Zero tolerance for abuse and neglect? Hardly.

Health Minister Deb Matthews talks about zero tolerance of neglect and abuse in Ontario’s nursing homes. Her actions would suggest the opposite.

Yesterday Matthews said that inspection of long-term care homes will be based on complaints and critical incidents only. If the home doesn’t get complaints or critical incidents go unreported, it doesn’t get inspected.

This is despite a requirement in the Long Term Care Homes Act that requires an annual inspection of each home.

Jane Meadus of the Advocacy Centre for the Elderly says the intent of the Act was that each home would receive an annual resident quality inspection (RQI) – a detailed inspection conducted by a team of specialists, including an RN, a dietitian and an environmental inspector. An RQI can take as long as 17 days to conduct.

Now the Minister is backtracking on that promise, saying only problem homes will receive an RQI.

The inspectors said earlier this week that their offices were setting a target of two RQIs a month. With five offices, that’s 10 a month, or 120 a year. There are 641 nursing homes in Ontario, including temporary ALC (alternate level of care) facilities.

At that rate it would take more than five years to visit them all. Deb Matthews says that’s wrong – many homes will never receive an RQI.

By making the inspection regime dependent on complaints and critical incidents, the province is relying upon residents, family and staff to understand the compliance rules in the new Act.

She is also relying on a resident population with high acuity needs to be able to speak for themselves. A resident in pharmaceutical restraints and with no family to advocate for them is now responsible for lodging their own complaint. This is not likely to happen.

It also means that effectively Ontario is waiting for residents to be abused, neglected or placed at jeopardy before they will act. And at that, only the most serious cases will be investigated in a timely manner. Most complaints will linger for months given the shortage of inspectors.

Matthews includes staff of the homes among potential whistleblowers, yet whistleblower protection exists more on paper than in reality. Diane Shay, a nurse who worked for the City of Cornwall, was fired after blowing the whistle on an abuse case in one of that city’s long term care homes. The firing followed a six month stress leave after she was harassed by her boss for her actions. She was eventually reinstated and the City was fined, but the case highlighted the ordeal legitimate whistleblowers face.

Deb Matthews takes issue with our figure of 74 inspectors. She says there are 81, but not all of these inspectors are doing inspections. Further at least one is off on long-term disability, at least four have been seconded to special projects and assignments, and each of the five offices has a lead inspector who can only spend 50 per cent of their time in the field. The inspectors also rotate through the position of duty inspector at each office, taking another five inspectors out of the field daily.

Seven short-term contract inspector positions were created in 2010/11, but these positions are instead going to be used for a Central Intake and Triage Team (CIATT) based in Hamilton. While a central intake facility is needed, these will not be inspectors in the field. The positions are only now being posted.

The province’s financial woes are likely at the bottom of this ordeal. Clearly there are not enough resources to fulfill the terms of the Long Term Care Homes Act. Rather than make it a priority, Matthews is sidestepping her obligations by reinterpreting what the Act really means.

Zero tolerance? Hardly.

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