Care by Design: Working in long-term care in Nova Scotia

The Care by Design program continues to transform long-term care (LTC) in Nova Scotia by blending innovation, patient-centered care and interdisciplinary collaboration to create a model that’s as effective as it is compassionate. 

Dr. Barry Clarke, the founder of Care by Design, started this program in the early 2000s when he was working as a community LTC physician and Director of Camphill Veterans Long-term Care program. Over the years, Dr. Clarke's work expanded to study the program in the Netherlands which gave him a unique perspective on how the challenges faced by seniors in long-term care facilities in Nova Scotia could be improved. By 2005, Dr. Clarke and his colleagues began developing Care by Design in response to a significant need in the province. The vision was a frailty-based program to support having the right care at the right time in Long-Term Care. Doing this, Care by Design has helped reduce the reliance on hospital transport for LTC residents and improved the efficiency and appropriateness of healthcare. 

Care by Design is about using the right healthcare professionals in the right way. Dr. Clarke explained, “the program was designed to provide more support to physicians and better utilize other healthcare professionals to ensure patients receive the care they need. It’s not just about reducing hospital transfers; it’s about creating a sustainable, community-based model where patients are the priority and healthcare teams can work collaboratively to address complex needs.”

In 2009, Care by Design officially launched. The program aimed to provide a more integrated, supportive model for healthcare in LTC settings, involving family doctors, nurse practitioners, paramedics and other healthcare professionals working together to provide high-quality care. With that, Care by Design reduced the need for physicians by 75% in some facilities, improved patient outcomes and received national recognition for its innovative approach.

In the Care by Design program, each physician is assigned to a specific floor in a long-term care facility where they work with a team of other healthcare professionals. The program also utilizes its own Emergency Care Paramedics (ECPs) to ensure immediate response times, with physicians available on call within 30 minutes to manage acute or complex cases. This model reduces the burden on family doctors while allowing them to continue their own practice if they wish.

One of the key selling points of the Care by Design program is the opportunity for physicians to work in a highly supportive, team-oriented environment. Dr. Yinka Akin-Deko, a family physician in Cole Harbour who joined the program in 2023, shared her experience balancing her family practice with her work at Glasgow Hall in Dartmouth. 

“Care By Design allowed me to broaden my practice and deepen my knowledge of geriatric care," Dr. Akin-Deko explained. "I’m able to work with residents who have specific needs, and the team at the facility is incredibly supportive. It’s a great opportunity to learn and grow as a physician."

Physicians in the Care by Design program are encouraged to continue their family medicine practice, which Dr. Akin-Deko sees as a key advantage. "Being able to practice in long-term care while maintaining my own practice allows me to be a better community doctor," she said. "It’s an enriching experience that provides continuity of care for patients in the long run."

The benefits of working with Care by Design are endless such as working with a dedicated team, improving your geriatric knowledge and making a meaningful impact on the lives of seniors. As Dr. Akin-Deko said, “It’s a rewarding job that allows me to build relationships with residents, their families and the team. It’s incredibly fulfilling.”

A typical day for a physician in Care by Design can vary, but there are some common themes. Dr. Akin-Deko shared that her typical day starts around 8:30 or 9:00 a.m., seeing residents with the help of the nursing staff. During rounds, she works closely with other team members, including dietitians, physiotherapists and occupational therapists, to develop and implement care plans. A key part of the job is keeping families informed about their loved ones’ care and making sure their concerns are heard and addressed.

On days when Dr. Akin-Deko isn’t doing rounds, the team members will contact her with any concerns or changes in residents' conditions. She also shares on-call duties with other physicians, providing support to other facilities when needed.

Dr. Akin-Deko finds it incredibly rewarding. “It’s fulfilling because you’re making a real difference in the lives of the residents,” she said. "A lot of the work is about listening and addressing the concerns of the residents and their families. When you make a diagnosis, it’s not just about the condition, but about giving people peace of mind."

Looking ahead, Dr. Clarke sees potential for expanding the Care by Design program to other parts of Nova Scotia. The success of the program during the COVID-19 pandemic, where it played a crucial role in managing care for COVID-positive residents in long-term care homes, has highlighted its importance as a model for future healthcare delivery.

Care by Design is currently operating in the Central Zone and Truro, but Dr. Maria Alexiadis, Senior Medical Director of Primary Care and Chronic Disease Management Network, explains that Primary Health Care is working to develop a provincial care model that will incorporate the benefits of the Care by Design program. She said, “As the number of LTC beds increases across the province, we must invest in supporting Nova Scotians living in their Health Homes in LTC. Primary Health Care, is working with others to create a provincial model that will use the benefits seen by the Care by Design program, while also integrating technologies such as virtual care and collaborating among healthcare providers to meet the growing care needs.”

Physicians considering joining the Care by Design program should be aware that working in long-term care can be a uniquely fulfilling experience. In addition to the intellectual and medical challenges that come with treating older patients with complex needs, there’s a deeply human element to the work that brings many physicians back for years. As Dr. Akin-Deko puts it, “It’s a calling. You help patients who are often anxious, worried and uncertain. You’re there to ease their fears, listen to their concerns and provide the care they need."

For those considering the shift to long-term care, Dr. Clarke offers a final piece of advice, “If you want to make a real difference in the lives of seniors and become part of a dynamic, supportive team, Care by Design is an opportunity you won’t want to miss.”

Interested in joining Care by Design? Learn more about the program and how you can make a difference in long-term care in Nova Scotia.

Photo of Dr. Barry Clarke (L) and Dr. Yinka Akin-Deko (R).