Facility living differs from supportive living in that it:
· Cares for residents with medical conditions that may be serious, chronic and/or unpredictable and require access to registered nursing services on a 24-hour basis;
· Provides 24-hour registered nursing care from nursing staff who are able to respond immediately and on a sustained and unscheduled basis;
· Has health professionals that are able to respond to the need for unscheduled assessments and prescribe interventions;
· Has specialized physical design and infrastructure to address highly complex needs; and
· Is governed by the Nursing Homes Act or the Hospitals Act.
Facility living includes nursing homes and auxiliary hospitals (a hospital for the treatment of long-term or chronic illnesses, diseases or infirmities). The provincial government estimates that there are approximately 14,400 people living in approximately 200 long-term care facilities.
All long-term care facilities are subject to the provincial Long-Term Care Accommodation Standards. Similar to the Supportive Living Accommodation Standards, there are eight broad themes and detailed standards within the Long-Term Care Accommodation Standards: physical environment; coordination and referral services; hospitality services; residential services; safety services; human resources; personal services and management and administration.
All long-term care facilities receiving public funding must also follow the Continuing Care Health Service Standards.
The cost to a resident for facility living is $54.25 for a private room, $47.00 for a semi-private room and $44.50 for a standard ward room. The provincial government pays the health-associated costs.
Protection for Persons in Care Act
The Protection for Persons in Care Act applies to all adults in publicly funded care facilities, including hospitals, seniors’ lodges and nursing homes. Private supportive living operators (e.g., where the residents do not receive public funds) are not covered by the Protection for Persons in Care Act. However, all supportive living operators are required to develop and maintain policies and procedures requiring all employees to receive education on identification, prevention and reporting of abuse or suspected abuse of residents.
Pursuant to this legislation, every individual or service provider who has reasonable and probable grounds to believe that there is or has been abuse against a client shall report such abuse. A telephone hotline is available to report abuse cases.
Complaints are investigated by individuals who are not government employees but are hired under contract and are external to the agencies involved in the allegations. The investigators come from various backgrounds, such as criminology, nursing and social work, and have expertise in areas such as long-term care, mental health, law enforcement and experience working with seniors or persons with developmental disabilities.
After completing an investigation, the investigator will make recommendations to Alberta Seniors and Community Supports, which may include reviewing the facility’s funding, recommending that an employee be disciplined or dismissing the report if there is no reason to believe abuse has occurred. Alberta Seniors and Community Supports will then make a decision based on these recommendations.
The definition of abuse in the Protection for Persons in Care Act requires intent. Consequently, many reported complaints do not meet this high legislative threshold. The Legislative Review Committee studied the legislation in 2003 and recommended removing the requirement of intent. While the issue of intent is important, they noted that it “should not be the critical component in the definition of abuse” but should “instead focus on the harm or potential harm to the client, rather than the apparent state of mind of the alleged abuser.” No such changes have been initiated.
Health Facilities Review Committee
The Health Facilities Review Committee Act establishes a committee responsible for regularly reviewing and inspecting long-term care facilities and investigating complaints or concerns about care, treatment and standards of accommodation in facility living. However, “the Committee does not have the mandate to determine whether a facility is in compliance with or in contravention of standards set out in the Nursing Homes Act and Regulations, or to enforce the standards or to impose sanctions.”
The Committee is comprised of two members of the Legislative Assembly and ten private citizens. The positions are part-time and members are not employees of the provincial government.
The Committee performs surprise inspections but, in practice, they only inspect each facility approximately every three years. If a complaint involves personal health information, the Committee’s rules require permission from the complainant or their legal guardian to investigate complaints. Consequently, many complaints about facilities are never investigated, although they may be considered during the next routine review. The Committee also restricts its investigations to those made by or on behalf of a specific patient, not complaints involving more than one person.
After its investigation, the Committee sends a report to the relevant parties, as well as the Minister of Health and Wellness. The homes are asked to respond in writing within 90 days, indicating the actions undertaken to address the recommendations. The Committee will follow-up if the response is not satisfactory.
Spencer summarized the impact of the Committee’s rules on its work:
As a result of these rules, between 2003 and 2006, almost seventy percent of the private complaints made were not investigated because the forms were not returned. In 2003/4, the investigation process took over a year in each of the 6 private complaints heard. In 2004/5, only one private complaint was conducted and concluded in the year, and in 2005/6 only three complaints for long term care (out of eighteen complaints) were conducted and concluded.
The Ombudsman in Alberta has jurisdiction to investigate complaints about the patient concern resolution processes of hospitals, as well as long-term care facilities.
Regulation of Congregate Settings
Assisted Living Facilities
Assisted living facilities, or “enriched living,” are privately owned facilities where residents are independent older adults who do not require substantial care but may be in need of some services (e.g., meals, housekeeping). Residents must be cognitively capable and have the ability to make informed, voluntary decisions regarding care requirements and living arrangements (or, if living with a spouse, the spouse must be able to do so). Some enriched housing units fall under the auspices of the Housing Services Branch of the Department of Community Services. No legal right exists to inspect these facilities.
Residents of assisted living facilities enter into a rental contract or lease agreement with an operator. However, the Residential Tenancies Act is silent on the issue of jurisdiction with regard to assisted living facilities.
Residential Care Facilities, Community Based Options and Nursing Homes
Three types of long-term care facilities exist in Nova Scotia: community based options; residential care facilities; and nursing homes/homes for the aged. Both community based options and residential care facilities can fall under the jurisdiction of either the Department of Community Services or the Department of Health, while the Department of Health has exclusive jurisdiction over nursing homes. The Homes for Special Care Act and its regulations govern long-term care facilities that are licensed (i.e., residential care facilities and nursing homes).
Community based options are small homes owned and operated by private individuals or organizations for a maximum of three residents who need some supervision and limited help with personal care. Although community based options are unlicensed, they are inspected and approved by the Department of Health.
Residential care facilities are similar to community based options but they provide services to more than three residents. They are also licensed and inspected annually by the Department of Health. Operators have a duty to permit an inspector at all reasonable times to enter and inspect the residential care facility, its records and equipment, and if required, to have any resident examined by a medical practitioner or registered nurse for the purposes of the Homes for Special Care Act.
Nursing homes, sometimes known as homes for the aged, provide accommodation and skilled nursing care to older adults. Residents are referred to this level of care if they: require assistance from a registered nurse; cannot ambulate on their own; have no physical/cognitive ability to evacuate independently; or they need more than 1.5 hours of one-on-one care per day. These facilities are inspected twice a year by inspectors at the Department of Health. As with residential care facilities, operators of nursing homes have a duty to permit an inspector at all reasonable times to enter and inspect the nursing home, its records and equipment, and if required, to have any resident examined by a medical practitioner or registered nurse for the purposes of the Homes for Special Care Act.
There are approximately 5,835 licensed beds in 70 nursing homes across Nova Scotia. Statistics show that 22 nursing homes are municipally owned, 21 are private-non profit, 20 are private for-profit and 7 are based in hospitals.
The government pays the health care costs for resident care while residents are responsible for accommodation charges and personal expenses. The daily accommodation charges are $47.50 for community based options, $52.00 for residential care facilities and $86.50 for nursing homes.
A June 2008 report on the status of persons with disabilities in residential care homes found that the residential sector operates in silos. No standards other than licensing requirements are in place for residential care facilities. Inconsistencies exist across the province with respect to infrastructure maintenance, the availability of social, vocational and recreational opportunities, as well as bedroom and common area furnishings and aesthetics. The report recommended converting all unlicensed community based options to licensed homes.
Residents’ Rights in Long-Term Care Homes
The Homes for Special Care Act Regulations sets out a number of requirements for licensed long-term care homes that help to respect the social rights, freedoms and interests of residents. Generally speaking, the legislation is silent about the mechanisms available to enforce these rights.
rotection for Persons in Care Act
The Protection for Persons in Care Act applies to residents as defined by the Homes for Special Care Act and patients under the Hospitals Act. Section 4 of the Protection for Persons in Care Act places a duty on the facility operator to protect the patients or residents of the facility from abuse and to maintain a reasonable level of safety for the patients or residents. People operating within the care facilities have an obligation to report any abuse. For all other persons, reporting is voluntary.
The Minister is required to make an inquiry into any abuse report received and, depending on the circumstances, may investigate the allegations. The report is then given to the facility with a time limit in which it must comply. Any employees or residents who lodge an abuse report are protected from retaliation under the legislation.
The Nova Scotia Ombudsman has the authority to investigate complaints about hospitals, residential care facilities for seniors and nursing homes. The Ombudsman has no jurisdiction over assisted living