Legislating home : the impact of the regulation of small house settings for long term care residents in Nova Scotia, Canada
In May 2006, the Province of Nova Scotia, Canada announced a Continuing Care Strategy (CCS)
in which issues of home care and long term care were addressed. The strategy is a 10-year plan
to enhance and expand Nova Scotia’s continuing care system. The CCS covers issues which
include home health care, adult day support, respite care, improved access to services, as well as
funds to build 1320 new long term care (LTC) beds. As a result of the CCS, the Provincial
government has built 11 new LTC facilities to support the vision of “living well in a place you
can call home” (CCS, 2006). A key feature within the guidelines is that all of the new LTC
facilities be built in the model of the small house (SH) community, with multiple households
(cottages) of 12-15 residents each. Each cottage is required to have a living room, dining room,
residentially scaled kitchen, and private bedrooms. In addition, implementation of person
centered care in which residents are given choices in the daily activities is an operational
requirement in the new facilities. In order to gain a better understanding of the implications of a
LTC system where resident choice and empowerment are provided for and regulated by
legislated policy, a qualitative case study was conducted in early 2012 in two LTC facilities in
Nova Scotia. The first facility was designed and built prior to the 2006 CCS regulations (n=48).
The second facility opened in 2009 as one of the first in the Province to be built to the new
guidelines (n=49). Observations took place for eight weeks at both facilities and interviews were
conducted with residents, family members, staff, providers, and legislators. Through place theory
and an ecological theoretical framework, key themes emerged relating to the philosophy behind
the SH model of care which include the need for shared goals, expectations and consistency in
leadership; frontline staff empowerment through the strength of teamwork; and the balance of
choice, risk and autonomy for residents in the setting. The physical environment had a direct
impact on the social environment in the communities and while the actuality of ‘home’ was a
very personal distinction based on the history and past preferences of each individual, the shared
themes between the two study communities were related to the core elements of LTC: the need
for and the provision of care.