Canada:Nursing homes getting surprise checks

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Canada:

Nursing Homes Getting Surprise Checks

by Moira Welsh, the Toronto Star

January 23, 2004

When Health Minister George Smitherman sat down with the Star's Moira Welsh, he was not prepared for what he was about to see...
...Five graphic pictures of nursing home resident Natalie Babineau's 15-centimetre-long, gangrenous bedsore made the minister cry.

The Ontario government has started surprise annual inspections of the province's troubled nursing homes and created a toll-free phone line for families to register their complaints.

Health Minister George Smitherman yesterday revealed the first stage of his promised "revolution" into long-term care — in response to the Star's recent series on nursing home neglect — pledging that the elderly in nursing homes are a "top priority" of his ministry, and that a series of sweeping changes is on the way.

"I would characterize the steps we've taken so far as progress, but we've got a lot more work to do," Smitherman said in an interview before the news conference. "I want to send a message today that we are being vigilant.
"We have a lot to learn and we are learning it as fast as we can because the clock is ticking and people's care is at stake," he said.

The Star's investigation into the province's 544 nursing homes, published in December, analyzed the ministry's own data, revealing widespread neglect and inadequate care for the system's 65,000 residents. It found that many residents suffered from serious neglect. They were left for hours in dirty diapers, went hungry and suffered from toxic bedsores. Some residents perished from that neglect, like 93-year-old Natalie Babineau, who died of a gangrenous bedsore that ate down to her tailbone in Stoney Creek 's Ridgeview Long Term Care Centre.

The investigation also found that the ministry gave homes up to a month's notice of its annual inspections — the one opportunity a year for investigators to take a hard look at the care the elderly receive.

That advance notice allowed many homes to cheat at inspection time by bringing in extra staff, who cleaned the facility and fixed medical documentation to give the image of a well-run operation.

Changes to those inspections were among yesterday's announcements:

Since Jan. 1, 11 homes have had surprise annual inspections, while another 93 have had surprise dietary and environmental inspections. Many of those were done in the southwest region, where the Star found a high rate of problems.

A toll-free phone number (1-866-434-0144) will be promoted through a poster campaign. The phones will ring in the ministry's call centre, where 14 existing employees have been trained to deal specifically with long-term care issues. A registered nurse and compliance adviser will work with them to determine which calls need immediate action.

The ministry already has a complaints system set up with its regional offices, but Smitherman said he has great faith in the new approach.

MPP Monique Smith (Nipissing), Smitherman's parliamentary assistant who had earlier been given the nursing home file, is now making unannounced visits to homes across the province, in addition to her continuing talks with families, employees, associations and operators. Smitherman, who noted that he, too, will make surprise visits to homes, said he expects her report to be filed within two months.

It is Smith's report that will create the blueprint for the revolution that Smitherman promises. But many are wondering whether he'll solve the system's most challenging problems.

Among the key areas that need fixing:

Ontario no longer has a standard for daily care — The previous Conservative government removed the regulation that gave residents 2.25 hours of daily personal care. Even that level was the lowest in 11 jurisdictions studied across North America and Europe .

Standards would ensure each resident is given enough time for personal needs, whether it is a bath, regular diaper changes or a walk around the building to maintain their mobility.

Hiring more workers — Donna Rubin, CEO of the Ontario Association of Non-Profit Homes and Services for Seniors, said the government must increase its funding (the ministry pays the homes $2.1 billion a year in operating costs) to add more staff, thereby increasing the levels of daily care for residents.

Rubin and Karen Sullivan, executive director of the Ontario Long Term Care Association, which represents mostly for-profit homes, say another $420 million is needed to bring Ontario up to the levels of daily care that Saskatchewan residents received in 1999.

Training — There is no requirement from the ministry that front-line nursing home workers have any formal training to work with the elderly. Most workers take a three- to five-month college course. Many are not trained to care for the complex needs of residents with dementia, who, for example, lash out violently when they are startled or rushed by staff.

As well, many homes are hiring more front-line staff as a cheaper alternative to the more expensive, but better trained registered nurses, or registered practical nurses. The former Conservative government also removed a regulation requiring an RN be on the premises 24 hours a day.

Family councils — Lois Dent, president of Concerned Friends of Ontario, the province's chief advocacy group for nursing home residents, was disappointed Smitherman didn't include family councils in his announcement. "I'd rather see the resources from a hotline go into family councils, to get the community working inside the homes."

Dent said a pilot project costing $145,000 a year helped create 154 family councils over the last three years. She calls them the "first line of defence" for nursing home residents.

Enforcement — Despite the thousands of records the ministry collects on nursing homes each year, it does little data analysis to help it target problem homes. As a result, elderly residents are left to live in sub-standard conditions for months and often years before the ministry takes hard action.

Transparency — Despite all of the data collected by the ministry, Ontario families have no way of knowing whether the home they are choosing gives good care. In American states, like California , public databases rate the homes based on indicators of good care, like the number of hours the home's residents are left in bed each day, weight loss, use of restraints and annual inspection results.

New Democrat MPP Shelley Martel (Nickel Belt) said there would be more opportunity for openness if the front-line workers were given whistleblower protection for speaking out about neglect and abuse.

"Too many residents don't have family to advocate on their behalf," Martel said. "It seems to me that if you really wanted a complaints system that works, you would bring in whistleblower protection and allow staff in long-term care facilities to raise concerns with the ministry with fear of reprisals."

Yesterday, Smitherman said that transparency of the system is key to his reforms.