Home care in N.S. struggling during Omicron, but no clear provincewide picture

Home care workers across Nova Scotia are stretched thin during the Omicron wave, but unlike other health-care sectors it's unclear to what extent they are off the job.

CARP (Canadian Association for Retired Persons) Nova Scotia is highlighting concerns from families that have seen last-minute cancellations or a rotating door of caregivers throughout the pandemic, made worse over the past few weeks as COVID-19 cases climbed.

"Some people have been left for days without anybody coming in," said Beverley Lawson, chair of the health advocacy committee for CARP Nova Scotia. "We want the general public to know that there's gaps in home care."

Although Nova Scotians regularly hear updates from the province about long-term care and hospital staffing challenges, Lawson said home care is often left out.

In an email Friday, provincial spokesperson Kristen Lipscombe said home care agencies provide more than 30,000 people with nursing and other supports in their homes each year.

As of last week, there were 1,278 people on the wait-list for 6,928 hours of home support, which includes personal care, respite and essential housekeeping. That's a slight jump from last February when 1,086 people were waiting for the service.

Lipscombe said 652 people on the wait-list are receiving some services, and some are receiving direct funding to purchase private services while they wait.

"Many home care agencies have been impacted by COVID exposures among both clients and staff members, so the pandemic has made existing staffing challenges even worse," she said.

Province says reporting difficult due to 'fluid numbers'

Lipscombe said Friday there are 3,876 home care workers employed by publicly funded agencies.

"Staffing levels due to COVID illness or exposure are fluid numbers and are only accurate as of that point in time," she said.

On Jan. 4, for example, Lipscombe said 39 staff members from nine agencies were in isolation.

However, Lawson said the province should regularly share how many home care workers — nurses, continuing care assistants and other roles — are off the job with COVID-19 or isolating as close contacts.

"We just don't know and that's part of the problem," Lawson said.

Clients report missed service

The system's structure is likely what leads to a lack of transparency, Lawson said. There are different service providers at the roots like VON, Northwood and local home support organizations around the province.

They are co-ordinated through Nova Scotia Health, which receives funding from the Department of Seniors and Long-Term Care.

In a 2021 survey of 191 CARP members across the province who had dealt with home care in the past year, comments included "too many different providers" and "frequent cancellations and no-shows."

Lawson said about half the survey respondents said they were afraid to bring up any concerns to service agencies or the province, because they were worried about losing the services they already had.

Many families are also worried about home care workers having the proper personal protective equipment like N95 masks, and whether they could decline to care for someone who tested positive for COVID-19.

While the health authority assured CARP this week that workers in agencies partnered with the province do care for everyone, and have the proper PPE, Lawson said that should be widely known.

Significant impacts

VON runs 11 sites across the province. Visiting nursing is offered at all 11, while home support (light housekeeping, meal preparation, personal care, etc.) is offered at six.

Carol Curley, VON regional executive director for the north and east zones, said their staff have been "significantly impacted" during the Omicron wave, but she did not give an estimate of how many have tested positive for the virus or been off work isolating.

"We definitely are feeling the pressures and our numbers are changing daily," Curley said.

VON currently employs about 1,680 nurses and continuing care assistants in home care, supporting about 10,000 clients overall.

The organization has seen a high volume of cancellations as people cut down on outside visitors during this wave, Curley said, but due to staff shortages it has still needed to adjust schedules and prioritize highest-need clients, which can cause delays.

"We're really grateful for our staff because it has been a day-by-day change. Starting early, staying late," Curley said.

Northwood Homecare supports about 1,500 clients in the Halifax region and West Hants with personal care and respite, said president Janet Simm.

As of Friday, Simm said 131 continuing care assistants have either tested positive for the virus or are isolating as close contacts, leaving about 400 staff working.

Although Northwood hasn't had to reduce services, Simm said scheduling has been a struggle and last-minute cancellations have happened.

The province is currently redesigning home care to place clients at the heart of a more flexible system, following criticism in a November 2017 audit of home-care support contracts by the province's auditor general.

Lawson said she knows the pandemic has slowed progress, but it's important to keep highlighting the need for change because the vast majority of Nova Scotians say home care does make a difference.

Just over 80 per cent of survey respondents felt the system helped them stay at home and avoid long-term care or long hospital stays, Lawson said.

Lipscombe said work is underway to update legislation and determine a new funding model for home care agencies.

Some initiatives include expanding a Home Support Aide pilot project for light housekeeping and meal delivery, and upgrading the home care technology platform used in many agencies to improve scheduling and reporting on service hours. 

The province also recently announced $57 million on long-term care, with $22 million of that amount covering 100 per cent of tuition costs for about 2,200 students to take the CCA program over the next two years.