Login Members Only
In late June the NSNU released a paper on staffing standards for long-term care and spoke with media about the importance of addressing this matter, once and for all. In the 27-page report, the NSNU revisited the 2015-2016 Broken Homes book on the state of long-term care in Nova Scotia, in particular safe staffing.
The report was released to NSNU members, health care stakeholders and media on Friday, June 26 followed by a Facebook Live panel discussion about the topic. It was hosted by Janet Hazelton with guests Glenda Sabine, RN, NSNU VP LTC, NSNU’s Dr. Paul Curry, author of our 2015-2016 report on long term care entitled Broken Homes and Dr. Ruth Martin-Misener NP, PhD, FAAN, Professor and Director of the School of Nursing and Assistant Dean, Research, Faculty of Health at Dalhousie University.
The paper, authored by Charlene Harrington, Ph.D., RN, Professor Emeritus from the University of California, San Francisco was commissioned by the Nova Scotia Nurses’ Union in 2019. Dr. Harrington’s findings are particularly relevant today given the difficulties nursing homes faced during the COVID-19 outbreak.
The state of Nova Scotia’s long-term care system is a leading concern of the members and leadership of the Nova Scotia Nurses’ Union. These concerns were formally articulated and validated in Broken Homes. In that book, we called for a series of reforms to the long-term care sector in order to improve care for residents, improve working conditions for staff, and improve data collection and transparency.
Despite progress on several fronts, the single most important recommendation from the report, the one that would do the most to improve the quality of life for residents, and the working conditions for health providers, remains unrealized. That is the call for explicit, evidence-based staffing standards. At a minimum, this would mean an average of 4.1 hours of care per resident per day, including 1.3 hours of nursing care (RN and LPN combined). Roughly, this would mean about one RN and one LPN staff for every 30 to 40 residents during the day, and for every 40 to 55 residents at night; and one CCA for every 7 residents during the day and for every 15 residents during the night. Compared to current levels, this would be less than a 20% increase.
It has been said that we lack sufficient provincial data to make definitive claims around a staffing ratio. The province has promised to introduce the tool that would provide this data, the internationally recognized Resident Assessment Instrument, many times over the past 25 years, but we are still waiting. Regardless, the Nurses’ Union has always believed that we have enough information to implement a minimum staffing ratio, one that can be adjusted upwards if our needs are revealed to be higher.
To make this point, the Nova Scotia Nurses’ Union contracted Dr. Harrington to investigate the long-term care staffing situation in Nova Scotia and fulfill the task of recommending a minimum staffing standard. Dr. Harrington is recognized internationally as a foremost expert on long-term care staffing. She served on the U.S. Institute of Medicine (IOM) Committee on Nursing Home Regulation whose 1986 report led to the passage of the Nursing Home Reform Act of 1987. She served on three IOM committees that examined the nursing workforce, long-term care quality, and patient safety. She has testified before the U.S. Senate Special Committee on Aging several times and has written more than 140 articles and chapters, co-edited five books, and lectures widely. In short, you cannot research the topic of long-term care without knowing her name and reading her work.
After examining the situation and data available for Nova Scotia, Dr. Harrington concluded that the province should implement the minimum professional standard of 4.1 hours of care per resident day. It is worth noting that this is based on the sparse data available that suggests residents in Nova Scotia have less complex needs than those in other jurisdictions in Canada. This is a very questionable premise, and only better data can help clarify this.
We cannot speak of reform to the long-term care sector without recognizing the tragedy we have just seen unfold in nursing homes. In our own province, over 90% of COVID-19 deaths occurred in nursing homes, a trend we saw across the country and internationally.
We are not here to criticize any particular facility, and it is imperative to clarify that the conditions at Northwood, where the tragedy struck hardest in Nova Scotia, are nothing like what we saw coming out of the military report in Ontario. We represent about 40 RNs and NPs who work at Northwood, and we represent many RNs, NPs and LPNs who provided help there during the crisis. The care these nurses provided was, and continues to be, of exceptional quality, and they and their CCA colleagues and other staff are true heroes for staying at the bedside, putting themselves and their own families at risk. Many staff paid a very high price for this commitment.
The issues of understaffing in long-term care, and the COVID-19 crisis in long-term care, are intimately related, as we discuss in the preface we have recently added to this report. The long-term care sector has been chronically underfunded for decades. Staff struggle to deal with increasingly complex residents, many of whom exhibit challenging behaviours that are no fault of their own. Increased funding and staffing levels would have helped buttress efforts against this deadly disease, with more resources for infection control and health and safety, staff to deal with residents who wander or who exhibit challenging behaviours, staff to perform vital, regular assessments, and enough staff to deal with the particular challenges presented by a pandemic.
In short, you, our members have been telling us for years that we need to do better in LTC. The COVID pandemic has further exposed the challenges the sector faces, which warrants more dialogue and action.
Visit nsnu.ca/StaffingStandards to read the full report.
