Friday, January 28, 2011

Nova Scotia should close large institutions for disabled people, expert says

From The Canadian Press:

Nova Scotia should gradually close large institutions for the disabled and move residents into smaller regulated homes to reduce the abuse of vulnerable residents, an international expert says.

Michael Kendrick, a Massachusetts-based consultant who has advised governments around the world on the care of the disabled, was reacting after the mother of a 20-year-old autistic man said her son was confined for 15 days in a room at Braemore Home in Sydney, N.S., in September.

'A lack of action will give permission for some not to care very much.'—Michael Kendrick, an expert on disabled care
During his confinement, the unidentified man was let out for exercise and meals at the 134-resident special care facility, the provincial government has said. But at times, he had to urinate in the room when he couldn't leave to use a bathroom, his mother and staff at the home have said.

The province should replace institutions with community-based care over a five to 10-year period, said Kendrick, who wrote an evaluation of Nova Scotia's system a decade ago.

"A lack of action will give permission for some not to care very much," he said in a telephone interview from Vancouver.

He proposes a plan that would include the appointment of independent monitors of homes and multi-year training of staff. Hundreds of unionized workers at residences like Braemore could be trained and reassigned to community-based care, said Kendrick.

"I'd be much more reassured if [the government] had even some new initiatives that gave you confidence they're trying to engage the issue," he said. "Otherwise, we'll be sitting here on the telephone two years from now discussing a tragic death and somebody will be saying it's an isolated incident."

Kendrick conducted his study of Nova Scotia's system after a Halifax man was fatally stabbed in one of the province's special-care homes in the late 1990s.

He said Nova Scotia hasn't done enough since then to ensure that residents and their families have control of their lives and environments, adding that he believes his recommendations have "been largely ignored" by successive governments.

The province still has one of the highest rates of institutional-style care in Canada, with about 660 people living in the large homes out of 1,666 people in various forms of licensed care, he said.

There are about 600 people living in unlicensed small homes, where up to three adults with disabilities live in the community with the support of either live-in staff or staff who visit the apartments in shifts. The rest live in other types of group homes and residences.

Kendrick believes the Braemore incident stemmed from a lack of options.

"If you look at the situation in Cape Breton, they didn't have many options for managing this fellow's needs, and so they basically resorted to what they could improvise on the spot," said Kendrick.

"If you have flexible options in the community, you can come up with an option that really suits the person."

He said abuse occurs at the small homes, but it's less common, "because these settings are so much more transparent."

Braemore's chief executive apologized Wednesday for the incident involving the autistic man. The incident came to light this week but the Canadian Union of Public Employees said a unionized worker wrote management at the home on Sept. 14.

Debra MacPherson said the home will adopt measures "to prevent an incident like this from occurring again in the future."

MacPherson declined to comment on Kendrick's views.

Brooke Armstrong, a spokeswoman for Nova Scotia Community Services Minister Denise Peterson-Rafuse, said the government will consider Kendrick's proposal.

Armstrong said the NDP government has made progress since coming to power in 2009.

"We've improved our relationships with members of the disability community, and work is underway to develop a disability strategy that will provide guidance on how we can best deliver our range of services to those who need them," she said in an email.

In an interview last week, Peterson-Rafuse said there's no proof that abuse occurs less often in smaller homes.

"One thing I've learned in this position is there are some ... extraordinarily complex cases where smaller options wouldn't work because the residents need more attention," she said, adding there's no specific plan to close the larger institutions.

Kendrick said it's now routine in provinces, including Ontario and British Columbia, to support severely disabled people in communities, and autistic adults often fare better in quieter home-like environments.

He has advised governments in Australia, Europe and New England when they brought in similar systems and has published more than 100 papers on caring for the disabled.

The Cape Breton case comes after a series of reports on abuse in the province's larger institutions in the past two years.

Government documents obtained under access-to-information legislation show there were four other cases at Braemore where residents either sexually or physically abused each other in the past two years.