A 6 September 1989 headline in the Cape Breton Post reading ‘Home care program finally reaches C.B.’ announced the arrival of home care in Cape Breton, with 10 designated agencies across the Island and provincial funding being provided for the first time. Colleen Chisholm, regional coordinator of the home care program, told the Post there were about 1,500 clients being served.
Coordinated home care, described as the “coordinated delivery of homemaker, nursing, housing, and volunteer services to help people remain in their homes” would be available for “seniors, disabled persons and families at risk.” As the story relates, there was quite a bit of “behind the scenes work” that led to the welcome announcement that not only would their efforts be expanded, but provincial funding would be made available.
Source: Home Care, Nova Scotia
There were 10 “Entry Agencies” in pre-amalgamation 1989, serving Glace Bay, Sydney, Cape Breton County, Dominion, Inverness County, New Waterford, North Sydney and Sydney Mines, Port Hawkesbury, Richmond County and Victoria County. People could check with the agency nearest them to determine if they were eligible for services. (Louisbourg was added in 1990.)
A great deal of the behind the scenes effort referred to in the Post was undertaken by Pat Drohan, who was working for the City of Sydney’s Social Services Department when she began to see a need for homemaker services for many senior citizens who lived on their own. Some were disabled or had health problems and were unable to perform many housekeeping activities.
Drohan recalls that there was no budget for what she saw to be a real necessity for such people, but in 1987, with some financial assistance from the City, she was able to hire Chisholm as services coordinator. Working out of a storage room in their office, they contacted various social workers, those involved with public housing and others who were assisting the disabled. Eventually, they hired seven homemakers, who received training from the VON and St. John Ambulance, and from local social workers who prepared them for going into peoples’ homes where they could “provide housekeeping services for those who weren’t capable of doing it themselves.”
In addition to her regular work with Social Services, Drohan took on the scheduling for this newly-created service that did what the provincial government eventually recognized as a “good thing”: allowing people to remain in their homes longer, thereby avoiding being transferred to nursing homes, something the government continues to promote many years later. The program, as set up by the province, was intended to “supplement, rather than replace family participation in a client’s care,” so that a “mutually agreeable level of service” could be developed. The home care program has grown and expanded over the years and has been a major benefit to those in need, but also for family members who find themselves trying to care for ageing parents, spouses or even younger siblings while holding down a job and raising their own children. More recently, a stipend of $400 a month has been introduced by the provincial government to assist those providing care to a family member, if certain conditions are met.
Susan Stevens, Executive Director Continuing Care, Nova Scotia Health Authority (source: CFHI)
Susan Stevens, senior director of Continuing Care for the Nova Scotia Health Authority (NSHA), recently gave presentations to boards of directors and executive directors of home care agencies in Nova Scotia. (Full disclosure: I currently chair the board of directors of Homemakers in Sydney). In her presentation, Stevens outlined the scope of homemaking services in Nova Scotia, which are offered in four zones, through 29 agencies providing home care support and/or nursing throughout the province. Cape Breton, with three agencies — Sydney City Homemakers, Cape Breton County Homemakers and the VON — is part of Eastern Zone 3.
In 1994-95, the provincial government, through the Department of Health, rolled out a new program called Home Care Nova Scotia. Stevens describes it as the evolution of the Coordinated Home Care Program, where she’d started work in 1996 as a care coordinator. The program was intended for “all Nova Scotians regardless of income who needed home care – both home support and nursing services.”
Stevens pointed out that the budget for Continuing Care for 2019-20, which includes long-term care and home care, is $869 million, with 16% or $142 million going to home care support and 9% or $78 million to nursing care. The home care support budget has increased from $121 million in 2006-07 to $282 million in 2019-2020. That represents 1,847,252 home visits in 2006-07 compared to 3,063,281 visits in 2018-19. On any given day in Nova Scotia, 15,000 clients receive home care support, including 100 children. Fees are geared to family or individual incomes and each agency receives its budget depending on the number of service hours delivered in the preceding year.
One of the most interesting items in her presentation was the fact that the average stay in nursing homes in Nova Scotia is three years. If more people were able to remain in their homes, the average stay in nursing homes would be two years, which would make 1,000 more beds available for long-term care. It’s also interesting that while 890 persons were waitlisted for home care in March of 2015, only 481 were in a similar position in May of 2019, a 46% decrease.
Any agency in the province delivering home care support and /or nursing care has to conform to very strict standards and is required to keep up with changes that are always being introduced in an attempt to provide the best possible service. There are committees set up within each agency, such as the Continuing Quality Improvement (CQI) committee, that review the many policies that govern home care, bringing them up to date every two years. Agency executive directors spend many hours in telephone conferences or face-to face meetings with the Department of Health and Wellness, and all agencies are audited by the Nova Scotia Health Authority each year.
Source: NSHA Continuing Care
A typical Executive Director’s monthly report to an agency’s board of directors includes mention of ongoing in-office staff training that includes safety accountability, staying safe in the community, hazard identification, a food handling course, feedback on surveys that have been issued to clients, CPR & First Aid, discussion on key performance indicators and much more. Providing home care support in clients’ homes requires that certain rules and procedures are in place that protect both home care workers and their clients and such rules are followed to the letter.
As Stevens points out in her presentation, over the last several years, the NSHA has seen some success in advancing the ‘Home First’ approach in some parts of the province. However, further work is needed to develop and support a comprehensive Home First culture provincially, and in particular, attention needs to be directed to those areas which haven’t achieved change.
A recent advertisement for continuing care assistants to work with the Cape Breton County Homemakers reveals exactly the type of worker they believe should be involved in this type of work:
Our agency is in search of compassionate employees who understand the importance of working safely and meeting the needs of clients while helping them maintain a quality of life. If you are passionate about providing care and willing to challenge yourself daily to make a positive impact on the lives of those you care for, we want YOU on our team.
That sounds like exactly the type of help anyone would welcome when the time comes.
Dolores Campbell, a lifelong resident of Sydney, is a freelance writer whose work has appeared in The Cape Breton Highlander, the Nova Scotian, Cape Breton Magazine, Catholic New Times and The Cape Breton Post.
