Ambulances and paramedics are tied up waiting to offload their patients because the emergency department is over-capacity and can’t handle any more. As always, every bed and gurney in emergency is occupied, some by patients who’ve been admitted to the hospital but are waiting for a bed. One in five inpatient beds in the hospital is occupied by a frail and elderly Nova Scotian waiting for a nursing home placement.
At the legislature’s health committee this week, both Nova Scotia Health Authority CEO Janet Knox and VP Integrated Services Tim Guest allowed that more long-term care (LTC) beds — nursing home beds — would help open the now-familiar bottlenecks outlined above. Both were quick to say that adding nursing home beds is not a panacea but would help relieve the patient flow problems — that Nova Scotians know better as long waits — somewhere along the line.
And yet there has been an undeclared and unacknowledged moratorium on new nursing home beds from the day the McNeil government was elected in 2013. The only new LTC beds the government has announced are the 50 to be split between North Sydney and New Waterford, but they’re a long way off and part of the redevelopment of health facilities across the Cape Breton Region, a redevelopment that will close hospitals in those same two towns.
For years now, when asked if any new nursing home beds are in the works, the provincial government has responded by talking about the expansion of home care. Those services have expanded. In almost every budget the Liberal government has delivered, there was additional funding for home care, while funding for long-term care remained stagnant or, in some years, was reduced.
Some of that is about to change, but NDP leader Gary Burrill and other vocal advocates for more nursing home beds in the province are unlikely to be placated.
When the provincial budget appears next month, it will include some added funding for LTC. It has to. The province just received a report from an expert panel it struck to look into quality issues in nursing homes and the picture isn’t pretty.
The panel identified a critical shortage of staff — both continuing care workers and nurses — and told the province it needs to act with urgency to address that issue, so that’s where any new money will go.
The panel wasn’t asked about access to nursing homes and so was silent on the issue, but it’s a safe bet that no new nursing home beds are in the government’s plans.
How could there be, when neglect of the sector for the past half-dozen years has led to a crisis in staffing with sometimes tragic consequences. At least three people have died from infections that started as preventable pressure wounds (bed sores) acquired in LTC.
Most everyone agrees with the provincial government that staying home is preferable to living in a nursing home, until it isn’t. Every year thousands of Nova Scotians reach a point where they need the level of care provided in a nursing home.
When that moment comes, they wait. If they’re waiting in Cape Breton or Yarmouth counties, they wait almost a year. In Halifax, the average wait is about six months. There are over 1,000 Nova Scotians waiting for a nursing home bed right now.
At any given time, up to 20 per cent of the province’s 1,700 hospital beds are “blocked” by folks waiting in a hospital for a nursing home placement. By some reckoning this is financial folly because maintaining someone in a hospital bed costs about three times as much as caring for that individual in a nursing home.
Ah, but that’s not how the math’s done. The province can’t manage demand for health services, so it rations supply. If it allows new nursing home beds to be added, they will be filled with additional costs to the province. And unblocked hospital beds will be filled immediately, too.
Nova Scotia hasn’t added a nursing home bed since 2013, not because more aren’t needed; they are and with the baby boom closing in on old age it won’t be long before there is a pronounced shortage of nursing home care.
The province isn’t adding new nursing home beds because it decided to control LTC costs the best way it knew how. No more beds.
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