There has been a bit of a political parallel universe in evidence this week. In the Liberal universe the Minister of Health has been holding court at Province House, standing before mostly-absent legislators to defend his department’s spending estimates and extol his own considerable management skills. If you tuned in legislative TV and watched Minister Leo Glavine for only a few minutes you’d be convinced he has accomplished something that has befuddled ministers of health almost from the inception of Medicare 50 years ago – he has tamed the health spending beast while reforming the system to make it work for the good of us all.
Even in the universe that is the legislative chamber everybody must know that the first part of the boast is bogus. The only reason health budget increases have been kept down the last two years is that the wages of tens of thousands of health care workers have been Frozen the last two years. To think that they will remain so is as much based in fantasy as the Disney franchise. Even the budget contains a hint of the coming reality. It includes a few hundred million dollars in “restructuring” cost, much of which will eventually wind up (as it should) as health care expenditure once health care workers get their due.
But that’s just accounting, and not very controversial. Most people agree that it is a good thing to keep health costs under control. The test is whether you can do that while protecting the health and well-being of Nova Scotians. That’s where the parallel universe comes along and, figuratively speaking, rains all over Glavine’s victory lap. In the parallel universe the guy calling the shots is Canadian Press reporter Michael Tutton. For many years Tutton has been doing God’s work, bombarding governments with freedom of information requests, frequently targeting poor treatment and living conditions of Nova Scotians in long-term care facilities.
Eight years, eight deaths
On Sunday, one day before the legislature was to begin examination of the $4 billion estimates of the Department of Health and Wellness, Tutton reported on the results of a request for information on deaths in nursing homes due to violence from other residents. The number that came back from the chief medical examiner in response to his request was eight since 2008 – one that year, one in 2009, two in 2011, one in 2012, one in 2013 and two in 2015. Only three of those deaths – all at facilities in Halifax – became public when police launched criminal investigations. The other five – in Lunenburg, New Glasgow, Sydney and two at the same nursing home in Bridgetown – remained under wraps because police decided against carrying out criminal investigations. (That urban-rural split in how violent nursing home deaths are handled by police raises questions, but I digress).
Reports of troubles in nursing homes are not good news for the government, given that the Liberals propose to cut over $3 million this year from the $548.6 million it budgeted for facility-based long term care last fiscal year. And the province had already been criticized in a report by the Nova Scotia Nurses Union for failing to enforce minimum nursing standards, falling short both in both Registered Nurse per client per day and client/nurse ratios in long-term care facilities.
In the aftermath of Tutton’s report, the media tended to focus on the failure of the government to report all of the violent deaths. Glavine tried to defuse the issue by suggesting that a process for reporting all violent patient deaths at nursing homes will be rolled out as part of – wait for it – a five-year strategy for continuing care now being developed. And from his tone in a radio interview, Glavine appeared to minimize the violence issue, implying that one death a year is no big deal. “We average one death a year at a nursing home, but if one death can be prevented that’s the course of actions that we need to take,” he said reassuringly to the CBC.
“Culture of indifference”
There was quite a different reaction in Ontario last year from a review committee of the Ontario chief coroner’s office, which called the incidence of homicides in that Province’s long-term care facilities an “urgent and persistent issue.” There were eight in 2015 and five the previous year. As reported by the London Free Press, an advocate for the elderly, calculating the homicide rate for the province’s 80,000 nursing home residents declared: “If this were a city, people would be going crazy…there is a culture of indifference.”
Interesting point. For cities, provinces or countries, StatsCanada calculates homicide rates per 100,000 population. Using that measure, the homicide rate in Ontario nursing homes last year was 10.0 – eight per 80,000. For Ontario as a whole in 2014 the homicide rate was just 1.13 per 100,000. But StatsCanada only counts homicides where charges are laid, so it’s an apples-and-oranges comparison.
In Nova Scotia, an average of one death per year for a nursing home population of 6,900 works out to a rate per 100,000 of 14.5. Last year, with two homicides in nursing homes, the rate was 29.0 – almost three times the level at which the aforementioned Ontario advocate for the elderly suggested people would be driven crazy. And that’s comparing apples and apples.
But it appears neither media nor the politicians did that math calculation. By Tuesday, primed by another Tutton story, everyone had moved on to violence against nursing home staff. According to the head of the Worker’s Compensation Board, 40 nursing home staff were off work and receiving payments for work-related injuries in 2015, up from 28 the year previous. The WCB head called it a disturbing trend, which nurses maintain is the result of inadequate staffing levels in the face of increasing dementia and mental health issues. Tutton quoted an RN who has worked in nursing homes for over 20 years. “Dementia is definitely on the rise. We also have mental illness creeping in,” said nurse Sheri Gallivan. “And some of the mental illness or dementia illness clients are younger…They are still agile.”
Meanwhile, in the other universe known as the provincial legislature, Leo Glavine stuck to his guns. Critics who maintained that cutting spending was the wrong response to growing violence in nursing homes, were dismissed as believing that “more money and money alone solves our problems.” His solution – the good old five-year plan. The government, he said, would appoint a coordinator “to look at a five-year plan that will do much more stronger professional development to make sure that staff and also patients are safer in nursing homes across the province.”
“We don’t have five years,” responded the NDP’s Dave Wilson. Full disclosure. I’m 68, same age as Leo Glavine. Leo and I probably do have five years, and many more, I hope. But the 6,900 folks already in nursing homes and the 1,492 who, at least count, were on the waiting list for nursing home care, don’t have that luxury of time.