Enhancing Governance and Accountability in Nova Scotia’s Long-Term Care Sector

Nova Scotia Department of Seniors & Long-Term Care

Health & Wellbeing
Strategy & Analytics
Davis Pier

The Challenge

Nova Scotia’s long-term care (LTC) sector includes not-for-profit, for-profit, and municipally-run organizations that serve over 8,000 residents in over 132 facilities. The Department of Seniors and Long-Term Care (SLTC) were working to create a funding model to ensure equitable funding and consistent service delivery across all LTC providers.


Nova Scotians reside in long-term care facilities


long-term care facilities in the province

The Approach

Davis Pier partnered with the Department of Seniors and Long-Term Care (SLTC) to address these challenges—leveraging our in-depth knowledge of the sector and engaging with service providers to provide critical perspectives on the work. Our approach included:

  • Data-Driven Analysis. We led a comprehensive review of existing service agreements and staffing models across various ownership structures and service delivery models. This analysis involved mapping over 2,700 budget-listed positions to establish current compensation benchmarks and staffing ratios.
  • Engaging with People. We hosted targeted sector engagements to understand current operations, challenges, and ideas. We worked closely with service providers, drawing insights from working groups and advocacy organizations to ensure our recommendations were shaped by clinical service delivery and community needs.
  • Best Practices and Governance.  We developed a best practice approach for sector governance and accountability, identifying opportunities to align funding oversight, improve governance capabilities at the board level, and enhance resident outcomes reporting.
  • Standardized Staffing Models. We supported the creation of a standardized staffing model to ensure consistent staffing levels and service delivery standards across all facilities. This was an iterative process that involved developing multiple options and the refinement of a chosen model that was supported by supported by new service agreements, updated funding policies, and detailed facility-specific impacts.
  • Operational Support. We also helped support the implementation of this work through the design of an operational support model to provide additional resources to LTC facilities when accountability measures or metrics could not be met.

The Outcome

A collaborative approach and comprehensive understanding of the complexity of the LTC sector drove meaningful outcomes for government, service providers, and communities.

  • Enhanced Equity and Consistency. Implementation of new service agreements and a standardized staffing model has ensured more equitable funding and treatment across all LTC facilities in Nova Scotia. This fosters fairness and improves the overall quality of care for all residents.
  • Improved Accountability. Development of Key Performance Indicators (KPIs) and a digital platform for collecting and reporting data has improved oversight and accountability for the use of public funds.
  • Supportive Tools and Resources. Creation of updated handbooks, guidelines, policies, and comprehensive change management and communications plans to support the implementation of new service agreements.

The Impact

Our collaboration with the Department of Seniors and Long-Term Care and service providers has helped provide everyone involved with a better understanding of the sector an enabled them to design changes to funding to achieves the outcomes they want for people and for service providers.

The implementation of new funding models and service agreements has addressed disparities and brought a higher level of consistency and accountability. This ensures that LTC providers, whether in Yarmouth, Antigonish, or Halifax, can deliver high-quality care, meeting the desired client outcomes and enhancing the lives of over 8,000 LTC residents in Nova Scotia.