premier Stephen McNeil was asked twice whether he’d launch a public inquiry on the situation at Northwood, something the Nova Scotia Government and General Employees Union is calling for. He was noncommittal.

We’re working very hard with Northwood, with unions across the province to ensure that we deal with COVID-19 in our province and we’ll continue to focus on that,” McNeil said…

“We’ll continue to put all of our energy and effort in ensuring that we continue to work with the hard-working frontline people at Northwood, those that have come in to support them, to ensure that we provide the best care possible for those residents,” McNeil said.

The next day, our prickly premier called calls for a review “highly inappropriate” so long as people still sick and dying. “There’s a lot of families suffering. We closed businesses, incomes have been lost and, in some cases, life savings have been lost … We’ll continue to look at our long-term care sector across the province, all of that will be reviewed.”

One should scoop an ocean-ful of sea salt on top of most of that. Working very hard with Northwood…?  As my colleague, Jennifer Henderson, reported earlier this month:

On February 28, during a debate over the provincial budget estimates,  Halifax Needham MLA Lisa Roberts asked Health Minister Randy Delorey why — for three consecutive years — the government did not support a capital funding request from Northwood to build new floors above to eliminate some of  the  “double and triple-bunking” of residents in the Centre.

“The Board of Northwood has determined they are not meeting the standard of care required, in terms of infection control, in rooms that have double and even triple occupancy,” said Roberts. “The initial proposal was for 13-million-dollars and would permit Northwood to maintain the same number of beds but in single occupancy rooms that would meet the standard we now require given the increased medical needs of long-term care residents.”

“There is no provincial standard that requires licensed homes to have single-occupancy rooms,” said Delorey. “We do have preferences for single rooms and that’s why most new-builds have more single rooms. But we still need the bed capacity we have.”

Or, how about working very hard… with unions across the province? Don’t tell that to the Nova Scotia Government Employees Union, McNeil’s favourite bête noire, whose leaders came under fire for even raising questions about conditions at Northwood and called for a public inquiry?

Or let’s parse work with the hard-working frontline people at Northwood? This from a government that waited two weeks before finally agreeing to join a federal program to provide a $2,000 “pandemic premium” to front-line workers, and then tried to cast the delay as part of its “lobbying” effort to improve the package. And a government that still won’t consider a permanent living wage.

And then, of course, there’s this: continue to look at our long-term care sector across the province? Continue…?

Judy Haiven, a retired Saint Mary’s University management professor and activist, offered an excellent history lesson on the government’s track record on long-term care in a recent edition of the National Observer. (The Observer, like the Examiner, is subscriber-based and worth supporting.) While acknowledging the problems in long-term care in Nova Scotia are long term and certainly predate the McNeil government, Haiven makes plenty of important points about his government’s actions and lack thereof. A sampler:

Two successive Stephen McNeil governments have cut the budgets of most of the province’s 132 nursing homes and residential care facilities. From 2015 to 2017, Premier McNeil’s Liberal government reduced grants to long-term care by $8.1 million. [Six-million dollars was eventually restored, but that still left “a net loss of funding to long-term care of $2,764,120” at a time when more investment was required.]…

Northwood’s president and CEO, Janet Simm, said the 2016 cuts amounted to $360,000 for her institution; in 2017, the cut was nearly $600,000…

Unifor, the union that represents more than 400 workers at Northwood, agreed that the quality of care was affected by the funding cuts; staff hours were also reduced, so staff noticed they had less contact time with residents…

In Nova Scotia, long-term care homes are workplaces that pay from $17 to $25 per hour (of course, the RNs earn more). Before you call that a good wage, think about this: Would you do the physically demanding and tedious work of an LPN, or a personal care worker (PCW), for that wage? Given full time hours, you could earn about $40,000 per year…

However, in Nova Scotia, with the budget cuts to long-term care, many care workers whose hours were cut in one home had to work at part-time jobs at one or two other long-term care homes to earn enough to live. Until recently, there was no restriction on the number of care homes at which staff were allowed to work.

And, worse, it’s all going to get worse, post-pandemic, if and when we get there. Before COVID, for instance, the waiting list for those needing places in long-term care was about 1,300. After existing facilities halted new admissions because of the virus, that waitlist has already grown by 10-12 per cen. It will get worse again if the province is forced to stop double-bunking residents.

Janice Keefe. Photo submitted.

Which creates a knock-on effect for the whole health care system. As Janice Keefe, a professor at Mount Saint Vincent University in Halifax and director of the Nova Scotia Centre on Aging, explained: “If the individuals who need care and are eligible for a long-term care facility, if they’re not able to be cared for at home … it may result in having to be admitted to a hospital.”

On Friday, the government touted its response: a deal with Shannex a private company, to covert part of its Bedford assisted living facility into 23 new nursing home beds.

So let’s do the math:

  • Waiting list: 1,300-plus.
  • New spaces: 23.

We need a public inquiry, both for accountability — why did the government do what it didn’t do? — and also to implement a plan to create safe, affordable, and healthy long-term care options in numbers sufficient for the needs of Nova Scotians.

Janice Keefe was also the author of last year’s independent expert panel report, established following the horrific death of one woman in a private care facility two years ago. Our current calamitous crisis is also an opportunity to do more than “just put putty in” the cracks-turned-gaping-holes of our long-term care system, she says. We need to rethink how it fits into our overall health system, recalibrate and reconstruct for a better future.

And then — perhaps most important commit to spending the money to make the system work.


This column originally appeared in the Halifax Examiner June 1, 2020.

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