Long term care: We told you so

Earlier this year the Ontario Health Coalition along with several community and labour representatives (including OPSEU) met with senior officials at Ontario’s long term care performance and compliance branch.

We asked a number of questions, most of which they could not answer at the short meeting. Instead they suggested that if we write down our questions, they would send us the answers.

We did, and got back no specific answers, but instead broad links to websites that have hundreds, if not thousands, of pages. The suggestion was the information was out there, we just had to dig for it — the proverbial needle in a haystack.

A few years ago a similar group met with Tim Burns, who at the time was the Director of the Performance Improvement and Compliance Branch.

We specifically addressed the problems of incontinence pads being rationed in long-term care homes – one of the issues raised in today’s Toronto Star.

You may remember us publicly raising questions around the indignity of Ontario’s seniors having to wear these garments until they reached to so-called blueline, a line the manufacturer claimed was the point in which it should be changed. We pointed out that to reach the blueline, the incontinence pad would have about five pounds of urine in it. Regulations call for such products to be clean and dry.

Burns promised us some very limited action on the charges that homes were rationing these products, including writing a letter to the homes to remind them that regulation prohibits such rationing, that incontinence products shall be freely available 24/7 to staff working in the home.

A week later we received a letter indicating Burns did not believe this to be a problem. He would not follow through on the very basic initiatives he had promised us at the meeting.

This wasn’t the first time labour raised this question. During the 2008 election the issue had even made the front page of the Toronto Star.

To say that senior managers at the compliance branch have an attitude problem is an understatement. This latest salvo is just more of their demonstrated contempt for labour and other advocacy groups who are simply trying to do better by Ontario seniors.

And yet these senior managers are the government’s appointees to enforce the rules in long-term care.

There is the appearance of a cozy relationship between the Ministry and the owners of the long-term care homes. The Ministry maintains a website for them – one which the public is prohibited from gaining access.

Those who have seen the web site say that most of the information should be reasonably available to the public. The labour/community group that recently met with the compliance branch asked, as stakeholders, whether we could get access. We’re still waiting.

The last two CEOs of the private Ontario Long Term Care Association are well-known former senior bureaucrats. When Health Minister Deb Matthews meets with them, she should encounter a familiar face from her own ministry.

At a recent meeting of the Ontario Health Coalition’s long term care committee, there was concern that the Ministry was not providing enough inspectors. While there is a new inspection regime in place, the investigation of so many individual complaints has meant that many of Ontario’s long term care homes have gone without annual inspections since 2009.

This week the Toronto Star is running yet another series on the deplorable situation Ontario’s long-term care residents find themselves in, including the story of an elderly resident who was raped at a Toronto long term care home.

One of the repeated points the story makes is the lack of staff resources in these homes.

In 2008 George Smitherman, then Minister of Health, told an election forum at the University of Toronto’s Hart House that there would be a minimum staffing standard. Many provinces and states already have some version of a staffing standard. Ontario is among the last to do so. Smitherman said he was waiting for the recommendations of his appointee – Shirlee Sharkey – before determining how that would roll out. Instead Sharkey recommended against staffing standards and the government listened – likely because that was the answer they were looking for.

At the time advocates were looking for a minimum of 3.5 hours of direct care per resident per day based on average acuity. This stemmed from a 10-year study by the US Congress on standards for long-term care homes. The report was influential everywhere but Ontario.

Ontario has argued that staffing has been as high as 3.2 hours of care, but labour has argued that the province was counting the time when staff wasn’t at bedside – such as vacation, sick days, and during administrative duties. The Ministry was also counting external providers who are not part of the regular care team. No matter how you count it, 3.2 still isn’t 3.5.

The US Congressional Study is now getting a little dated, especially given the “average” acuity in long-term care homes has been quickly rising. Ontario is driving that acuity up further by urging hospitals to push its so-called “alternate level of care” patients into long-term care homes.

The 3.5 average may have been acceptable over a decade ago, but it is likely not enough today.

There are many complex problems involving Ontario’s long term care homes, including a model that squeezes an already tight funding situation in search of profit to the private owners of more than half of the province’s stock of nursing home beds.

When it’s private, access to information is also much harder to acquire. And when information is harder to scrutinize… well just read the Star to find out the consequences.

Health Minister Deb Matthews says she is bringing in the Ontario Long Term Care Association and groups representing family and residents (but not front line workers or their representatives) to find out why nursing homes are still not following rules on reporting abuse and neglect.

She may also want to call in her senior officials at compliance to ask why they ignored the blatant warnings labour and community groups already provided.

6 responses to “Long term care: We told you so

  1. U all just worry about resident’s abuse, but who is there worring about workers abuse. We get bitten and yelled at everyday by residents, or receiving attitudes from families. Who will worry about us front line workers? Maybe our employer should, but as we all know, this people are suffering with dementia, ulzheimer, parkinsons..etc. , it is our job to be be ready for abuse. Majority PSW, Nurses, managers…etc. we all trying to do our best, so you as a newspaper need to start writting about something else then resident abuse. Noone want to abuse other human been unless even that worker is mentally sick. Please do not write in plurals about LOng Term Facilities and scaring elderly people away from them. Most of the Long Term Facilities are very good places to be, and these people are very well taking care of there. It is very upsetting for us front line workers to read articles like that especially for the ones what never raced the voice on any of those residents, and trying to do even more then we should for them. You need to get stories from both sides before you post articles, and that is not done. Just continue scaring elderly people, and you are the one who emontianly abusing them from letting them to be afraid of our facilities.
    Good luck taking care of them at home until the end of their life, or are you going to force them to go Nursing home? o no, u can do that it is against their wishes. So you all see now, how come u do not write about families what forcing the parents to go to nursing home.

  2. Thank you for posting this amazingly accurate assessment of the situation with long term care homes in Ontario. My mother lived for less than six months in a privately managed nursing home that was rife with internal issues between management and staff whom targeted and treated me as a troublemaker when I tried during daily visits with my mother to advocate for her best interests.
    How you describe the attitudes of the MOHLTC Performance and Compliance Branch senior management is spot on, and this I know from direct and discouraging experience.
    My mother died almost a year ago and I am still trying to get justice for her and for me regarding the neglect she experienced and the retaliation I experienced for having made complaints. The MOHLTC inspectors did not conduct a thorough or effective investigation into my complaints. They “lost” my initial complaint to the Action Line. They did not review my documentation or interview my witnesses to conversations and events, and essentially they exonerated the Home from having to take responsibility for the retaliation – which the Ministry dismissed – and left my mother and I completely unsupported in the situation and exposed to continued abuse.
    My mother became dehydrated at the nursing home and a week later she died in hospital. Her death in my view was completely preventable had anyone with the power to do the right thing listened to and acted upon my legitimate concerns and fears for my mother’s well-being, health and safety, and mine.
    The health Minister’s response to the Toronto Star’s investigative reports is an insult which only adds to the injury of the many people who have suffered at the hands of some powerful and well-connected long term care companies, some management and staff at these Homes, and even worse by the betrayal of trust of some of the MOHLTC inspectors and senior management and government officials.
    The Minister does not need to call an emergency meeting among all these powerful and influential groups and stakeholders with vested interests so they can all sit in on a meaningless task force for months talking about what everyone but them apparently already knows. Rather the Minister needs to go back to my letter of January of this year when I appealed directly to her and other senior ministry deputies and officials along with a compliance and performance manager pleading to them for justice for my late mother and me. She should ask herself why no one in her Ministry, including herself, is held accountable to the people she serves whose lives are deeply affected and irrevocably altered by the incompetence, dishonesty and heartlessness of the long term care industry and the government body with it appointed managers whom are supposed to oversee it, enforce its laws, and protect the most vulnerable from abuse, neglect and abuses of power.
    I’m certain I’m not the only person who has raised concerns both privately and publically about how this Ministry handles things, so it is more than suspicious and truly unconscionable for the Minister to plead ignorance about the cases of neglect and abuse that the Toronto Star has so recently and yet again exposed.
    It seems that the public keeps hearing from those involved with long term care, including the Minister herself, that there’s more work to do. Yes, and I would like to know when the necessary work finally will get done?
    The MOHLTC public reporting web-site for long term care homes is an embarrassment to this government or at least it should be in my view. My mother’s nursing home was listed as having been accredited which it was not. Many Homes were listed as such on the Ministry’s public reporting web-site which is misleading to the public. The public inspection reports are useless as a resource for anyone to determine if a Home is safe, or not. And why are not all Homes held to a high standard of care and accountability? Why should people have to choose between the “good” Homes and those no one wants to live in? Why will this government not establish and insist upon a minimum staffing standard of at least 3.5 hours?
    And yes, you’re right, we’re on the cusp of 2012 and yet this Ministry cannot conduct annual inspections or update its web-site in many cases for the past two+ years.
    We need this government to provide us with solutions, transparency, and accountability, not more idle talk. They need to act honourably by increasing the mandate of the Ontario Ombudsman to have the power to independently oversee and investigate long term care homes and hospitals. Until that happens many of us will have no faith in anything the Minister of Health and Long-Term Care and her allies and cherry-picked Resident and Family Council participants of an “emergency” task force will promise to do.
    The siren has been sounding for years!
    Catherine Richards
    Cause for Concern: Ontario’s Long Term Care Homes

  3. Zuzana — We understand your frustration. These meetings that we refer to are attended by our members who also work on the front lines of long term care. They too are frustrated by unreasonable workloads, rationing of supplies, and too few protections in the workplace. We can’t pretend there are not problems with abuse and violence in our homes — not just worker-on-resident, but resident-on-resident and resident-on-worker too. We know the overwhelming majority of long term care workers are trying to do their best in very difficult circumstances. Our goal is to make these homes not only a better place for our members to work in, but ones that produce better outcomes for residents too. If there is one thing that is abundantly clear — the people who work in our nursing homes care deeply about improving the lives of those in their care. Surely our seniors, after a lifetime of contributing to Canada, deserve to live out their final years in a safe and dignified environment.

  4. Great article!
    @Suzana: I have to say it worries me to read comments such as yours.
    by someone who works with and cares for the elderly, infirm and the disabled. I know for a fact that a worker has the option, if not the responsibility, to report any incidents of violence against their person. Not so for the elderly, vulnerable, communication challenged resident. Unless s/he has a witness and /or is able to speak and relay the incident to others or unless someone will do it for him. Where does s/he go? Instead of taking offense to these reports of abused or injured residents that are finally being given credence, one would expect that every LTC worker would be concerned for people and their families, both present and future.

  5. As a former employee of a nursing home, I was witness to the discouraging and demoralizing atmosphere that existed in a work environment when there was weak management at the helm. One of management’s roles is to foster professionalism and motivate positive attitudes in the workplace. But I found that too often, this role was hijacked by the ambition to have a good reputation in the community; managements’s tendency was to ‘blame’ workers when complaints emerged. During my period of two years working in the home, many workers were either let go or left work because management did not support them either through continuing education, mentor ship programs or meaningful recognition for their work. The onus is on management to provide the environment where open and honest communication is encouraged and expected in order to facilitate learning and team building. In my view, only a positive supportive workplace will foster a trusted, caring nursing home.

  6. Holy crow I have been looking for 6 months for a forum like this Catherine Richards I need to speak to you … please contact me andreamarcusworld@hotmail.com we should talk. it is almost impossible to get anyone to listen!!! I am shocked… and i thought I was alone. what about the people out there in those homes who have No One to speak for them.
    Elder Abuse in my opinion has more to do with what the homes Don’t do, than actual physical abuse.

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