Seniors’ Care: What a difference an Ombudsperson can make

In February the British Columbia government received a 216-page report on seniors care. In it are 176 recommendations covering home care, assisted living and residential care. It is the second major report on senior’s care in that province since 2009. Both reports were investigated and prepared by the BC Ombudsperson.

BC walks the talk on integration: the Ombudsperson includes many recommendations to bring consistency to seniors’ care in that province.

It also makes important recommendations around mandatory staffing standards — something Ontario has resisted for years. The BC Ombudsperson pointed out the inconsistency between the province’s handling of vulnerable seniors and vulnerable children, of which there are measurable staff-to-children ratios for child care facilities but not for seniors’ care.

The BC Ombudsperson says the regional health authorities were asked to work towards a staffing level of 3.36 direct care hours per resident per day, but failed to achieve it despite a new residential rate structure that was introduced in 2010.

By comparison, Ontario maintains that its nursing homes have an average of 3.0 hours of care per resident per day, but Ontario counts paid hours, not direct care hours. Nor is any of this made mandatory by legislation.

As the BC Ombudsperson points out, “measuring the hours that staff provide direct care is more precise than measuring the number of staff hours because it accounts for the fact that not all staff provide direct care, and the even those who do also have other duties to perform.”

In Ontario the Ombudsman’s office is shut out from investigating long-term care homes. Andre Marin points out that the Ombudsman has authority over long-term care in most other provinces.

He also states that the Quebec Ombudsman reported in her annual report that interventions by her office led to 15 recommendations to reduce the risk to seniors of injuries and death from exposure to overly hot water.

While Marin says he cannot investigate Ontario’s nursing homes, he can investigate the Ministry’s long-term care accountability process. In 2010 his office issued a special report that found four areas of concern, including inconsistent application of the standards used to monitor long term care homes, delayed inspections, less-than-rigorous investigation of complaints, and inadequate public reporting of compliance.

His report notes that there has been some progress made – including the new more rigorous inspections process. The problem is, since 2009, only about 80 of Ontario’s 641 homes have received this new inspection. Further, the inspectors say each unit office is setting a target of two per month, which means it will be more than five years until all homes can receive one.

Most jurisdictions require more frequent inspection. In BC inspections can range between 12 and 18 months, although the Ombudsperson is recommending greater consistency within that range. If the home is considered “high hazard,” that inspection regime gets shortened to every three months.

Health Minister Deb Matthews has muddied the waters by suggesting some homes may never receive this new stepped up inspection process, that inspections would be based on complaints and critical incidents. If a home gathers few of each, they may never see a full resident quality inspection.

Not surprisingly, when we raised this issue last week, the Ombudsman was among those retweeting our story on the web. Clearly there is much more work to do and the Ombudsman does note that this “continues to be a work in progress.”

Yet the Health Minister continues to defend the present system rather than acknowledge the work left to do. Does that mean she has dropped this file?

Last year Marin said he received 2,539 complaints in the so-called MUSH sector – Municipalities, Universities, School Board and Hospitals — including 19 about long-term care homes. These complaints are outside the Ombudsman’s authority.

Within his jurisdiction, 616 cases were received regarding the Ministry of Health and Long Term Care and its related programs. That includes 81 on the Niagara Health System, which came under the jurisdiction of the Ombudsman’s office after the Ministry appointed Kevin Smith as supervisor of the hospital. When a supervisor is appointed, the hospital is legally being operated directly by the Ministry of Health and Long Term Care.

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