Aberdeen Hospital racks up $1M bill for guards to watch patients

Over the last year, a common sight greeted visitors who walked down hallways at Aberdeen Hospital in New Glasgow: uniformedsecurity guardsperchedoutside the rooms of patients with dementiaand otherconditionscausing confusion or aggressive behavior.

With104 beds and an emergency room, the hospital is far from Nova Scotia's largest.

Yet, between October 2014 and September 2015it spent $936,000 on security guards to watch patients nearly one third of the $3 million spent across the provinceon so-called patient watches in hospitals, according to figures obtained by CBC News through freedom of information laws.In addition, Aberdeen spent another $425,000on regular security services, such as perimeter checks.

By contrast,Digby General Hospital spent just $171 on security last year.

The two facilities are polar opposites in what a CBC News investigation has found is a patchwork approach to providing patient watch services in the province.

While the new provincial health authority is promising changes, critics are calling for a complete overhaul.

"I believe that security in the province of Nova Scotia needs a thorough review," said Janet Hazelton, president of the Nova Scotia Nurses Union. "We need to look to say where are they, what training do they have."

"There's a random assortment of qualifications for security in this province. It goes from no training to minimal training."

Security guards at Aberdeen are assigned to patients at risk of leaving, getting out of bed or pulling out IVs.In the event of an incident, they alert clinical staff who are responsible for patient care.

Costs at the New Glasgow hospital rose in the last year because of an increase in the number of people requiring patient sitting, mostly due to delirium and dementia, according toKimChisholm, the director of health services at Aberdeen

Waiting for long term care

There are upwards of 30 patients waiting in hospital for placement at long-term care, Chisholm says.

Even so,CBC News has also learned some of the cost can also be attributed to a handful of guards assigned to shifts when there were no patients to watch.

"Since August of this year, we've changed that practice," Chisholm says. "Moving forward we are looking at certainly alternatives to patient sitting and working with our partners across the zone and across the province to look at best practice."

And correcting disparities across the province is a priority, according toAllan Horsburgh, thechief financial officer of the Nova Scotia Health Authority, which took over from nine district health authorities this spring.

"That's one of the reasons why we are looking at new ways of doing things as one system, not just security, many of the services that we are looking at, trying to make sure we are standardizing our processes," Horsburghsays.

Patient watch security guard costs at a selection of N.S. hospitals (Oct. 2014 to Sept. 2015)

• Aberdeen Hospital, New Glasgow $935,694
• Nova Scotia Hospital, Dartmouth $701,881 (11 months)
• Colchester East Hants Health Centre, Truro $355,469 (11 months)
• South Shore Regional Hospital, Bridgewater $207,362 (11 months)
• Valley Regional Hospital, Kentville $202,808
• Halifax Infirmary, Halifax $159,004 (11 months)
• Digby General Hospital $171

Security costs can also differ from hospital to hospitaldepending on the availability of other services in the community.For example, themuch larger Halifax Infirmary paid guards only $159,000 for patient watch duties because the hospital was able to hire a patient sitting agency.

Hazelton wants the new health authority to adopt a model similar to one in Ontario. She says personal care workers in that province sit with most patients, whilesecurity guards have training to allow them to restrain agitated patients if necessary.

"They have considerably more training and they're all qualified to be part of the team so if a nurse is concerned about a patient ... then they can have the security in the room with them to help deal with the patient if the patient were to become upset," she said.

As a result, she says the violent incident rate and nurse injuries have decreased.

Change coming

The health authority insists change is coming in Nova Scotia, though likely not enough to satisfy Hazelton.

Chisholm says there's amove away from using security guards and restraints, towardsbed alarms and other devices and techniques to monitor patients.

In June, the authority issued a provincial request for proposals for security services. It's still evaluating bids.

Horsburgh says the goal is to make security more efficient and effective than what's in place in various hospitals now.

"They might have had to bring in more expensive services for situations that maybe didn't require it," he says. "So for the taxpayers that's one of the things we're looking at to make sure we have the right type of skill set for the right type of circumstances."