HANSARD

NOVA SCOTIA HOUSE OF ASSEMBLY

STANDING COMMITTEE

ON

HEALTH

Tuesday, February 14, 2023

COMMITTEE ROOM

Delivery of 4.1 Hours of Care Per Resident in Long-Term Care

Printed and Published by Nova Scotia Hansard Reporting Services

HEALTH COMMITTEE

Trevor Boudreau (Chair)

Kent Smith (Vice Chair)

Chris Palmer

John White

Danielle Barkhouse

Hon. Brendan Maguire

Rafah DiCostanzo

Gary Burrill

Susan Leblanc

[Trevor Boudreau was replaced by Melissa Sheehy-Richard.]

[Danielle Barkhouse was replaced by Larry Harrison.]

In Attendance:

Judy Kavanagh

Legislative Committee Clerk

Gordon Hebb

Legislative Counsel

WITNESSES

Department of Seniors and Long-Term Care

Paul LaFleche, Deputy Minister

Tracey Barbrick, Associate Deputy Minister

Janet Lynn Huntington, Senior Executive Director

Michelle MacDonald, Project Director

Office of Healthcare Professionals Recruitment

Craig Beaton, Associate Deputy Minister, Department of Health and Wellness

Suzanne Ley, Senior Executive Director

Nova Scotia Nurses’ Union

Janet Hazelton, President

Canadian Union of Public Employees

Nan McFadgen, President, Nova Scotia

Govind Rao, Atlantic Region Research Representative

HALIFAX, TUESDAY, FEBRUARY 14, 2023

STANDING COMMITTEE ON HEALTH

1:00 P.M.

CHAIR

Trevor Boudreau

VICE CHAIR

Kent Smith

THE CHAIR: I call this meeting to order. This is the Standing Committee on Health. My name is Kent Smith. I’m the MLA for Eastern Shore. I am typically the Vice Chair of this committee, but in the absence of MLA Boudreau, I am sitting in as Chair today.

The topic for today’s discussion is the Office of Healthcare Professionals Recruitment, the Nova Scotia Nurses’ Union, the Canadian Union of Public Employees - sorry, those are the witnesses we have today discussing the delivery of 4.1 hours of care per resident in long-term care. One housekeeping note: Please put your phones on silent.

I will now ask the committee members to introduce themselves, beginning at my left with MLA Sheehy-Richard.

[The committee members introduced themselves.]

THE CHAIR: Thank you to the members. I would now like to invite all the witnesses to introduce themselves. Just stick with an introduction of your name and title for now - we’ll do formal opening remarks in a moment. I’ll begin again on my left with Ms. Barbrick.

[The witnesses introduced themselves.]

THE CHAIR: Thank you very much. We do have additional witnesses in the second row. If and when you get called upon, we’ll ask you to introduce yourself at that point in time. I will also note that Deputy Minister LaFleche is absent for about five minutes or so; he’ll be returning shortly. Finally, I’d like to make it official and recognize the fact that we have Legislative Counsel Gordon Hebb present, as well as Legislative Committee Clerk Judy Kavanagh.

We will now move into the opening remarks for our witnesses. We are asking for three to four minutes per organization - try to keep it concise, if we can. We have a lot of witnesses and a lot to talk about today. I will begin with Nan McFadgen, please.

NAN MCFADGEN: As I’ve said, my name is Nan McFadgen. I am speaking here on the unceded territory of the Mi’kmaw people, colonially known as Nova Scotia. I represent about 21,000 public workers across the province, 4,700 of whom work directly in long term care.

I, myself, am a licensed practical nurse with a little over 20 years of experience in a long-term care facility, so this topic is near and dear to my heart, as you might expect. I want to thank the committee for discussing the topic of 4.1. It is CUPE’s goal to achieve 4.1 in Nova Scotia - and I hope it happens before I’m in care. I will be excited about that.

I bring to you a clear and simple message. CUPE has been advocating for 4.1 hours of hands-on care since I began as an LPN - and I’ve already told you how many years that is. The hands-on care is not what we have now - 4.1 hours of hands-on care. However, I will define to you that hands-on care is provided by continuing care assistants. As I said, I am an LPN myself, so I’m going to explain to you with a bit of a thread to make it easy for the layperson to understand.

If you take, for example, what I would call a decubitus ulcer in long-term care - what you would probably call a bed sore. Our focus on long-term care would be to have no bed sores, no decubitus ulcers. That’s our goal. That starts with clean laundry, appropriate nutrition, mobility, nursing care, hands-on care from continuing care assistants. The complete person requires significant help with their ADL so that they don’t have a decubitus ulcer or bed sore.

To say that we now have 4.1 is not actually what we have. What we have now is three for continuing care assistants - 3.0 hours of hands-on care. While we were very happy about the recent announcement - because this has been my life-long fight to get 4.1 hours of hands-on care, I know the difference between what we have now and what we achieve to get. We have three hours of hands-on care - which are continuing care assistants - which sees approximately 25 minutes in a 24-hour period of increased, hands-on care. The LPNs and RNs see approximately nine minutes - but you can’t quote me on that.

When we’re talking about care and human beings, we really cannot just think about the pieces of care. When you got up this morning, you got a shower. You put on clean clothes. You likely had breakfast. If you didn’t, you should have. You likely did that in your home, which would be a clean and safe environment for you, and you likely did it with everything in your home functioning as it should function. Then you got in your car and came here to attend this meeting.

In a nursing home, a resident needs to get up in the morning. They would need a physio aide, perhaps occupational health and safety. They would need a continuing care assistant. If they require nursing care, they would also need that. They would also need their room cleaned and their bed changed, and they’d need someone to make their breakfast.

When you think about hands-on care, it’s far more complex than to say that Nova Scotia now has 4.1 hours of care. If you’re talking hands-on care, Nova Scotia has three. That is not, in fact, what CUPE has lobbied for over 15 years for. So when the announcement was made, we were asked, why aren’t you happy about this announcement? Well, we were happy about the announcement, because at least it’s a step, and a step is better than no step at all. I acknowledge that freely. I’m happy to say it.

However, we’re not where we need to be for caregivers and the people who receive their care in Nova Scotia. The story’s not over. You’ve started the story. In 2002, when CUPE negotiated 2.45 hours of hands-on care, we’ve been trying every successive year with every government to increase that. In that, I will acknowledge here now, that’s great. You’ve increased it by 0.45 hours of hands-on care, so thank you. That’s beautiful. But the work is not done. We’re not finished. We really do need to think about the resident in their entirety and not just the piece with the CCAs. It’s so much bigger than that for us.

Thirty-three more minutes of care in a 24-hour period - maybe that doesn’t sound like a lot. That is what was achieved with the increase: 33 more minutes in a 24-hour period. If you’re the person in the bed, that 33 more minutes would be pretty special. But for some facilities, the three hours of care - the end result was no increase in continuing care assistants.

We have some nursing homes - we used to call them old builds. I won’t get into all the different names of all the different governments. Some nursing homes will see that increase of 33 minutes in the 24-hour period. Some nursing homes will see no increase with the three hours of care. When it comes to nursing, some were already funded over complement of what was - I keep wanting to say “bargained,” but it wasn’t bargained. Legislated. The 1.1 - some were already over that. Government has agreed to continue funding that, but there’s no security in that, because what you’ve guaranteed is the 1.1.

It’s great to have a guarantee, but if you had nursing homes already funding beyond complement because they couldn’t get by, guaranteeing funding under what they were funding is not a win for us. We don’t see that as an amazing development. We see that as securing the 1.1, but everything over that doesn’t have that same security. Your government has committed to continuing that funding, but that is by the will of the government - and we know the will of the government is a thing. Government’s will changes, the wind blows in a different direction, government feels different about something.

Anyway, I said this when you made the announcement, and I say it again. We appreciate the increase, so thank you for that. But it’s nowhere near what is required so that we don’t see a repeat of what we saw, which was 17,000 seniors who died from COVID in long-term care facilities across Canada - and Nova Scotia does not have a proud moment in this history. Thank you.

THE CHAIR: Ms. Hazelton.

JANET HAZELTON: Good afternoon. Thanks again for your interest in this topic. Like Nan, it’s very important to the Nova Scotia Nurses’ Union. We actually published two books, one in 2015 and a follow-up in 2020, called Broken Homes and Staffing Standards for Nova Scotia’s Nursing Homes. In both of those we asked for 4.1 hours of care.

I’ll keep my introduction short. At this point, the requirement of 4.1 hours . . . (Blasting sound) Oh my God. What was that? (Interruptions)

THE CHAIR: Order, please.

JANET HAZELTON: Is there an AED in here?

THE CHAIR: Order. Please accept our apologies. We should have announced that we’re doing some renovations here. That might not be the only one that we experience. Hopefully if someone hears the bell chiming, they can make sure that everyone is aware.

JANET HAZELTON: At this point, the requirement for 4.1 hours of care is outdated. Research of this type is retrospective by its very nature, and 4.1 represents the minimum hours of care required for patients over the last decade. We need to be planning for the needs of residents for the next decade. This means following through on campaign promises and mandate letters, commitments to a modernization of the Homes for Special Care Act, and an increase to the number of clinical staff in long-term care. We shouldn’t be satisfied with a staffing increase that merely maintains the status quo and is only intended to prevent deterioration. Do our seniors and long-term care residents not deserve to be able to thrive in their homes?

This government has made some commendable changes to our long-term care system. Increasing the wages of continuing care assistants to better recognize the value of

the work they perform, making training to become a CCA more affordable and accessible, and increasing the number of CCAs working in long-term care are all great examples of positive initiatives.

We’ve also taken steps in the right direction to increase the number of nurses in long-term care from one to 1.1, which is nine minutes. That’s not a lot of time, but like I say, it’s a step in the right direction. This is really 20 per cent short of what is expected and what research shows. We should have 1.3 minimum hours of licensed staff, and that would be your LPNs and your registered staff.

As Nan said, it’s unfortunate if we see ulcers, but it’s the registered staff who would deal with those ulcers. It’s the registered staff who are supposed to be assessing the residents to make sure that an ulcer is not on its way. It’s the registered staff who have to monitor the medications of our residents in long-term care to make sure that if they’ve lost 30 pounds, someone is taking a look at their medications to make adjustments.

It’s the registered staff who look after our diabetics, to do the glucometer checks, to make sure of their insulin doses. Those are big responsibilities of the registered staff, and you have to remember that there are more than 100 residents in some of our buildings, and sometimes we have registered staff responsible for 40, 50, 60 residents. If it weren’t for the CCAs, it’s true we wouldn’t survive. However, the CCAs are very good at what they do, but there are a lot of things that they’re just not educated to do, and they need the registered staff.

Also, the introduction of the Resident Assessment Instrument is another positive step forward that the Nova Scotia Nurses’ Union has long called for, but without an increase in clinical staff to support it, the initiative risks becoming more of a burden than a benefit. The data potential for the interRAI tool is a valuable addition to assist in our ability to plan for the needs of long-term care residents. We’ve asked for this tool. My understanding is that it’s in some facilities but not others. It needs to be in all facilities. We need to be able to use that data to make sure we make good decisions going forward for the residents within our care.

With more nurses in long-term care, there is the potential to explore innumerable innovations to enhance the quality of care. More nurses could mean the expansion of registered nurses prescribing in long-term care - an initiative that would prevent unnecessary transfers to our hospital. This would not only be better for residents themselves, but would also free up paramedics and emergency room staff.

We have introduced prescribing registered nurses in this province, but for now, it’s just in acute care. That needs to be expanded. As a matter of fact, my mother-in-law is in a home for special care, and she waited 13 hours to get an antibiotic in the local emergency for a urinary tract infection. An easy fix could be done if the RNs were able to prescribe, and/or if we better utilized NPs in long-term care.

[1:15 p.m.]

We need to expand that. We need to have NPs. They don’t need to be assigned to one long-term care facility - they could look after several. They could go to long-term care facility A today and B tomorrow. More importantly, the staff within those facilities would have someone that they could reach out to and get answers right away. They’re assigned to those facilities so that I could call up my nurse practitioner and say, Mrs. MacDonald looks like she has a UTI, she needs an antibiotic - and the NP would be able to do this.

These are just some of the few ways. We’re happy to participate in any conversations with anybody who will improve our long-term care. We are very lucky in Nova Scotia that we have such dedicated staff in long-term care. I can tell you that most registered nurses and licensed practical nurses must love what they do because there’s no shortage of jobs. They agree to stay there and look after our residents - and thank goodness for them, but they need help. They need help now.

We don’t want them leaving long-term care to go to work in acute care or into the community. We need to make their work life better. We need to make sure that when they leave after their shift, they can say: I did a good job for my residents today, I at least laid my hands on them today, whether I did an assessment or not. They need to be able to say that.

Hopefully - and this is the last thing - this has to be baked into legislation. Whatever hours we have needs to be baked into the Homes for Special Care Act so that future governments can’t change their minds when they need to save money. If it’s in legislation and you want to change it to reduce it, you can be sure there’ll be an outcry. We need to introduce this in the Spring sitting. We’ve asked for this over and over again. It needs to happen. It needs to be increased, but it also needs to be in legislation.

That’s it for me. Thank you.

THE CHAIR: Thank you, Ms. Hazelton. ADM Beaton.

CRAIG BEATON: Thank you, good afternoon. I’ll also try to keep my comments brief. Before I begin, I just want to thank you, Mr. Chair, and the committee for allowing us to be here today to join you.

As I said earlier, my name is Craig Beaton. I’m the Associate Deputy Minister at the Department of Health and Wellness, and co-lead responsible for the Office of Healthcare Professionals Recruitment with Dr. Nicole Boutilier. I’m pleased to be joined by the many witnesses here today to speak about the delivery of 4.1 hours of care, and in particular, how our office is supporting that.

The office continually works with communities, key partners and stakeholders within and outside government to understand what is working and where the gaps and challenges are, and how to seize on those opportunities to boost the recruitment and retention of health care professionals in our long-term care facilities. As a government with our partners, we need to be collaboratively working to ensure there’s a steady workforce in place to deliver the care and support required in the many long-term care facilities in the province.

There’s no doubt there are staffing shortages across the health care sector, but we’re not remaining complacent. We are taking action. I’m sure you’re all aware, as we have an Action for Health plan. The office plays an integral role in Solution No. 1, which is to become a magnet for health providers. It’s our job to work with and support our partners to fill those positions to ensure Nova Scotians have access to the care they need, when and where they need it.

The health care worker shortage is not something that we are only experiencing here in Nova Scotia - it’s across the country. We hear that from our federal colleagues, and our other provincial colleagues. We need to be innovative, and we need to be competitive. We also need to increase the production of health care workers, while also recruiting qualified health care workers from around the world to our beautiful province.

Another key component to ensure the delivery of the 4.1 hours of care in long term care facilities is ensuring that we have licensed practical nurses and registered nurses. We are investing to add 80 additional Bachelor of Science in Nursing seats, as well as 120 licensed practical nursing seats. This investment will allow for more nurses to enter the workforce and strengthen the system that’s there.

I’d like to take a moment to speak about another recruitment opportunity. This is an effort in which my colleague Suzanne Ley - who is Senior Executive Director for the office and is here with me today - took part in last Fall. She helped lead a recruitment trip to a refugee camp in Kenya. From that trip, 65 CCAs received conditional job offers. They are being matched with employers now and we anticipate their arrival as soon as Summer.

This program gives these 65 people a safe and welcoming place to call home, an opportunity to use the skills they have, and at the same time provides a much-needed workforce and enriches our communities. We are actively engaged in planning additional recruitment missions this year because we know there are many qualified health care professionals across the globe who are willing to relocate for employment opportunities or various reasons - and we are digging deep to try to find them.

I thank you for your time today and look forward to answering your questions and taking part in this discussion.

THE CHAIR: Deputy Minister LaFleche.

PAUL LAFLECHE: I want to apologize. I have an eye infection, and I’m hoping the cameras were on that side, because if it’s shown on the six o’clock news, I don’t want to have children and so on disgusted. (Laughter)

ADM Barbrick has been introduced. Janet Lynn Huntington is behind me, as well as Michelle MacDonald, who replaces Katelyn Randell, who is apparently having as much fun as me today.

I’m pleased to be here today with our partners. I want to acknowledge and thank both the NSNU and CUPE for their continued advocacy in the continuing care system, and the many suggestions they have brought forward to improve this system for both Nova Scotians receiving this care and for the people who work in the sector. I also want to take a moment to talk about the hard-working, compassionate people who work in continuing care. They are, in fact, the heart of the system, and we are extremely grateful for all they do.

Too many Nova Scotians are waiting to get into long-term care, and this demand is only expected to grow. This places a strain on people waiting for placement, their families, and also the health care system. The continuing care system has been underfunded for many years. Our department was created in August 2021 when the government changed with a mandate of ensuring Nova Scotians live with dignity, and get the care and support they need as they age.

As a department, we hit the ground running and took immediate steps to address long-standing issues facing the sector. Since then, our focus has been on supporting staff in the sector, building the workforce, building capacity in long-term care, and providing the support seniors need to live in their homes longer. A big piece of this is improving the quality of care. We’re doing this by setting a standard of care which will see nursing home residents receive an average of 4.1 hours of direct care each day. This will ensure all Nova Scotians living in our facilities receive the same high-quality care, regardless of where they live.

Government has listened to the facility operators and the staff. My colleagues hear from organized labour, residents, and the families we serve, and made this level of funding a priority. We’re not doing this alone. This is a collective effort involving all partners in the continuing care sector. To do this, we need to build the workforce so that facilities have the staff to deliver this level of care.

Government has made strategic investments to hire and train staff, and support people working in the sector. These investments include: free tuition and books for 2,000 continuing care assistants; a targeted investment in continuing care assistant wages to address a specific shortage in that area; investing in workplace safety initiatives, such as a new Home Lift Program for home care providers, and the Employee and Family Assistance Program; recruiting nationally and internationally, as ADM Beaton mentioned; and investing in quality initiatives such as wound care, and prevention and management of infectious diseases.

Government is also building and improving more long-term care rooms, investing in home care, and better tailoring supports to meet individual needs. While there is much more work to do, we’re seeing positive results. Efforts to establish the 4.1 standard are well under way. Some facilities have already reached 4.1 hours of care per person. Most facilities are on the cusp of implementing it, and we continue to work with other facilities to support them as they prepare to meet this goal. With this investment, Nova Scotia is one of the first provinces in Canada to set this standard of care.

Our department is working closely with the sector to recruit and retain the staff needed, making continuing care a great place to work, and ensuring seniors receive the best possible care. We know that there is more work to do, but by working all together - all of us here in this front row - we can achieve this.

We look forward to answering your questions. Thank you. I may have to excuse myself from time to time to take medications, but ADM Barbrick will be here.

THE CHAIR: Thank you, deputy minister, and thank you to all the witnesses. I believe everyone here has been at committee before, but if you’ve forgotten the way this committee works, it is two rounds of questioning. The first round is 20 minutes per caucus. The second round is under 10 minutes; it will be determined by how much time we have left. We need to wrap up by about 2:45 p.m. or so. Please wait until you get recognized and the red light on your microphone turns on before you begin responding to the question.

That being said, we’re going to turn to the Liberal caucus. MLA DiCostanzo will begin the questioning. It is 1:26 p.m.

RAFAH DICOSTANZO: Thank you for your opening remarks. I think I’m going to start with some questions to Ms. Hazelton, the president of the NSNU. We know that there is a shortage of nurses across the province. Can you explain to us how this is impacting long-term care? We know with the announcement that there are 30 out of 90 that have achieved the 4.1. Maybe you can explain to the committee here why those 30 were able to achieve it, and they’re working on another 30. Maybe some timelines - when do we expect this? What do you expect to happen to achieve the 4.1 at all 90 long-term care centres?

JANET HAZELTON: It’s certainly going to be a challenge because we have upwards of 1,200 registered nurse vacancies within the acute care system. Attracting nurses to work in long-term care, what we’re going to have to do is make it attractive. By making it attractive, we want to make sure that they’re able to achieve a work-life balance, and they’re able to have the help and support they need by increasing staffing. But it is going to be a challenge.

Some of the places are able to achieve it, depending on location - so in some of our smaller rural communities, the same options are not available to nurses. For example, in Inverness, there might be one hospital - there is one hospital - and so long-term care facility is an option if you want to stay. So some of our rural communities are best able to achieve their nursing complement. Luckily, there are a lot of nurses who want to do that. They want to work in long-term care, they want to work with seniors - because it’s in their homes. It’s a whole different nursing. It is not like acute care nursing at all. They develop very long-lasting relationships with their folks. They know them, they’re family, and they know they’re family. That is attractive to some nurses. Like everywhere, there’s going to be a challenge to recruit nurses to work in any of our sectors.

RAFAH DICOSTANZO: Thank you, but are there any timelines that you can offer us here of your expectations to achieve that? Also, I’ve heard that there are empty beds that in long-term care because we don’t have staff. There are people on waiting lists, but there are beds empty. What can we do when it comes to that? Maybe that’s something that other members can reply to as well.

JANET HAZELTON: The beds are empty because there’s no staff. We can’t fill beds if we don’t have staff to look after the residents. We just can’t do it. Most days, they’re working short as it is. The timelines, I think, would be better answered by someone else because I’m not sure how long it’s going to take. I don’t know how long they’ve been working on it. I’m not sure of the timelines.

RAFAH DICOSTANZO: Maybe we can ask the deputy minister to answer that one. Maybe give us numbers of how many beds are empty at the moment, and how long do you expect them to be empty?

TRACEY BARBRICK: Thanks for the question. Things are in really good shape in terms of closed beds. This time about a year ago, we had about 500 beds closed in the system due to a combination of staffing, outbreaks, other reasons. We’ve only got seven beds closed due to staffing right now. That’s as a result of multiple initiatives. I think the wage increase certainly has helped, the 4.1 has helped - it allows more people to be on the floor.

The announcement of 4.1 equalled about 550 new staff in the system. About 70 per cent of our nursing homes have demonstrated that they’re ready to fill the positions, and we’ve actually advanced the money to move to 4.1. Fifty per cent of them have actually achieved it. So of that 550 staff who were part of the 4.1 announcement, 400 of them have been hired. Certainly, there were a lot of beds closed - a combination of COVID, wages, all of the other things - but it’s moving in the right direction, I’m pleased to report.

THE CHAIR: MLA DiCostanzo.

RAFAH DICOSTANZO: My second question is to the department. What consultations are in process right now with the private long-term care facilities? Are they going to receive the 4.1? Is that going to be applied to all long-term care - private and public?

[1:30 p.m.]

PAUL LAFLECHE: When you say the department, do you mean that department or this department?

RAFAH DICOSTANZO: Whoever can answer the question.

PAUL LAFLECHE: I think ADM Barbrick is best placed.

TRACEY BARBRICK: Sure. When we talk about private, I’m going to break it down in the following way, because I think it’s sort of a mystery in a lot of cases. We have licensed nursing homes, and within that bundle, there are for-profit and not-for-profit nursing homes. Then there’s this other sector of assisted living that people would pay to live in - some accommodation rates, and maybe a bit of support for care, housekeeping, dietary, some of those things.

I think you mean the assisted living facilities that are not licensed or funded by the Province. Is that what you mean?

RAFAH DICOSTANZO: Yes.

TRACEY BARBRICK: Right now, we have no licences for that segment of the population. So if there is a concern in one of those facilities - it’s not a nursing home - calls come into our Adult Protection Services line and we follow up to ensure that there’s adequate care. But we don’t actually set any standards for those private assisted living facilities that aren’t licensed nursing homes under the Province.

THE CHAIR: If I can just remind everyone to please make sure to wait until the light is on and make sure that everything is captured on Legislative TV and in Hansard. MLA DiCostanzo.

RAFAH DICOSTANZO: My concern is that there is no oversight over the private sector. I have a constituent who came to me in his eighties. His wife, who had dementia, passed away. He’s still living with the guilt that there was an incident where somebody pushed her. She ended up with a concussion. No reporting. No one is watching over the private sector. What do we have as government to monitor - some kind of reporting of these incidents? Who is monitoring the private sector? We saw what happened with COVID in Montreal and in Toronto. Who is looking after the private sector for incident reporting, and for standards as well?

THE CHAIR: Deputy Minister LaFleche.

PAUL LAFLECHE: Just give me one minute to confer. ADM Barbrick will speak.

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: I want to keep going back to that point around a licensed nursing home for the Province versus an independent assisted living facility. I have the financial means to pay $6,000 a month to go live in a Berkeley, for instance, and that pays for accommodation and maybe a couple of hours of support in the run of a month. So there are our licensed nursing homes, for whom there is for-profit and not-for-profit operators. Shannex, for instance, operates both some licensed nursing homes and some independent assisted living facilities that don’t provide 24/7 nursing care.

I think if we’re going to the assisted living facilities that are completely independent and unlicensed by the Province - right now, they’re an independent business. It’s a consumer-based approach to that business, and so the Better Business Bureau licensing sides of things would apply. The government does not provide oversight to those facilities. However, if under the Adult Protection Act there was a concern around the care and safety of a senior - just like if they lived at home in their own house - our adult protection team would follow up if there was a complaint about their safety.

RAFAH DICOSTANZO: My concern was actually at a licensed long-term care facility. These incidents are happening, and they’re not being reported. The private sector will not report it because it will not. I think government needs to keep an eye on what is happening, and it’s happening all over the country as well.

I’ll move on to the next question quickly, before I lose my time. I’m excited to hear more about the immigration, the newcomers and the refugees we are bringing from Kenya, but who is looking after their housing? When they arrive here, how are they treated? Are they treated as a landed immigrant? Are they on their own looking for housing? Can somebody help me out with that one?

THE CHAIR: ADM Beaton.

CRAIG BEATON: There are a number of supports. We work with a number of partners to potentially look at that. We’re working with not only the Department of Seniors and Long-term Care, but also the Health Association Nova Scotia, as well as the providers. The example that I would have given around the Kenya trip, one of the providers was with us, MacLeod Group. They are actually looking at sourcing housing for a number of the employees in those communities. We also have partnerships with the Immigrant Services Association of Nova Scotia and other community organizations.

One of the other things that we also have is the Office of Healthcare Professionals Recruitment Community Fund, which is providing funding to 28 organizations across the province for recruitment and retention. That is intended to create the conditions - because we know retention is a big issue in communities. An example I would give is that we’re recruiting people from other parts of the world. They’re going into rural Nova Scotia. Simple things like making sure that if they have dietary needs like halal food, as an example, that it is accessible within their communities. It’s working with communities to ensure that. It’s not just one individual who’s responsible. I’d say it’s a multitude. As MLAs, you guys are ambassadors as well and can certainly help support that.

THE CHAIR: MLA Maguire.

HON. BRENDAN MAGUIRE: My question to the department is: How many CCAs and long-term care workers are currently off on full-time long-term disability as of right now?

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: We have 140 independent operators in the province that are independent employers, so while they don’t report specific injury rates to us, they do to the Workers’ Compensation Board of Nova Scotia. As you probably have seen over the last couple of years, we’ve done a lot of investments in a number of things, both in home care and in long-term care, to support safety. WCB will be releasing some numbers later this week around injury rates in both home care and long-term care, and there has been some significant reduction.

In long-term care, we’ve got about 15 per cent reduction in injury rates, and 8 per cent in home care. With the investments that we’ve made in recent years and the 4.1, which means additional staff on the floor, we are seeing injury rates start to decline.

BRENDAN MAGUIRE: It’s actually 407 CCAs who are out on long-term disability, and that’s from AWARE-NS, whom we met with, who work with the Workers’ Compensation Board. It’s actually not declining. That was what we were told from AWARE-NS. I met with them personally. It’s actually spiking, and 407 CCAs out is a huge impact on the system, is it not? We’re struggling to get people to work, yet there are 407 of them out.

We talk about retention and bringing people into this province. We need to start talking about retention and keeping people who have given their heart and soul, their hips, their knees, their back to this profession and figure out why the heck they’re injured and why the heck they’re out on long-term. Four hundred and seven is an awful lot of people to be out.

I’ve spoken to some of these people personally. They have never had the department reach out to them to ask them why, what happened, what caused this? I think that’s something we should be doing. While WCB is great, it’s also very complicated, and it can be very hard to deal with. We deal with WCB all the time. I think it should be on the department to figure out why they have such a high number of people out in this profession - because word gets around.

When a young person comes into the profession and they see some of the people who have been around for a long time and they feel beat-down or they feel tired, we’re seeing a lot of people come in and then quickly getting out of the profession.

This is to Ms. Hazelton. I’ve been meeting with a lot of nurses and friends of mine who have actually reached out to me who were full-time nurses for a long time, and now they’re going part-time. That has a massive impact on the health care system. These are young people. These aren’t people in their - sorry - 60s and 70s. These are people in their 20s, 30s and 40s. I recently met a friend who’s been doing it for 10 years. She said: I’m done, I’m going part time, and I’ll never go full time again. Why is this happening? Why are we seeing more full-time nurses than - I would argue - ever before going part time, and what’s the impact that it’s actually having on the system? I mean, it’s bad retention.

JANET HAZELTON: It’s true, nurses are going part time. They’re going part time or leaving the profession altogether, or going to travel nursing because they need the work-life balance. I met with administration and nurses in one of our emergency departments - I know it’s not long-term care, but they haven’t had a vacation day in five months, and the employer told them: and you’re not getting one for another four. So they’re saying, well, I’ve got to do something. That’s not even talking about the overtime they’re working. They’re called in, they’re staying late, they’re working 24-hour shifts. We have to fix the work-life balance.

We have to figure it out because nurses have a lot of options, and they’re just saying, I’m out. It’s not okay for me not to see my family, or not to be able to go on a vacation. That’s not okay. I have options, and I’m going to exercise my options.

Even when they reduce to part time, they can still do full-time hours if they want, but it’s if they want - it’s not scheduled. What it’s doing to our full-time staff is not good. Our full-time staff are burning out quicker, and that’s why they’re opting to go part time. It’s because they’re burning out. They can’t do it. The overtime is through the roof. We have 24-hour shifts in this province in long-term care and acute care - 24 hours. You can’t work 24 hours. It’s not good. It’s not safe for anybody. So they’re saying, I’m not doing it.

BRENDAN MAGUIRE: We’re hearing that from CCAs, that they’re burnt out, they’re tired. I talked to one the other day who works overnight shifts - been doing it for 20 years. There are two of them on the floor - and it’s supposed to be more than two. People are calling in sick and they don’t have a work-life balance. Guess what happens when one of those people goes to lunch? She’s left all by herself. Do your members - and I know it’s not on the union - have a work-life balance?

NAN MCFADGEN: I think that depending on what part of the province they’re working in, it would depend on what kind of work-life balance they get to have. We do see larger amount of people going to part time. Our workforce is aging - further to that 60 comment. (Laughter) There was a time when you could work as a CCA until you were 65, but the acuity of care, the needs, working short, all of the perfect storm of the situation - we’re just not there anymore.

I would even suggest that your 407 number - it’s probably even larger than you have there in your information because many, many nursing homes don’t have long term disability. LTD is something that a lot of private homes won’t have. It’s a costly benefit for employers to provide, so it’s more rare than not. So unless you’re injured and you can prove it at work, as opposed to your body’s worn out, it’s very difficult to get WCB. You need to break your body to get WCB. LTD is more if you’re worn out and your body can’t do it anymore. You can get the LTD, but you need access to LTD first. As a union, it’s very difficult to bargain LTD into a sector that if it doesn’t break you, it wears you out.

BRENDAN MAGUIRE: To Mr. Beaton quickly: We heard today from Ms. Hazelton and Ms. McFadgen that they want 4.1 baked into legislation. Does your department have legislation ready to go for the Spring session that bakes 4.1 hours into law?

CRAIG BEATON: I would pass that over to the Department of Seniors and Long-term Care.

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: Certainly, the minister’s mandate letter has referenced the intent to include the 4.1 in legislation. In terms of the timing of legislation, that will be up to the government’s mandate.

BRENDAN MAGUIRE: While I appreciate it’s up to government to decide, it does have an adverse effect the longer we wait. Have you personally worked on the legislation, or anyone in the department personally worked on the legislation or a draft of the legislation?

TRACEY BARBRICK: I just want to point out that 70 per cent of the facilities have identified that they have their beds all open, they’re at a full complement of staff, and they’re ready to upscale to the 4.1. They’ve received their funding. So legislation or not, 70 per cent of the facilities have the funding - 50 per cent of them are at 4.1. We continue to work with each of those facilities that aren’t there yet to achieve that level.

[1:45 p.m.]

THE CHAIR: Order, please. I apologize. I don’t mean to be rude - 20 minutes is 20 minutes. I will respectfully request from MLA Maguire the statistics he cited - the 407. I’d appreciate it if you could table that for the committee, please and thank you.

We’ll now move to the NDP. MLA Burrill.

GARY BURRILL: I’d like to go back, Ms. McFadgen, to the point you opened with - that the 4.1 that has been called for by CUPE and the Nurses’ Union and others all through these years is not the same as the 4.1 that is being implemented at the moment, if I understood you correctly.

Just to be clear, could you speak - and perhaps, Ms. Hazelton, you could comment on this as well - to what some of the differences are for residents in this sector and differences for staff working in the sector that we could see if the 4.1, as you define it, were being brought into place, which we are not going to see as it’s being implemented?

NAN MCFADGEN: Before COVID - that seems to be our world now - CUPE carried out a social experiment at a nursing home. Our members came in and volunteered at 4.1 hours of care. I’ll share with you what I think. While it’s a philosophical difference, it’s a very meaningful and a very real difference. What one of the CCAs said to us, after that 24-hour period of 4.1 hands-on care staffing, was that it was the first shift they’d worked in years that they didn’t cry before they went home.

When you’re talking about retention and 4.1 - I think it was Brendan who brought it up - if you have an appropriate level of staffing, when you’re looking at your day as a caregiver and you’re thinking to yourself, what exactly have I done with my day. Maybe you’ll feel the same way about your day. When you go home today, you’re going to ask yourself, did anything meaningful happen in my day? Did I do anything that was worth getting up in the morning and coming to work for? Well, continuing care assistants who work throughout long-term care are no different.

When you are chronically working in an understaffed facility or a facility that’s just not staffed properly or with enough people, then at the end of each day you’re going home and you’re feeling a little bit more like a failure. Of course, you’re not a failure. I mean, that’s not my message. My message is that the work that they went to do there in the morning - well, they came out at the end of the day and they hadn’t done it, right? When someone’s waiting half an hour to go to the washroom, how does anybody feel good about that? If you sat here now and said to yourself, I’d like to go to the washroom, and I said, the timer’s on and you can go in 30 minutes, there’d be no joy in your day.

These are the kinds of impacts that continuing care assistants have. Maybe you’re lying in bed waiting to get up for breakfast. Maybe you’re 80 and you’ve laid there waiting two hours for your breakfast, and your entire life you were up at 6:00 a.m. for breakfast. I don’t recommend that, but maybe you were up at 6:00 a.m. for breakfast. Now, because you’re in care, you’re lucky if you’re up by 10:00 a.m.

Most of us get a shower every day. I shower every day. Residents get a shower or a bath once a week. Is anybody going to die from only having one shower a week? Probably not. However, when you think about yourself - those of us who may be 60 or over are closer to a nursing home than we might like to think about - that I’m going to wait until 10 o’clock for my breakfast, I’m going to get one shower a week. That is actually staffing at the ratio that we now have in Nova Scotia, which is three hours of hands-on care per day.

The difference for us, 4.1 - one of the comments, as I said, was that she didn’t cry when she went home. If I could go to work and not cry going home, that goes a long way towards me showing up tomorrow. It goes a long way to me not being stressed, it goes a long way to me going for coffee with a friend and saying, oh my gosh, I have this amazing job in long-term care, I’m a continuing care assistant - I’m well paid and I get vacation, I have a pension, go figure. I have all these amazing things. If I’m saying that because when I go home from work I’m not crying at the end of my shift, then that’s more than half of your recruitment and retention battle.

People will look at the sector - I look at the long-term care sector with pride, with the work that they do. Of course, I come from that sector, so I’ll concede to being biased, but the work that they do is amazing. The work that they do without enough people, without enough hands, it’s amazing. My own mother was in long-term care and received beautiful care from beautiful workers, and they did it without enough.

I look at the 4.1 and I think to myself, someone did a study somewhere 15 years ago and said, 4.1 hours of hands-on care would be a beautiful thing. Here we are in Nova Scotia, 15 years later, and we have three hours of hands-on care. I may have mentioned earlier that we’re happy about it, but really, is it about us being happy about it? It’s really not. It’s about the quality of care. Earlier, I did say 33 minutes and I misspoke, because I typed my notes so small I can’t really see them well. It’s a problem, but there you go.

It’s actually 24 minutes of care that we’ve increased, so 24 minutes of care in a 24-hour period. We’re not getting to the end result of 4.1 hours of hands-on care with that. That’s the difference for us: the quality of care, the quality of work, the quality of work-life balance, the vacation thing that Janet talked about, that’s not different for CCAs.

When I talk to facilities, one of my questions usually in the Summer months is: Were you able to give everybody a vacation this year? Once in the very bluest of moons I’ll hear from an administrator, and they’ll say, yes we were. It’s a very rare thing. We should not be sitting here thinking it’s a very rare thing to get vacation. I get vacation. I’m feeling confident that the people around the table have vacation. I think we need to want that also for hands-on caregivers.

GARY BURRILL: I was wondering if Ms. Hazelton might like to comment on the difference between the 4.1 that had been called for and the 4.1 that’s being implemented.

THE CHAIR: Ms. Hazelton.

JANET HAZELTON: So 1.1 is what licensed care was increased to. We asked for 1.3 15 years ago. We also have to know that long-term care doesn’t have the luxuries of acute care in many incidences, like overtime. It’s very rare overtime will be authorized because they’re funded differently. I don’t know, but most of my nurses will say, if someone calls in sick, that’s it - they work short. As a matter of fact, they work one CCA short. They have to have two CCAs short before they can even think about overtime. That’s what I’m told. Whether it’s true or not, that’s what they’re being told.

They don’t have any of the extra supports that we have in acute care like physios, OTs, infection control. Some have them, but most don’t. All those tasks land on the registered staff like the infection controls. If there’s an incident in the home where somebody hits someone, that takes up three or four hours of paperwork - again, licensed staff. We need more licensed staff. We need it.

That 4.1 is great. Like Nan said, we’re saying it’s great, but it’s not enough because if someone calls in sick, it’s not like acute care. If someone calls in sick, they can pay the moon and back in overtime, and they do. That doesn’t happen in long-term care; they’re not replaced. This government and others have done a really good job of keeping people in their homes, but as a result of that, when they come to long-term care, they need a lot of care. If not, they’d be in their home. With the assistance they can get now, it’s good. My mom is 95 and in her home because she gets some assistance, and my family get help, but if that was taken away, she’d need a lot of care in a long-term care facility.

We need to look at what’s in our long-term care now. Many can’t ambulate. None of them can look after their own personal hygiene, for the most part - and it is one bath a week, regardless. We don’t treat our children at the IWK Health Centre this way, so I’m not sure why our seniors don’t get the same kind of treatment.

And sharing a room? Although efforts have been made, but having a neighbour in one bedroom? You’ve been living alone or with your spouse your whole life, and now you’re with this stranger who you may or may not get along with, who may or may not be yelling half the time. We wouldn’t do that. When we go away on union things, we all get our own hotel room when we could probably share a room. We wouldn’t ask that of our members, but we think it’s cool that our seniors can be in rooms with other people they’ve never known. It’s awful.

We need to improve the system because, like Nan said, we’re all going to be there. I personally don’t want to share a room with anyone. I don’t want to. I might have the means to pay someone to go into - I don’t know. It’s just sad. We’ve been talking about this since I’ve been president, and that wasn’t yesterday. We have an opportunity; we just got a bunch of federal funds. We should use some of those federal funds to improve our long-term care, not just our acute care. The acute care, they have their problems, but I think long-term care is worse in some ways.

GARY BURRILL: I’d like to ask you both about the national standards document that came out a couple of weeks ago. This has really framed the discussion about improvements in long-term care nationally in a new and exciting way. There have been calls for those national standards to be implemented in provincial legislation. I wonder what your two opinions are about those calls. Is that something that would be helpful for the sector?

JANET HAZELTON: I think it would be awesome, but those standards are like a yellow light - maybe, sort of. It’s just a recommendation, like you can stop or not. Those are excellent standards, but like everything, they’re not going to be worth the paper they’re written on unless provincial governments put them in the legislation. We are strongly advocating for that to happen, but we’re not very optimistic because many of those recommendations are wonderful, but we all know they’re expensive.

People need to make a decision in this province. We’re either going to invest in long-term care or we’re not, and if we can live with not, then let’s live with it. Let’s tell our seniors that this is your life, this is it, but stop telling them and their families that we’re going to improve it and then not do it. I think the standards are a great thing. I think they should be adopted in every province.

NAN MCFADGEN: I would agree that the federal standards would be awesome because they do call for 4.1 hours of direct care which we’re still working on here in Nova Scotia. CUPE, federally or nationally, did participate in those queries that formed the federal standards. It’s a more receptive space for CUPE, federally, for us to have a voice. We did participate at multiple levels with that, and I do think that the federal standards would be a beautiful thing.

I agree with Janet - don’t let it go to your head. (Laughter) I agree that to set a federal - the recommendations, that’s just government speak. It’s weak. I think that we either need to decide that the residents who live in care and the people who care for them are worth the investment, or they’re not. If you go with not, well, I’m not going to be okay with that. I’m probably going to lose my mind.

But if you decide to make the investment - it truly is about decisions because not that long ago, a decision was made by this government to raise the wages of continuing care assistants outside of bargaining. All that took was the will of the government to do it. Government woke up one day and said, I think we’re going to be doing this - and then they did it. Granted, I have other thoughts on that and all the unintended consequences about the decisions like those make. Just the same, I think the recommendations are not going to work, and I don’t think they’re going to work for any province across the country. Nova Scotia’s not alone.

[2:00 p.m.]

GARY BURRILL: In Nova Scotia, when the recommendations of the standards were introduced and our minister of Seniors and Long-term Care was asked about it, she made the comment that in Nova Scotia it’s not as relevant because we’re really ahead of those standards, we’ve moved beyond them already. Does this accord with either of your experience of life in the sector?

JANET HAZELTON: If that’s the case, then put them in legislation. Perfect. Problem solved. I don’t believe it is.

NAN MCFADGEN: Yes, I would agree because I just finished saying that in the federal standards, it says 4.1 hours of direct care, and we have 3.0 hours of direct care. So we’re not the same there. I didn’t do a side-by-side comparison, but we’re not there. We’re pretty pleased with these standards because, of course, we had a voice in them. We’re proud of that voice, so that also makes a difference, right? Like Janet - this is twice I’m agreeing with her - I think that if we’re already there, just write it down because we’re done like dinner. We can all go home.

GARY BURRILL: I’d like to go back to the comment, Ms. McFadgen, you made a few moments ago about the CCA wage increase. I think everybody was happy when that happened, but we also recognize there are a lot of people who work as part of the care team - dietary, laundry, and lots of other places - who were not included in that. Your union represents many of them. Can you speak about some of those unintended consequences - I think you called them - in the sector, and what kind of effect that’s having on morale and retention?

NAN MCFADGEN: For those who have never sat at a bargaining table, bargaining tables generally have two sides, but in Nova Scotia, there’s the employer and the union, and then the government is somewhere in the closet. It was the same with every government. Not a disparaging remark - it’s just how it rolls in Nova Scotia. There’s mutual exchange of thoughts and ideas. We make proposals, the employer makes proposals, and in the end at an amazing session of bargaining, we usually meet somewhere in the middle.

When government wakes up one morning and says, I think we’ll give the CCAs a raise, we briefly do a dance of joy because those are our members. A meaningful economic increase for a worker is a meaningful economic increase for a worker. It doesn’t matter what you say, that was a beautiful thing.

However, they work side-by-side with all those people I mentioned in my opening remarks: housekeeping, environmental workers, dietary workers. They all continue to make $16 an hour. Very often because of being short-staffed, environmental or housekeeping workers are helping with transfers, using mechanical lifts, assisting CCAs in doing that - so they’re side by side. Where a CCA just saw pretty near $25 an hour, they continue to make their $16 an hour. What happened was, while we briefly did our dance of joy, because it was a beautiful thing, we very quickly came to the realization that this workforce, that is very often a second-class citizen to acute care - and I can say that because it’s my sector - was divided.

You saw this one group get $25 an hour, and everybody was happy for them. Then everybody else who wasn’t a CCA, those people I listed, they could continue to live in poverty - we’re good with that. Had that been at bargaining and government said, we’re going to give CCAs $25 an hour, we would have said, woo-hoo, that’s great - however, if you do that, you will divide the workforce. You will create an environment where you have people living in poverty whose work is just as valuable to quality, activities, and daily living as the continuing care assistants.

Then you have licensed practical nurses: me. They now make $3 more than a continuing care assistant after two years of community college and having the responsibility very often of running a unit. They make $3 more. The unintended consequences were continuing care assistants were very pleased with the economic increase, as were we, but the people who continue to live in poverty or the people who have greater responsibility now making $3 more . . .

THE CHAIR: Order. Apologies again. I don’t mean to be rude. We will now turn our attention to the government caucus, beginning with MLA White.

JOHN WHITE: My question is to Associate Deputy Minister Beaton and Deputy Minister LaFleche. $39.8 million of the department’s investments were aimed to implement immediate CCA retention, such as tuition and tuition reimbursement. Has there since been an uptick in CCA program registration?

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: Yes, the investment was 2,000 free tuition seats for over two years. We have just celebrated our 1,000^th student entering the CCA program in this last fiscal, and we’ve got another 1,000 in the upcoming fiscal. We’re absolutely seeing the impact of those 2,000 students starting to make their way into the workforce, and with the 4.1 hours of care, which is a leader in the country. Except for the Yukon, Nova Scotia is the only province that has 4.1 hours of care per person in the country. That’s 550 additional, brand-new staff in the long-term care sector who were never there before. Those CCA students are desperately needed because we want to fill all those positions.

We’re building another 1,200 new beds in this province over the next four years, and we’ll need those students in those facilities as well.

JOHN WHITE: This is a great program, obviously. You praised yourself right there. Is there any strategy being used to make sure that these folks are going into areas where they’re most needed, such as rural communities?

TRACEY BARBRICK: One of the new methods of learning that was created in the last year is the Work and Learn CCA program, which means that the student is in the classroom three days a week and working in a long-term care facility under supervision two days a week. One of the great benefits of that program is we’re seeing that really pick up in the rural parts of Nova Scotia.

We’ve done a number of customized training programs in rural long-term care facilities across the province to bring people from the community - people who are looking to work in that sort of meaningful profession - into the program and do that work-and-learn model. We’re really seeing a big difference in rural communities with that particular model.

JOHN WHTIE: Earlier, you spoke about the progress being made with the 4.1 hours of care for residents. With respect to facilities that are preparing to do so, can you share a little bit more about what the department is doing to help reach that goal?

TRACEY BARBRICK: A combination of things. We’ve got our Nova Scotia Community College in-class program that we’ve traditionally always had, as well as this new specialized work-and-learn model. We have about 350 CCA seats in the Nova Scotia Community College and another 450 in that work-and-learn model. That really is showing a big impact in the community.

The stories that we’re hearing from the facilities - the 70 per cent of our nursing homes that are now moving towards the 4.1 because they have all their vacant positions filled - they’ve got all of their beds open. They’re meeting our placement standards in bringing new residents into the facility. They are really seeing a significant difference.

We were just speaking with an administrator at a facility the other day. They’ve brought on a whole new shift from 1:00 to 8:00. That’s a really important time of day. It’s helping with meals at dinnertime. It’s helping with bathing and personal care. That facility has brought on a whole new shift of people with this 4.1 hours of care.

JOHN WHITE: I’m going to pass it on to MLA Palmer for a second.

THE CHAIR: MLA Palmer.

CHRIS PALMER: Before I ask my first question, I’d just like to give a big shout-out to all those in the long-term care, continuing care sector. We’ve talked a lot about them this afternoon and we can’t stress enough the important work they do for our seniors - in places like Grand View Manor back in Berwick where I represent - and support staff in dietary and different places that support all the work that is given to seniors. I just want to give a shout-out to all them and ask them all to hang in there. They’re working under trying times. I’ll just stress that your work is very much appreciated. We’re discussing some of that here this afternoon.

One of the recommendations by the long-term care expert panel was a mandatory CCA registry. It’s been just about a year since that opened up here in Nova Scotia. My question would be to Associate Deputy Minister Beaton. Could you give us an update on how it’s supported your roles in what you’re doing, as well as your recruitment strategies? Or you might direct that to Associate Deputy Minister Barbrick.

THE CHAIR: I think it’s been diverted to ADM Barbrick.

TRACEY BARBRICK: The mandatory registry was announced about three years ago, but came into effect just last April. We’ve now got about 9,000 CCAs who have registered with that mandatory registry. CCAs don’t have a college like nurses have, so the CCA complement of workers in the province, what happens with our students after they graduate, and how long they stay in the sector has always been a bit of a black box. So the value of that mandatory registry is that it will actually allow us to do proper workforce planning for the CCA segment of our population that is critical in nursing homes. They are the backbone of our nursing homes in combination with the LPNs and the RNs who work there. They do provide the three hours per day per person for that formula of 4.1 hours a day. The 1.1 is LPNs and RNs.

It’s a critical workforce for us and the registry will really help us map our needs into the future. We’ve got our 1,200 net new beds. Right now, there are 8,000 beds in the province. There will be 9,200 coming with these new builds. We will need a new segment of the workforce that we haven’t had in the past and that mandatory registry will be critical to us.

CHIRS PALMER: This question may be for Associate Deputy Minister Beaton or Deputy Minister LaFleche. Could you share with us what efforts have been implemented to support those with health care experience having prior skills, like for the RPL program? Can you talk about those positions and those programs’ work in your work - how they’re being applied?

CRAIG BEATON: One of the initiatives we have under way with the Nova Scotia Health Authority is through their Interprofessional Practice and Learning team. The RPL program is one of those - really taking a complex look at individual skills when they arrive here in the province and determining what upskill and training is needed to be able to get them quickly into the workplace.

[2:15 p.m.]

We’ve certainly seen some great advancements with, for example, internationally educated nurses (IENs) - whether they’re LPNs or RNs - to sort of upscale and quickly put them through bridging programs. In addition, there’s a close connection with the licensing bodies as well with the Nova Scotia College of Nursing on supporting those initiatives.

CHRIS PALMER: This question is probably a little bit more of a conversation around workplace injuries and different things. Could you elaborate on what your department is doing, more nuts and bolts, to help staff who are already working reduce workplace injuries? More specific answers or more detail.

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: The 4.1 hours of care alone is a huge safety initiative. When you’ve got colleagues to help with either a lift or support of a resident in the facility, not being short-staffed on the floor, having the additional support within the facility is a huge safety initiative in itself.

On top of that, the announcement around all the facilities that we build in the future will be single-bedroom, single-bathroom. That too is a safety initiative. You’ve got less likelihood of transmission of communicable diseases. That will make a huge difference in the future. We have created and invested in new equipment for lifts, both at home and in the facilities. We have created an EFAP, an employee family assistance program, for the workers in the sector if the facility does not have its own EFAP. They were able to sign on to a provincial EFAP to support people to stay at work or return to work.

We have invested in additional wound care supports over the last few years, again from a safety perspective for both the resident and the worker, and what’s required of them to care for someone with a wound. We have invested in additional infectious disease control staff for the facilities, again, this past fiscal year, and we’ll continue to do that for the foreseeable future. Our long-term care assistant element that we brought in as part of COVID has continued to be funded to ensure there are additional staff for cleaning and transporting residents from place to place within the facility.

The other thing that we’ve recently done is the protected envelopes of funding, which ensures that money for staff is used for clinical staff on the floor, and that that is not reallocated for other purposes. All of those things are contributing to a safer workplace into the future.

THE CHAIR: MLA Palmer.

CHRIS PALMER: Just to confirm, it’s been mentioned by one of our colleagues that a report that was highlighted was talking about 407 absent workers. I think that same report might have been referencing 2021 numbers. Can you confirm that we are moving in the right direction for sure? We are definitely seeing progress.

TRACEY BARBRICK: There are two things that you measure as it relates to injuries in the workplace. One is the number of injuries; the second is the length of time lost from the workplace as a result. Those two numbers you see are the number of incidents, and the other is return. Where we’re seeing the improvement is the return to the workplace time shortening. We’ve seen significant improvement, both in long-term care and home care - 15 per cent and 8 per cent respectively - in reduction of length of stay on a workplace injury. That is both confirmation that the injuries are less significant, and that the supports to return to the workplace are working.

THE CHAIR: MLA Sheehy-Richard.

MELISSA SHEEHY-RICHARD: I find this conversation is a very important one, so again, thank you for being here to talk about the changes that are occurring. I want to go back to when we talked about how the Office of Healthcare Professionals Recruitment is dealing with more of the retention side - not just the CCAs, but in particular the CCAs. I know everyone is important, but could we elaborate a little bit more on how your role is interacting with the retention of CCAs?

THE CHAIR: ADM Beaton.

CRAIG BEATON: In terms of retention of CCAs, I would say we work closely with our colleagues in the Department of Seniors and Long-Term Care, who have predominantly - most CCAs would work in the sector that would support long-term care. I think some of it was outlined earlier. Deputy Minister LaFleche has already spoken about incentives, whether it’s around compensation - it certainly has been helpful. I think ADM Barbrick has talked about that in terms of filling a number of those seats with tuition relief and other pieces.

One of the key ones is definitely those wraparound community supports, and that’s why the office has been partnering quite extensively with a number of community partners. I mentioned the 28 organizations - we’ll be working closely with them. They filled out applications submitting their ideas, because really, communities are the ones that will tell us what will work in their communities in terms of keeping retention. That is a key one.

The Nova Scotia Federation of Municipalities recently hosted an event in the Fall, and invited the office to participate and have a table there. There was quite a bit of interest. Suzanne, who is behind me, was there to present on that. We had a number of follow-ups in working with those communities around building capacity within those communities.

It’s not just the office - there are other government entities that also support this type of work. I think of the Department of Communities, Culture, Tourism and Heritage, which is also key in terms of supporting welcoming communities.

MELISSA SHEEHY-RICHARD: I want to go into a little more detail about community organizations. I have been watching along in the press releases where communities are getting the funding to help. If you’re from a community that doesn’t necessarily have that in place - mine, for example - what kind of ways would the office look at the big picture, and see communities that maybe don’t have a community navigator?

Is it the Chamber of Commerce that you’re reaching out to? You just mentioned being at the Nova Scotia Federation of Municipalities earlier to discuss that. Do you guys look to see how you can facilitate community by putting the bug in their ear as well - how that can be so beneficial to the greater of the whole?

CRAIG BEATON: The quick answer on that would be yes. I could probably have Suzanne come forward and talk about it, but we’re certainly open. I would say some of the applications that came forward were actually reach-outs from community groups and the office working with them.

You don’t necessarily have to have a dedicated group with a mandate around building community capacity. It could be a Legion potentially, as an example, or a Rotary Club. It could be an ad hoc group of folks. I don’t want to speak completely about the guidelines, but we are willing to work with any community that expresses an interest and define need around how they can encourage retention in the community - whether that’s through funding resources or just through some conversations with the department.

MELISSA SHEEHY-RICHARD: I think that’s a really good piece because we’re getting the people to come. So we’re really building on the momentum and engaging in communities for the buy-in to make sure that if we recruit the professionals, we’re able to maintain them on a community level. It is something that is definitely on my agenda. My cousin is actually a recruiter and put the bug in my ear at a hockey game about how she’s finding that the role of the community navigators is really successful.

I don’t really have anything more on that. Since I’m subbing on this committee, I don’t know if my colleagues wanted to finish up with the time.

THE CHAIR: MLA Harrison.

LARRY HARRISON: My question would be for Mr. Beaton. Certainly, CCAs are absolutely central for long-term care, no question, but there are also pressures with the broader health system. How do the recruitment efforts for CCAs align with efforts for the rest of the system?

CRAIG BEATON: What I would say is that we’re actively recruiting across all professions in the health system, whether it’s CCAs, LPNs, NPs, RNs - MLAs. We’re looking for people who are interested in working with the system. We’re also looking at trying to build capacity as well with homegrown approaches. We’re working quite extensively with our colleagues at the Department of Advanced Education, Nova Scotia Community College, and the universities around how we can expedite training programs to have more professionals ready for practice sooner.

It’s a combination of a couple of things. It’s not just about recruitment, but it’s also about retention and in some cases it’s about redesign - thinking differently about how we work within the system and how people are utilized across the system. Scope of practice would be one of those, and enhancing and looking at broad scopes of practice. So when you’re talking about recruiting across the system, there are multiple areas. It’s not just necessarily about recruitment efforts.

From a recruitment perspective, we do know that about 30 per cent of our recruitment efforts last year came from international markets. So we do know that’s a significant area of focus for us. It’s typically easier to get people to stay and live here when they’re actually trained here, so the training aspect of that is really important.

LARRY HARRISON: How much more time, Mr. Chair?

THE CHAIR: One minute and five seconds.

LARRY HARRISON: You did say something about the infrastructure with the 65 coming in from Kenya. I know that’s always a concern - to put the infrastructure in place to allow more people to come in. Would you like to say a little more about what is being done for that infrastructure?

CRAIG BEATON: Sure. I would say that one of the things we’re excited about is actually a recent example from Deputy Minister LaFleche’s other portfolio, which is a significant investment in housing that will support health care. We’re still working out the details on that. Housing is obviously a key element to that, but it is the community supports.

One of the things I mentioned we’re doing is working with a number of community organizations to sort of build that capacity. The Kenya example is really interesting, but we also in 2022 had some interesting success in both Dubai and Singapore. I’m probably going to get the other one wrong, but . . .

THE CHAIR: Order. My apologies, ADM Beaton. That concludes the first round of questioning.

Looking at the fact that we’d like to be wrapped up with this section of the meeting by 2:45 p.m., we’re going to go with five minutes per caucus. That will allow a minute or two for wrapping up for closing remarks for the witnesses.

MLA DiCostanzo, with five minutes.

RAFAH DICOSTANZO: I have two questions, and I’m going to start with Ms. Hazelton. I want to thank her for all the information she provided today and for all the work that they’re doing.

Maybe you can highlight the travel nurses. Is that impacting long-term as much as acute care? What is the dollar value, and how many nurses are we losing in long-term care because of travel nurses?

JANET HAZELTON: Yes, it is impacting long-term care. We never used to have travel nurses in long-term care, and we do now, which I’ve expressed concern about. There are a lot less supports in long-term care. They don’t have other licensed staff to call upon or rely on. Often some of our residents have dementia, so they may or may not know who they are - like with medications. It puts it at higher risk if it’s a travel nurse, because the travel nurses aren’t part of the community. They don’t know the residents like regular staff would.

As far as how many, I’ve just recently been hearing about them in long-term care. The majority of them are in acute care, but where they are in long-term care, there are very significant safety concerns, because of the fact that they don’t know the residents. They don’t know the routines. It’s very upsetting to the residents to have someone they don’t know introduced into their world. It is their world. It’s their home.

I don’t know the exact numbers. I don’t pay them so I’m not sure how many are in the system, but they do make significantly more hourly rate than the regular staff. That creates a lot of problems as well.

RAFAH DICOSTANZO: Maybe we can put the question to the deputy minister to tell us about the numbers of how many we’re using in long-term care?

THE CHAIR: Absolutely we can. ADM Barbrick.

TRACEY BARBRICK: This workforce has been underinvested in for years. It has left us in a significant deficit of CCAs, LPNs, and RNs, to have what we need to run these systems. Travel nurses have absolutely been a necessity while we ensure that we’ve got beds open in the nursing homes in the province so that people who are waiting at home can get into a facility when their families are exhausted from holding it up at home.

We absolutely have just shy of a hundred travel nurses in the province right now. It’s been as low as 60, as high as 90. We use them as we need to keep the nursing home beds open and in operation. It was probably 16 months ago that we had 500 nursing home beds in the province closed. Travel nurses have been part of the strategy while we grow a proper workforce that meets the needs of the sector as a short-term plan. It’s not our long-term plan.

[2:30 p.m.]

RAFAH DICOSTANZO: Maybe the cost as well. You gave us a number, but also the cost, if you have that as well.

TRACEY BARBRICK: We have spent a little over $30 million on travel nurses in the sector.

RAFAH DICOSTANZO: In what period?

TRACEY BARBRICK: In about the last 18 months.

RAFAH DICOSTANZO: Thank you. That’s a high price that we’re paying.

I have one other question before the time lapses. I’ve heard that we have over 2,000 Nova Scotians waiting for a long-term care bed. Can you update us as well on how many are waiting in a bed in a facility and how many are from home? Either they’re in hospital or at home - maybe some numbers. Where are we, and what’s the future as well?

TRACEY BARBRICK: In our last quarterly report that was published online, we were at about 1,700 people on the wait-list for a long-term care bed. We have about 250 people who are in a hospital bed waiting for a nursing home bed, which has been the importance of some of these travel nurses while we grow a proper workforce and build some additional beds.

The positive news is that about 73 per cent of the people on a wait-list for long-term care have home care right now, either in the form of our agencies that provide home care or direct benefits where we provide funding and they purchase the services that they need.

THE CHAIR: The time for the Liberals has elapsed. We’ll move now to the NDP - MLA Leblanc.

SUSAN LEBLANC: I just want to pick up on a little bit of this travel nurse discussion. We have paid $30 million over 18 months to bring in travel nurses to satisfy some of our vacancies and to keep beds open, but we also know that we’re losing nurses to go do travel nursing elsewhere. It doesn’t make much sense.

Ms. Hazelton, this is for you. The last time you were at a legislative committee, you spoke about the idea of a travel nurse program for Nova Scotia. Do you know if there’s been any movement on this?

JANET HAZELTON: We’re in bargaining. We’re starting our bargaining process at the end of February, and that will be a target. It was successful in Newfoundland and Labrador. They have their own travel nurses who are from Newfoundland who travel to Labrador, and they make a higher hourly rate than the other Newfoundland nurses. It certainly has worked in some other provinces, so it will be something we intend to discuss in bargaining.

SUSAN LEBLANC: Earlier in the conversation, we talked about how one of the reasons why nurses and LPNs and CCAs are leaving their jobs is because they can’t figure out a work/life balance, for all of the reasons we’ve already talked about.

In a nutshell, if that’s possible, what does the government need to be doing to, as the union recently put it, “. . . address the staggering nurse vacancy rate and urgent and untenable pressures on nurses?”

JANET HAZELTON: Well, as I said, we’re going into bargaining. We need to do something around retention. There are lots of recruitment incentives, but we need to do something about retention. If I’m a 10-year nurse, what’s keeping me here? If I can’t get vacation, what are we going to do about that?

Money isn’t the answer to everything, but money is the answer to some things. I think this round of bargaining is going to be very important for nursing. We need to make sure that our Nova Scotia nurses are wanting to stay, live, and work in this province. Having no solution is not a solution. We can’t keep spending millions and millions of dollars - and that $30 million is in long-term care. Can you imagine how much they spent in acute care?

If they’re spending it anyway, we have to figure out a way to spend it more appropriately within our own province.

SUSAN LEBLANC: Nursing overtime at the Nova Scotia Health Authority has exploded in the last year or so. You did mention that there’s not a lot of overtime in long-term care because it’s difficult to fund or difficult to get, but can you give us a picture? Are there times when there is overtime in long-term care? What does it look like in long-term care in general, and then how would that compare to acute care? What is the impact on the residents?

JANET HAZELTON: Rarely is overtime worked in long-term care. Very, very rarely. I have a board member who works in long-term care, so she reports on it regularly. Overtime is extraordinary to authorize, especially for licensed staff. It has to be authorized, and they never get the authorization. What it means is that somebody somewhere is on the end of a phone taking calls for that home if they can’t get a licensed staff to replace. It’s not good.

In acute care, there’s just no question. Someone calls in sick, you just call in overtime. It’s not even up for discussion - it’s never no. In long-term care, it most often is no. I don’t know the funding formula for long-term care, I don’t pretend to know, but I’m told - and it may not be true - that they’re not funded. They’re funded for a full-time position with the vacations, but they’re not funded for overtime.

If they’re not funded for it, they’re not paying it, they’re not doing it. That’s what I’m being told by administrators. That’s all I can say to that.

TRACEY BARBRICK: Every FTE is funded for 43 days of replacement staff, so there is funding there. That’s not to say they have the capacity or the workforce they can draw on.

THE CHAIR: Order, please. Turning to the government caucus, MLA White.

JOHN WHITE: I really want to give you guys at the Department of Seniors and Long-term Care to have a chance to talk about this, so it’s to the deputy minister and the ADM. So much of what you do is future oriented. We’ve got to train people, put them through a program, wait for them to come out.

Yet, somehow when you came out with the Work and Learn program for continuing care assistants, that managed to provide new students right now - some new employees - but also immediate relief to the sector. I wanted to give you a chance to tell us a little bit about how that’s working out in the industry.

PAUL LAFLECHE: I will start, and ADM Barbrick will continue. I want to thank you for that. I want to go back to the time that I was Vice President Academic and a principal in the community college over 20 years.

The predecessor program with the CCA was full - a long waiting list. I was very surprised when I took over this department 16 months ago to find out that these programs were not attracting the number of students. Something happened in that interim. ADM Barbrick mentioned the neglect in the system, but the career became unattractive over those 20 years from being a very popular career 20 years ago.

So there are many things that we’ve done to create an attractive career for CCAs. I’ll leave aside other things being done for LPNs and RNs at this time, one of which was the 23 per cent instant wage increase to $25 an hour. Another thing we’re looking at is a career path. People want to have a career path. I’ve spent a lot of my time in education. I was a professor, principal. People need a career path. They might start as a CCA, and many of them will want to continue as a CCA, but there’s also a number of them who want to move up to something else - LPN, administrator, whatever it is.

We’re working hard to create career paths for CCAs so it’s viewed as an attractive career, and we can attract people into the discipline. The government has been very supportive - Treasury and Policy Board - of giving us the money to look at these types of investments, and to make the CCA career more attractive after it has fallen down so far over the past 20 years.

ADM Barbrick, would you like to . . .

THE CHAIR: It seems as though the question has been sufficiently answered. MLA White.

JOHN WHITE: I will pass it over to MLA Palmer.

THE CHAIR: MLA Palmer.

CHRIS PALMER: We’ve definitely gotten a lot of information this afternoon - very constructive. Hopefully those who are watching in Nova Scotia see that a lot is being done on their behalf, and for their parents and grandparents as we move forward.

Maybe I’ll ask Associate Deputy Minister Beaton to go back to the question around those with prior skills and those coming to our province. The area I represent has a lot of people from the Filipino community and the Indian community who come with previous skills in health care and long-term care. Can you talk about any specific programs for those communities, or what we’re doing to expedite the process to allow them into more LPNs and RNs?

CRAIG BEATON: I think what I would go back to is the work that’s being done by the Interprofessional Practice and Learning team within the Nova Scotia Health Authority. There is a credentialling recognition that takes place through the licensing body. Often times, the recognition is not the same for somebody coming from the Philippines, as an example, but we know that they’re skilled, so there are competency assessments that need to be done in order to be able to assess whether or not their credentialling or their abilities can be licensed here in the province.

The work that’s being done right now is about expediting that process and putting as many people through as possible. I don’t have the numbers in front of me about how many, but I do know that it’s been growing in terms of the capacity that they’re able to do. It’s a sustained effort that I know the Nova Scotia Health Authority is focused on.

I will say, though, that the Interprofessional Practice and Learning team is not just necessarily focused on the acute care system. They are upskilling and getting those folks into positions of maybe moving from an LPN into an RN, and then leaving the choice up to them to where they would work.

THE CHAIR: MLA Palmer, 19 seconds remaining.

CHRIS PALMER: This will be for the deputy minister. Just quickly, can you give us any kind of information on the feedback you’re receiving from people who have taken the continuing care assistant program? (Interruption)

THE CHAIR: That concludes the question and answer portion of our committee meeting. It is 2:43 p.m. I’m going to offer closing remarks to those who would like to offer it back to us. I will say, if you’re not done your closing remarks by 2:46 p.m., I’m going to call order and say, we’ve got some business to attend to. If you don’t mind being concise, I would appreciate it. I will begin with Nan McFadgen.

NAN MCFADGEN: I guess I would say that in the end, we will remain hopeful, yet at the same time ever vigilant. It’s our responsibility to hold government to account, so we see that 4.1 hands-on care is the answer. It’s been the answer for over 15 years, so we will continue to lobby for that until we see it. Thank you.

THE CHAIR: Ms. Hazelton.

JANET HAZELTON: I agree that we need to remain on this file. It’s sad that it has to take so much attention, because I believe our seniors deserve more. I think it’s imperative that we bake it in legislation. That Homes for Special Care Act hasn’t been opened in a very long time. We need to open and modernize that Act, and make sure that we put adequate care within the Act so that future governments can’t just change it on a whim. That’s what happens when things get expensive. When cuts start to happen, it’s always our most vulnerable that get cut first. We cannot allow that to happen.

THE CHAIR: ADM Beaton.

CRAIG BEATON: Thanks for the opportunity to be here today. I would just say that workforce is certainly a major enabler in this system, but it’s also currently right now a bit of a limiting factor. Our efforts are really focused on recruitment, retention, and redesign, and really looking at opportunities for continued and sustained service, thinking differently, and maximizing scope. I really appreciate the opportunity to be here today.

THE CHAIR: Deputy Minister LaFleche.

PAUL LAFLECHE: We have a minute left - I think ADM Barbrick wants to speak. I just want to say one thing. In almost 20 years as a deputy minister, I’ve never seen a government so committed to doing whatever it takes. You can look at a flip side on money, travel nurses, and they’re doing whatever it takes to keep these facilities open, to open beds, and to ensure that seniors are treated with dignity.

THE CHAIR: ADM Barbrick.

TRACEY BARBRICK: I don’t think I’ve conveyed properly, to my mind, the journey that we’re on. We are on a journey in this sector. That includes increased capacity in long-term care beds, increased quality, increased safety, increased home care, different types of home care like the Capable pilot program that you would have seen. We need to grow a workforce, we need to adequately compensate them. We are all on the same page about the journey.

THE CHAIR: Thank you very much. I appreciate everyone being mindful of the time to help us out. That concludes this section of the meeting. We’re going to take about a two-minute recess while we let you gather you belongings, but thank you all for being here today.

[2:45 p.m. The committee recessed.]

[2:47 p.m. The committee reconvened.]

THE CHAIR: Order. Thank you to everyone for respecting the two-minute break to let the witnesses leave. We have a few pieces of committee business to attend to.

The very first piece of committee business that Ms. Kavanagh has asked me to address is the scheduling for the next meeting. We had asked Ms. Kavanagh to schedule a meeting in March that would accommodate the witnesses. We have been proposed the date of Thursday, March 23^rd from 10:00 a.m. until noon, with the caveat that if the House happens to be sitting, the meeting would be scheduled from 9:00 a.m. until 11:00 a.m.

Could I have approval for Thursday, March 23^rd as the next meeting date for the Standing Committee on Health? It will be 10:00 a.m. to noon unless the House is sitting, when it would be 9:00 a.m. to 11:00 a.m.

I see everyone nodding and thanking Ms. Kavanagh for the work that she’s done to put this meeting together for March 23^rd. I’m going to take that as unanimous consent and we’ll say that meeting is scheduled for the March 23^rd. Thank you everyone.

The first item of correspondence that I have on my agenda is the January 25^th letter from the Department of Health and Wellness regarding public health job vacancies. That was in response to the request for information that was made at the January 19^th meeting. Everyone received this via email on January 27^th, and again yesterday. Is there any discussion on that piece of correspondence?

Seeing none, we will move on to the next piece of correspondence - a February 13^th letter from the Department of Health and Wellness regarding NSGEU’s 59 suggestions, in response to requests made at the January 19^th meeting. This was emailed to everyone yesterday. Is there any discussion on that piece of business?

Seeing none, we will announce that the next meeting, as we just agreed, will be Thursday, March 23^rd. The topic will be Tajikeimik - Mi’kmaw HHHHHkasdjf;alkjgarkjgaeegjaer’jaeioe09Health and Wellness. Witnesses will be . . . (Interruption) Pardon me, we’ll book witnesses. We have the date.

With that, everyone knows when the next meeting is. This meeting was quite helpful, educational and informative. I thank everyone for being polite and respectful. We are adjourned.

[The meeting adjourned at 2:50 p.m.]