Examining a "Household" Model of Residential Long-term Care in Nova Scotia

In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household model as a requirement for owners/operators seeking to build government-funded new and replacement nursing homes. The specific goals of the reform (the adoption of the household model) included increasing the proportion of single rooms, improving the home-likeness of the facility, and more generally, providing high-quality care services. The reform was influenced by recognition of the need for change, rapid population aging in the province, and strong political will at a time when fiscal resources were available. To achieve the reform, Nova Scotia Department of Health released two key documents (2007) to guide the design and operation of all new and replacement facilities procured using a request for proposal process: The Long Term Care Program Requirements and the Space and Design Requirements. Results from a research study examining resident quality of life suggest regardless of physical design or staffing approach high resident quality of life can be experienced, while at the same time recognizing that the facilities with “self-contained household” design and expanded care staff roles were uniquely supporting relationships and home-likeness and positively impacting resident quality of life. La Nouvelle-Ecosse a lance en 2006 la mise en oeuvre de la Strategie pour les Soins de Longue Duree, bâtie sur l’idee de procurer des soins centres sur le client pour ceux ayant besoin de soins de longue duree, y compris les residents des institutions. Les avantages du modele de soins dit de “domicile” etaient amplement demontres empiriquement, ce qui a conduit la province a imposer aux proprietaires ou operateurs cherchant a construire ou renover des institutions de long-terme financees par le gouvernement un modele de logement autonome de petite taille. La reforme (adoption du modele de domicile) avait pour objectifs specifiques d’accroitre la proportion de chambres simples, de rendre l’institution plus proche d’un domicile privatif, et, plus generalement, de procurer des services de tres bonne qualite. La reforme a ete motivee par la reconnaissance d’un besoin de changement, le vieillissement rapide de la population de la province, et une forte volonte politique a une epoque ou les ressources fiscales etaient encore abondantes.  Pour reussir la reforme, le Ministere de la Sante de Nouvelle-Ecosse a publie deux documents cle (2007) detaillant la conception et le fonctionnement de toutes les institutions creees ou renovees a travers un appel d’offres: les normes du programme de soins de longue duree, et les normes d’espace et d’agencement. Une etude mesurant la qualite de vie des residents a montre que, si une qualite de vie elevee pouvait etre atteinte quels que soient l’agencement physique et la dotation en personnel, les institutions organisees en domiciles autonomes et confiant plus de responsabilites aux soignants etaient idealement placees pour encourager la socialisation et le sentiment d’etre chez soi, et influencent donc positivement la qualite de vie.