We all remember former Health Minister George Smitherman tearfully promising a revolution in long-term care.
That revolution never really happened.
Now we’re beginning to wonder if modest gains made during the Smitherman years are now beginning to be reversed.
It’s been a while since the Ministry has offered us their estimate of hours of direct care nursing home residents are actually receiving. The most recent Ministry data we could find is from 2009.
Nursing homes have received a modest increase in funding this year – the largest amount going to the accommodations envelope (although the biggest percentage increase was for raw food). The smallest percentage increase went to direct care.
Last week Edgewater Gardens in Dunnville gave notice that they are reducing scheduled registered practical nurse (RPN) hours by 75 hours weekly effective February 15, 2013. The non-profit home adjacent to and operated by the Haldimand War Memorial Hospital, is putting a small portion of that back in the form of additional personal support (PSW) hours. The home says it is doing so to be “fiscally responsible,” meaning it’s about money, not about reorganizing the home to improve quality.
The net effect is that there will be about 8-9 minutes less care per day available to residents in the small 64-bed facility. It also means that the home’s registered nursing staff will be spending more time administering medications.
While some may argue that the cut is relatively modest, we were supposed to be marching towards higher levels of bedside care, not less.
Ontario is still nowhere near international staffing standards. According to an industry task force report earlier this year, present average daily hours of direct care per resident per day based on average acuity is 2.9 – far less than the 3.5 recommended by a landmark 10-year U.S. Senate study conducted in the 1990s. Not-for-profit, municipal and charitable homes provide higher average levels of staffing than their for-profit counterparts. Ontario also has the highest percentage of for-profit beds in Canada at 57 per cent.
In May of this year the long-term care task force on resident care and safety concluded that “there are not enough direct-care staff to meet the needs of all long-term care residents safely.” The task force recommended that the Ministry implement recommendations to strengthen staff capacity from the May 2008 Sharkey report.
Cuts in staffing come at a time when the complexity of residents is sharply on the rise. The task force reports that 83 per cent of residents had high or very high assessment scores in 2010/11 compared to 72 per cent in 2007/08. Currently more than half of Ontario’s long term care residents are 85 years of age and older with multiple co-morbidities.
Many argue acuity levels have risen considerably since the U.S. Senate study and that Ontario should be setting a target in excess of four hours of direct care daily, not 3.5.
If cuts to nursing home staffing aren’t enough of a recipe for disaster, the government is also reinterpreting the requirement for an annual inspection under the Long Term Care Act. Whereas an annual inspection was once considered a detailed inspection of the home, the Ministry is now interpreting any complaint-related visit by an inspector to fulfill that role.
Given inspectors are instructed to focus only on the complaint, this makes residents all the more vulnerable, particularly those who cannot speak for themselves and/or do not have the support of local family members.
According to the spring task force, about one in five complaints the inspectors receive reflect the highest level of harm – “the improper or incompetent treatment or care of a resident resulting in harm or risk of harm to the resident.”
Staffing is one of the key determinants for abuse and neglect in a long-term care home.
The last posted inspection report for Edgewater was in 2010.
Clearly any net cuts to front line staffing in Ontario’s long term care homes should be a red flag for the Ministry and the Local Health Integration Networks.