Senior Home Care
A senior contacted this Office after their home care nursing service was discontinued. They were receiving this service through the health authority and reported that they did not know why they were removed. This Office contacted the continuing care staff within the health authority zone but was unable to resolve the issue.
A formal investigation was launched that included the Nova Scotia Health Authority (NSHA) and the Department of Health and Wellness as respondents. The Department of Health and Wellness was named as a respondent as it has oversight responsibility and sets provincial policy for provincial home care services. The investigation included a review of the senior’s continuing care file and review of relevant provincial and NSHA policy. Ombudsman Representatives also interviewed the senior, NSHA staff within the zone, and Department of Health and Wellness staff responsible for monitoring the administration of home care services within the province.
The investigation revealed that the NSHA zone was utilizing a high-risk client policy from 2012, that had been previously developed under the District Health Authority. This policy was being used pending the development of a NSHA policy applicable to all zones. Utilising this policy, the NSHA zone developed a client contract with the senior to address safety concerns. All parties acknowledged that the terms of the contract were upheld by the senior.
There were conflicting reports as to why the home care nursing services were removed from the senior’s home. Staff of the NSHA zone reported that it was due to safety issues. The NSHA’s investigation into reported safety concerns in the senior’s home was inadequate as it did not provide the senior with the opportunity to hear and respond to the alleged safety issues in the home. In addition, it became clear during the investigation that decision-makers did not have all the facts of the situation before supporting the decision to remove service.
The senior was initially advised by NSHA staff that they could appeal the decision to remove the service. However, they were later informed that this decision could not be appealed. It was at this point the senior contacted this Office.
It was determined that the staff of the NSHA zone believed the decision could not be appealed because it was related to safety concerns. Policy did not support this perspective. Further, the assessment of risk relied heavily on subjective information without evidence supporting the assessment.
With respect to the role of the Department of Health and Wellness in the matter, it was identified that continuing care nursing home care services provided through the health authority were not monitored through the Department of Health and Wellness home care auditing process for compliance with provincial policy and standards. While the proportion of home care nursing services provided through the health authority is small, it is important that these services are incorporated into the provincial auditing process to ensure the consistent delivery of service and adherence to provincial policy and standards.
As a result of the investigation several recommendations were issued to the NSHA and Department of Health and Wellness in July 2018 (See the recommendations section of this report).
The recommendations were accepted by the Department of Health and Wellness and the NSHA. The Office is continuing to monitor the NSHA and Department’s progress in implementing the recommendations. The NSHA did complete the assessment of the senior’s file, as recommended, and concluded that they could provide home care nursing services to the senior with certain provisions in place.