CUPE Submission to the Nova Scotia Expert Advisory Panel to Recommend Improvements in Long-Term Care

Respectfully submitted on behalf of CUPE Nova Scotia and the CUPE Long-Term Care Coordinating Committee.

Fix residential long-term care workers’ conditions of work, to improve conditions of care

CUPE Nova Scotia welcomes the opportunity to share our views and recommendations on improving quality of care in long-term care (LTC) for consideration by the Expert Advisory Panel convened to review this matter.

Nova Scotia has an opportunity to become a leader in the delivery of high-quality seniors’ care by addressing a key determinant of care quality – a stable and adequately resourced team of care staff.

It is urgent and important that Nova Scotia get residential long-term care right. We have the highest percentage of the population aged 65 and older in Canada. The elderly population will only continue to grow as a share of our population: the first wave of baby boomers born in 1945 turned 73 this year.

Nova Scotia provides provincial funding to support a staffing minimum of 2.45 hours per resident day (hprd). This is inadequate, and CUPE has called on the Government of Nova Scotia to increase funding for CCAs to 3.1 hours per resident day effective immediately so that the care standard can eventually be raised to 4.1 hours per resident per day.

In 2016 the Nova Scotia Government cut funding transfers to long-term care by 1%, making an already poor staffing problem worse. This came on top of cuts to transfers to most LTC facilities in 2015. The system is in crisis and must be funded properly.

In a 2018 survey of 677 CUPE Members carried out by the Long-Term Care Coordinating Committee, we found 95% of residential long-term care workers have been affected by working short. Seventy-five per cent of workers said they work short either daily or weekly (37% daily, 37.5% weekly). The result is that CUPE continuing care assistants, LPNs and other workers do not have enough time to adequately meet the needs of residents.

Inadequate staffing levels exacerbate high rates of musculoskeletal injury and resident- on-worker aggression. This has resulted in the astounding fact that workers in Nova Scotia’s LTC sector have the highest injury rate of any workforce sector in the province, and four (4) times the provincial average. Although workers in the home care, long-term care and disability support program account for only 7% of total provincial assessable payroll, they make up 22% of workers’ compensation time loss claims.

When long-term care workers are off work, it takes an average of 30% longer for them to return to work when compared to all employees in Nova Scotia. This comes with significant social costs to seniors and care workers, as well as a financial cost to employers through higher WCB Nova Scotia premiums.

Based on the academic research and the experience of CUPE members, it is clear that the conditions of work are the conditions of care. Therefore, by increasing staffing levels and improving working conditions, the Nova Scotia government will significantly improve the quality of seniors’ care.

The Nova Scotia government should adopt promising practices from other jurisdictions, and the experience in Nordic long-term care facilities is particularly compelling. Generally, in Nordic countries, a greater share of GDP is spent on LTC, resulting in higher staffing levels and better, individualized resident care.

Establishing legislated minimum staffing levels plus enhanced staffing based on higher levels of acuity is long overdue. These legislated standards must be enforceable through strong accountability measures including robust reporting requirements and regular monitoring and audits.


CUPE Nova Scotia offers the following recommendations for the Expert Advisory Panel for a plan of action by the Nova Scotia government:

1. Conduct a comprehensive review, involving leading health policy and long-term care experts, and key stakeholders, to establish an appropriate legislated minimum staffing level for CCAs, and all members of the care team that is necessary to provide quality care. Such a review should:

  • Examine acuity levels and their variance by facility characteristics and ownership type across the province and consider enhanced staffing levels in relation to acuity
  • Examine how to enhance and implement person-centered and relational care models in publicly funded LTC facilities
  • Develop a model of care to respond to the increasingly complex needs of clients living with cognitive impairment and significant behavioral and psychological symptoms
  • Examine and recommend a funding formula and accountability measures for LTC operators
  • Recommend measures to increase financial accountability, and
  • Compare the difference between public, non-profit and private for-profit facilities on working conditions and quality of care.

2. As an urgent interim measure before an appropriate legislated level is determined, immediately increase funding so all publicly funded LTC facilities reach a minimum staff funding for CCAs of 3.1 hprd. This immediate staffing increase should be supported by new funding to the health authority and include: 

  • Recruitment of more continuing care assistants, and other members of the care team
  • Reinstatement of the financial support for CCA program students at a Nova Scotia public institution ($5,000 bursary) cancelled in 2013 and a new financial support program of grants for study.
  • Accountability requirements to ensure new funding is directly applied to care
  • Standardization of the calculation, collection, and reporting of staffing levels, and
  • Standardization of musculoskeletal and violence prevention programs including training across employers.

3. The collection of data and create a seniors’ advocate:

  • Require the health authority to track and report staff turnover and retention, contracting out, the number of public, non-profit and private for-profit beds and other data necessary to enhance evidence-based decision making, and
  • Create a Nova Scotia Seniors’ Advocate to monitor and analyze seniors’ services and issues and make recommendations to government and service providers to address systemic issues.

Read CUPE’s full submission to the panel.