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.