Canada:
Nursing Homes Getting Surprise Checks
by Moira Welsh, the
Toronto
Star
January 23, 2004
![](nursin13.jpg)
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.
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