The association that represents nursing homes in Nova Scotia has called a memo sent to its members last week discouraging.
It goes on to say it is a sign there's been a breakdown in communications between the homes and the Nova Scotia Health Authority.
Michele Lowe, managing director of the Nursing Homes of Nova Scotia Association, said the people who run the nursing homes were particularly dismayed by the tone of Tim Guest's message.
The three-page memo from the Nova Scotia Health Authority vice-president warned care homes that if they sent residents to hospital who did not need urgent care they would be immediately sent back.
The move is just one of the ways the authority is trying to deal with lengthy ambulance offload times and emergency room overcrowding.
The fact that beds in other departments are taken up by patients awaiting discharge home, or to a long-term care facility, is exacerbating the problem in ERs with patients with nowhere to go within the hospital.
Implicit in Guest's memo was that nursing homes are part of the problem, but Lowe disputed that suggestion.
"We were very dismayed and discouraged by the tone in that memo," said Lowe, who noted residents sent to hospital in the Halifax region are routinely assessed by paramedics before the decision to transfer a resident.
She said the homes followed a "stringent process" before sending anyone outside a facility for treatment.
She also said nursing home administrators had done "significant work" to try to resolve the sometimes slow readmission of residents from hospital over the past few years.
But the health authority has mostly ignored their efforts.
"Our association has submitted different solutions and innovative ideas to help to support the health authority's goals and in some cases, they have been somewhat adopted. But in most cases, they have not been implemented. In many cases, they've not been recognized," Lowe said.
"It's very unfortunate."
"There's clearly a communication breakdown between the health authority and providers," said Lowe.
"There's no way that, if all of the significant work that has been done in nursing homes across the province had been shared with all of the individuals with the health authority, that that memo would have gone out with that tone."
She admitted readmissions from hospital was an "area we need to work harder at."
Greater health risk at ER
The day after Guest's memo, nursing homes also received a message from Robert Strang, Nova Scotia's chief medical officer of health, imploring them not to close their doors to new residents or readmissions only because of an outbreak of illness.
Strang noted the provincial policy on dealing with a respiratory illness outbreak was only a guideline, and "ultimately the decision on closure/acceptance of a resident rests with each individual LTC (long-term care) facility.
"Keeping a resident in an ER or hospital bed may well create a greater risk to their health than accepting them into a facility, even if that facility has an outbreak," said Strang's memo.
"It also can create health risks to many others by contributing to challenges in timely access to ER and in-patient beds."
Between 2011 and 2016, nursing homes refused to accept residents back into their facilities after hospital care a total of 311 times, according to figures supplied by the health authority. That's an average of 52 times a year.
Between January and October of 2017, there were 68 refusals.
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