Category Archives: Health System

“Care as a relationship” is key to good long-term care: research

What are long-term care residences around the world doing right?  That’s the question an international research team travelled across North America and Europe to find out.

Led by Pat Armstrong and Donna Baines, researchers visited nursing homes in Canada, Germany, Norway, Sweden, the United Kingdom and the United States, looking for practices that make long-term care centres feel like home to their residents.

diablogue fotoTheir findings won’t surprise long-term care workers. Good long-term care means building strong care relationships between residents and their care providers. Strong staffing levels, good working conditions, secure jobs, proper levels of public funding, full-service kitchens with in-house food service staff, and sensible standards – not onerous bureaucratic one-size-fits-all rules – lead to excellent care for residents.

The research by Armstrong and Baines resulted in a highly-readable, information-packed book called Promising Practices in Long-term Care: Ideas Worth Sharing (2015). A collection of short and moving vignettes from 13 long-term care homes is accompanied by solid statistics and eight recommendations for promoting care as a relationship. (Download it free here.)

Removing private profit leads to better care

The researchers found that non-profit nursing homes with adequate public funding were more likely to have better working conditions.  The links between good working conditions and strong care relationships with residents are obvious:

  • Adequate staffing levels ensure that staff have time to interact with residents;
  • Permanent, secure jobs with stable work schedules help residents get to know regular staff who care for them at predictable times;
  • Paid sick leave allows staff to rest when sick and avoid infecting residents at work;
  • Good wages, hours of work, benefits and pensions reduce staff turnover, which ensures continuity of care;
  • De-emphasizing excessive paperwork and charting allows staff more time to interact and socialize with residents;
  • Offering staff continuing education increases their ability to provide quality care for residents;
  • Having all services provided by in-house staff instead of contracting it out (e.g. food service, cleaning and laundry) results in better quality and more personalized care for residents.

These findings are in line with a recently-published study by the Journal of Post-Acute and Long-Term Care Medicine showing that for-profit nursing homes in Ontario have 16 per cent higher death rates and 33 per cent higher hospitalization rates than non-profit facilities.  For-profit homes also have higher rates of falls, incontinence, and use of restraints.

Focus on good food

The way to our hearts may not be solely through our stomachs, but good food makes a big difference to quality of care, Armstrong and Baines found.  Many of the promising practices in their book revolve around food.

Time and again, they found that long-term care residences where all meals are prepared, cooked and served onsite by their own staff provided much better meals, and better overall care for residents, than those who contract out food services.

When food is cooked onsite, residents can smell it cooking. It stimulates their appetites and makes them look forward to meals. Directly-employed food service staff get to know individual residents’ likes and dislikes. They interact with residents at meal and snack times, creating another continuous care relationship.

When food service is contracted out, strict meal times must be observed because contractors enter and leave at set times. But when in-house food service staff have food available all day long, or even 24 hours per day as it was in one residence in the book, there is no pressure for all residents to eat at exactly the same time.

This takes a lot of pressure off of other care staff as well. Care relationships are built through conversations and exchanges during and in between routine care tasks. In homes with flexible meal times, personal support workers don’t have to rush through care routines to get residents to the table by a set time.  That leaves time for relationship and trust-building.

In a care home in Germany, residents were even encouraged to help with the food preparation as they were able, with food service and personal care staff nearby to assist when needed.  This created a social atmosphere between residents and care staff, and fostered residents’ independence.  In a residence where food preparation and service is contracted out to private companies, this kind of interaction doesn’t have a chance to happen.

Time to care: Relationships over bureaucracy

Decreasing staffing levels lead to lower quality care, which then leads to bureaucratic rules requiring excessive documentation and the regulation of what should be common sense.

Personal support workers in Ontario often have to do well over an hour of routine charting every day – time they could spend assisting and interacting with residents.  In contrast to this, one Manitoba nursing home visited by the research team “charts by exception” – in other words, they only document occurrences that are out of the ordinary or things they specifically need to track.  This gives them time to build care relationships with residents.

In the nursing homes visited in Germany and Sweden, there was a greater focus on putting “more life into days than extending the days of life.”  A certain level of risk is accepted in exchange for quality of life.  Residents engage in activities that encourage independence, like food preparation using knives, or walking about instead of being pushed in wheelchairs. Residents with dementia who wander are watched and redirected by staff instead of being restrained or locked in. Staff have time to sit and talk with residents, meeting their socialization needs, not just their personal care needs.

But these practices require a high ratio of staff to residents.  The German nursing home above had staff to resident ratios as high as 1:3. In Ontario, there are no regulations for minimum staffing levels to ensure that other regulations are met, such as the provision of toileting assistance, repositioning, and other types of assistance.  Some Ontario PSWs are responsible for up to 42 residents at a time.

Good care also requires more staff time per resident. On average, residents in long-term care homes in Ontario currently receive the following:

This is well below the four hours of direct care per day that the Ontario Association of Non-Profit Homes and Services for Seniors recommends.

According to Armstrong and Baines, high quality long-term care could be the norm instead of the exception in Canada, if we had the desire and political will to make it happen. It will require a culture shift – a move from thinking of care for seniors in terms of a business model, to thinking about what long-term care residents need in order to live fulfilling, dignified lives.

Relationship-building cannot be legislated.  But we can create the conditions under which care relationships can thrive by setting minimum staff ratios and care hours per resident, creating better working conditions for staff, committing to strong public funding and removing the profit motive from long-term care.

Press conference aborted after doc asks question about cuts to refugee health plan

University Health Network CEO Bob Bells tried to apologize after a doctor and a medical student interrupted a press conference by Federal Natural Resources Minister Joe Oliver at the Toronto General Hospital yesterday.

Is this really Dr. Bell’s role?

The doctors vow to “interrupt” the Harper government over their cuts to the Interim Federal Health plan for refugees to Canada due to take place June 30.

The cuts remove so-called supplemental health services from newly arrived refugees, the Harper government stating that these are not services normally covered for most Canadians. This is not entirely true.

In fact, similiar health services are normally made available to Canadians on social assistance. Most refugees arrive in Canada without money for dentistry, drugs and other non-insured services.

As Dr. Chris Keefer states in the video, these are similiar to services available to Ontario Works recipients.

CBC’s clip of the aborted news conference is below:

 

Read about the open letter sent by AMMI Canada regarding the Harper cuts.

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Frail and elderly asked to pay more in Ontario

Frail and elderly residents in Ontario’s nursing homes may be paying in more ways than one for the province’s budget shortfall.

While Health Minister Deb Matthews is holding the line on increases to long-term care funding to 2.8 per cent (only 1 per cent dedicated to direct care), she is asking residents to kick in a lot more than that.

On May 30th the Ministry issued a bulletin to say the basic co-payment rate is increasing by $1.81 per day. That amounts to a 3.4 per cent increase.

The premium rate is also increasing from an additional $8 a day to $9 a day for semi-private (8.8 per cent) and from $18 to $19.75 a day for private (9.1 per cent).

Depending on the accommodation level, that could mean a hike of between $54 and $106 per month.

This comes at a time when Deb Matthews is also holding the line on the Ministry’s complement of inspectors, who say they are so short-staffed that homes will be waiting as long as five years for a detailed inspection.

While business is being told to wait for another cut in their taxes, frail and elderly residents are being asked to pay more for their care.

A reminder of what we’re fighting for

OPSEU represents about 36,000 health care professionals and support staff who work in settings ranging from community mental health to large urban hospitals.

When it comes to this BLOG, we don’t hide our perspective as workers.

We hope that those who read our BLOG do so with the understanding that the stories we write about and the positions we advocate are with the intent of building a better public health system.

We are aware that not everyone shares that goal. Since Medicare was founded, there have always been those who would undermine it, and sometimes it makes for odd bedfellows in the opinion pages.

Sometimes we need to ask ourselves, are we building on Tommy Douglas’ legacy, or are we tearing it down by only pointing out the system’s weaknesses?

It was therefore refreshing to see a letter this week in the Windsor Star by health reporter Veronique Mandal that points out what we hear too seldom – for most of us, the health system still works.

“As a health reporter, I have written hundreds of stories about Canada’s health system – some were laudatory, many showed its shortcomings and failures,” she writes.

The public letter goes on to thank the “doctors, nurses, admitting and technical staff” at Windsor’s Hotel Dieu Grace Hospital who saved her life April 20. Mandal doesn’t specify what her medical emergency was.

Mandal says that “being rescued from the brink of death is a profoundly life-changing experience.”

At Diablogue we often write about hospitals being overcrowded, cuts to cleaning and its impact on infection control, unhealthy and inedible rethermalized food, poor performance scorecards and the perils of privatization. At the end of the day, however, most hospitals still score above 90 per cent in patient satisfaction surveys and Canadians are still embracing our public Medicare system.

For all the problems, we’re obviously still doing some things right.

This does not mean that everyone is getting the care they need, or as the province likes to rhyme off, we’re not finding the right care in the right place at the right time. Not yet.

Letters like Mandal’s do remind us what we are fighting for.

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Ontario budget “Republican-lite” — Roth

Ontario’s deficits have more to do with unsustainable tax cuts than they do with public spending says Dr. Reuben Roth, a Laurentian University sociologist.

Roth was speaking Tuesday night in Oshawa as part of a province-wide series of town hall meetings hosted by the Ontario Health Coalition.

“Ontario is no Greece and no Spain,” says Roth, “but we inherited two structural deficits from the Harris government.”

Laurentian University's Reuben Roth with Natalie Mehra

Laurentian University’s Reuben Roth with Natalie Mehra

Roth explains that tax cuts and high unemployment have contributed to the current deficit – neither of which are the result of spending on health care and public services.

Roth says the government even brags that Ontario spends the least on program spending than any other province in Canada.

“If we are the lowest, then why cut more?” he asks.

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Diabetes epidemic finds Health Canada more worried about fragile economic recovery

Apparently regulating fast food companies to improve population health is not an option for Health Canada, who recently told CBC News that the “fragile economic recovery” is an important consideration.

Health Canada was responding to a report by the Canadian Medical Association Journal which noted sodium levels were higher in Canada’s fast food outlets than their counterparts in other countries.

The Chicken McNuggets you eat in Canada have more than twice as much salt as the McNuggets in Britain. While Canadian fast food outlets brought in salads in response to growing health concerns, these salads have higher levels of salt than any other nation. Combined with high fat levels in the dressing, you might as well have had the fries.

This week ICES – the Institute for Clinical Evaluative Sciences — issued what is effectively a wake-up call on Ontario’s spiralling diabetes epidemic. Hint: there may be a connection between these two stories.

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Austerity costly to UK economy – is Ontario headed the same way?

The McGuinty government is big on British policy imports, from the costly public-private partnerships to his recent mania for austerity.

If you want a preview of what’s going to happen in Ontario, look to Britain.

This week it became official. Britain is back in recession after having two consecutive quarters of negative growth.

Since the austerity-minded Cameron government came to power in 2010, net growth in the British economy has only been an anemic 0.4 per cent. During the last two quarters Britain’s economy has shrunk by 0.2 per cent – this at a time when they had been predicting modest growth.

While cutting taxes at the top end of the scale, Cameron’s belief in “trickle-down” economics has led to considerable criticism of his economic policies, Cameron himself described as “speaking for the few.”

Like Ontario, Cameron’s government is implementing the harshest public sector cuts in a generation.

Sound familiar?

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