Promises to fix long term care tepid despite 29 violent deaths

We hope they will take time to remember the 29.

Today the Ontario Health Coalition is launching their rocking chair tour across the province to draw attention to the lack of staffing in the province’s nursing homes.

Lack of staffing means missed baths, long waits in soiled incontinent pads, rushed feedings and too little time to pause for a friendly bit of conversation with a frail and often isolated senior. It also means danger.

Between 2003 and 2012 there were 29 seniors killed in resident-on-resident assaults in Ontario’s nursing homes.

Last year it was Francisco DaSilva and Jocelyn Dickson. He was age 87, she 72.

There are numerous remedies that have been proposed, including better staff training and specialized facilities for persons with cognitive impairment.

Every report that has looked at the situation has come back with a recommendation to increase staffing in these homes.

The Canadian Institute for Health Information reports that three-quarters of Ontario’s long term care residents are either totally dependent or require extensive assistance with their activities of daily living. Just over three-quarters are cognitively impaired, while one-third have responsive behaviours and over half show signs of health instability.

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) says 11 per cent of residents in Ontario long-term-care homes are aggressive. That works out to be about 8,500 individuals in these homes.

As a Toronto Star editorial glibly states, “the final years aren’t looking very peaceful.”

Nursing home owners, union leaders and seniors’ advocates have formed a new coalition to campaign on this issue. The Staffing Alliance For Every Resident (SAFER) is pushing for four hours of care per resident per day based on average acuity.

If that sounds like a lot, consider a groundbreaking and comprehensive U.S. government study recommended that a daily minimum of 4.1 hours of total nursing time (including personal support workers) is required to avoid common quality of care problems. Those problems include bedsores, weight loss, and loss of bodily functions. That was back in 2002.

Since then the demand for Ontario’s nursing home beds has completely outstripped supply. That means only those who are of the highest acuity levels are being admitted.

Assigned the job of coming up with a Seniors Strategy for the province, Dr. Samir Sinha said in his 2012 report “over the last three years, the care needs of those being admitted to long-term care have risen substantially, so that long-term care homes are now increasingly meeting the needs of the very frail older adults who cannot be cared for elsewhere.” (emphasis added).

At the moment we have an election campaign taking place in the province.

None of the parties are currently promising any substantial change to address this problem.

The Wynne government announced back in March it would be adding 75 Nurse Practitioners (NPs) into the staff mix of Ontario’s more than 630 nursing homes (or less than one NP for every eight homes). We’d be curious to know if they found even that few – there is a considerable shortage of NPs in the province. Health Minister Deb Matthews said she’d like to add 500 more – a number that represents about 20 per cent of all NPs in the province. The only way she is going to recruit that many is to create even greater shortages in other sectors, including the multi-disciplinary primary care sector which is already facing NP vacancies that leave nearly one in five positions vacant.

To their credit, the Wynne government has also substantially increased the number of nursing home inspectors, albeit none of them have contracts that will guarantee them any more than a year’s employment.

The NDP say they will add 1,400 new beds – a 1.8 per cent increase on the existing 77,000 beds. Given almost 20,000 seniors waiting for a bed of choice, this is more than a little underwhelming.

The Tories say they will make more beds available by relying more on home care – showing they completely do not understand who the residents are in these homes. Did they not read Dr. Sinha’s report?

There is no question this is going to cost a lot of money to fix. To reach the magic number of 4.0 hours of care that SAFER is seeking, it means about a 25 per cent increase to the existing front line staffing mix.

Keep in mind per capita funding for long term care in Ontario is 58 per cent of what they spend in Manitoba.

The question is, would we instead rather take the latest round of tax cuts on offer by both the federal and provincial Tories?

Sooner or later we all get old.

Many of us will someday end up in one of these homes.

Ontarians should think very carefully about this.

The Ontario Health Coalition is touring a giant rocking chair around the province for the next few weeks to draw attention to this issue. Check out our activist’s calendar (at right) for dates, locations and times.

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