Provincial budget fails to recognize that long-term care is in crisis

KJIPUKTUK (Halifax) – The recently tabled 2021-22 Provincial Budget seems to provide substantial and long overdue new funding for Long-Term Care (LTC), but it still fails to present a concerted plan of action on the real crisis in LTC in Nova Scotia in the short-term, and certainly, for the longer-term.  

The Rankin government has said in this year’s Budget Address that they are: “committed to doing better for our seniors in long-term care facilities and in our communities”.  This sounds encouraging, but what does this mean in real, concrete terms?

Single-year billion dollar investment

The Budget Address points out that this is the first year where (for) a single-year billion-dollar investment in continuing care; however, roughly $900 million was (actually) budgeted for continuing care in 2019/2020. So, for this year, there is approximately $100 million in new spending on continuing care, not $1.05 billion.

Of this $1.05 billion, only $700 million is for  long-term care (LTC). Approximately $300 million is in Home Care, and another $3 million is budgeted for Adult Protection. While these raw numbers seem large, they follow years of funding “increases” which barely kept pace with inflation. Past budgets also failed to account for the increased number of patients and residents entering hospitals and LTC facilities with a higher level of acuity.

Furthermore, it is still unclear how much of this is new, ongoing spending by the provincial government, and how much is temporary COVID spending or flow-through monies from federal government programs.

Minister’s Expert Panel on Long-Term Care

This year’s Budget provided more money to implement recommendations from the Minister’s Expert Panel on Long-Term Care for the second Budget in a row. This task force was set up in September 2018 and reported in January 2019. Last year’s Budget provided $2.8 million to enhance long-term care in Nova Scotia based on the Panel’s report. 

This year’s budget provides $22.6 million to continue implementation of the LTC Expert Panel Recommendations, including $10.3M related to COVID-19 LTC assistants. These positions were originally supposed to be a temporary fix, meant as a stop gap until more Continuing Care Assistants (CCAs) could be recruited, trained, and hired. This budget does not provide adequate funds to improve recruitment and retention of CCAs..

To our knowledge, there has been only one public report on the status of the 22 recommendations from the Expert Panel.  In September 2019, the Department reported that five recommendations were completed.  Since then, in last year’s budget and in this year’s budget, there has been no public reporting of the status of the recommendations or when they are expected to be fully implemented. We still do not know the overall status of the Panel’s recommendations, even with this year’s budget.

New beds and facilities

On January 29, 2021, former Premier Stephen McNeil announced the end of the government’s six-year moratorium on adding new beds and facilities for long-term care and he announced that 236 beds will be added for the Central Zone. Seven facilities have been identified for immediate work based on their overall condition and best practices for infection prevention and control. The first project is anticipated to be completed by 2024-25. 

When the government released its Capital Spending Plan, there was no reference to spending on long-term care in 2021-22. In fact, there was no reference to long-term care in the document at all. We were told that the government cannot talk about the amounts set aside to help ensure competitive bidding.

But what does this mean in the meantime? Are we adequately planning for the future needs of ageing Nova Scotians? In its note “Looking Ahead” (Bulletin 2 from January 2021), the Atlantic Provinces Economic Council has estimated that by 2040, there will be three seniors for every two young people. The share of seniors aged 75-84 years will increase from 29% to 39% by 2040. Meanwhile, the number 85 years and older will more than double to 134,000 by 2040, accounting for one in five seniors. APEC estimates that with Atlantic health care costs, assisted living facilities will also be in greater demand, as nearly one in three people aged 85 and older live in a collective dwelling. They estimate that Atlantic Canada will need another 25,000 places in nursing or senior homes by 2040. Even current wait times data estimate 1,200 to 1,300 people are currently on the nursing home placement wait list.

The government’s projection of 236 beds, none of which will be completed until 2024 at the earliest, represents only a drop in the bucket of what is needed. To expand our provinces’ current long-term care capacity to meet the needs of over 1,000 people on the waiting list and up to 10,000 new potential LTC residents (between 2025 and 2040), the government would need to fund and staff roughly 700 new beds per year, including building dozens of new facilities. This budget does not provide evidence of a long-term plan to build and staff these beds and facilities. The longer it takes to begin this process, the more likely it means we will not meet future needs when they arrive.

Northwood reviews

During the first wave of COVID-19, there were 53 deaths at Northwood. The Budget provides $12.3 million to extend Regional Care Centres to support long-term care patients with COVID-19, and $11.3 million to meet infection Prevention and Control Recommendations. Once again, the government has provided no official update on the progress of their implementation of the two Northwood Reviews, as announced on September 21, 2020. 

New national standards

During COVID-19, 67% of all deaths in Canada were in long-term care and Canada fared worse in protecting LTC residents than any of our peer nations. Given the carnage of COVID-19 and our regions’ developing demographic crisis, there must be new, national standards for long-term care to protect residents, ensure proper staffing and resources, and to layout clear rules around accountability and transparency. 

As the federal Liberals said during last fall’s federal budget debate, national standards are essential to address critical gaps in long-term care facilities, especially for the Atlantic provinces. These standards are vital to improving retention, recruitment, and training of staff in the sector. We fully support the provincial health coalitions’ efforts for the federal government, provinces and territories to work together soon to establish national standards for long-term residential care. 

Our volunteer coalition (Nova Scotians for Long-Term Care Reform) wants a government that acknowledges that our long-term care system is in crisis, with serious, systemic problems. We want a government that recognizes that these conditions were worsened by austerity budgets.  We want more than anything else for everyone living in long-term residential care to not only be safe, but that to be given every opportunity and support needed to live healthy, dignified, and joyous lives. This work must begin now!

Ian Johnson and Chris Parsons on behalf of Nova Scotians for Long-term Care Reform

See also: Authorities ignored early warnings from Northwood’s long-term care workers and unions