Category Archives: Long Term Care

In today’s Toronto Star Christina Bisanz, chief executive of the Ontario Long Term Care Association – which primarily represents for-profit nursing homes – said Ontario leads most provinces in improving the quality of long term care thanks to new legislation aimed at making care uniform. Bisanz says that includes legislated minimum staffing levels. Oh yeah? That would be news to us.

For some time OPSEU has been among those calling for a minimum staffing standard of at least 3.5 hours of direct care per resident per day based on average acuity.

The call for 3.5 hours was recently reinforced by a new report from the Institute for Research on Public Policy. The IRPP report notes there is a significant quality gap between for-profit and not-for-profit long term care homes.

The report’s authors, Magaret McGregor and Lisa Ronald, write in Monday’s Globe & Mail: “We have reviewed Canadian and U.S. research evidence on the link between ownership and care quality and concluded the contracting out care to private, for-profit facilities is likely to result in inferior care compared to the care delivered in public and non-profit facilities.”

The authors say studies have consistently found for-profits have lower nurse staffing levels compared to their not-for-profit counterparts. If we had a minimum standard of care that was applicable across the province, then Bisanz might begin to have a point.

The OLTCA has in the past called for a minimum of three hours of care per resident per day. In 2008 they were quick to point out that Ontario facilities offer residents about 2.6 hours of care per day, while in the rest of the country that average varies between three and 3.5 hours of daily care.

Did the OLTCA actually forget the Ontario government has still failed to deliver on what everyone from the Ontario Mental Health Association to the Ontario Health Coalition has been asking for – a minimum staffing standard that reflects the needs of Ontario’s long term care residents?

To read McGregor and Ronald’s full study, go to

http://www.irpp.org/pubs/IRPPstudy/2011/IRPP_Study_no1.pdf

This week Ontario Finance Minister Dwight Duncan showed that he was listening to labour, if not quite getting the point.

When labour pointed out relatively low-wage nursing home workers would be suffering under a wage freeze while their for-profit CEOs and shareholders would not, Duncan suggested the government might ask the for-profit nursing home bosses to also freeze their wages.

That would include CEOs such as Extendicare’s Tim Lukenda, whose compensation last year was $1.5 million from the $200 million the government paid out to his nursing home chain. His counterpart at Chartwells, Brent Binions, might make the case that he would suffer more being frozen at his measly $697,000 per year in compensation. After all, hydro bills have sharply increased.

Duncan told the Globe and Mail “we have spoken about fairness and everybody working together. In that context, the unions make a very valid point.”

With a growing income gap between rich and poor in this province, labour has made a stinging point about who will really be affected by wage restraint. While for-profit companies receive tax breaks that pad their bottom line, workers will be once again asked to sacrifice.

The Central East LHIN is blaming the long term care homes for the current lack of nursing home beds, suggesting at the LHIN’s June 15 board meeting the industry filled the last bed expansion with healthy seniors who didn’t need to be admitted.

The blame comes amid conflict between the LHINs and the for-profit long term care association. The LHIN reports that the association has instructed its membership not to sign accountability agreements with the LHIN pending a fight over disclosure of the nursing homes’ finances.

Remarkably, despite significant public funding, the province has never been able to get audited financial information from the nursing homes. The for-profit industry has maintained that this is proprietary information. Paul Barker, a senior director with the LHIN, said the province has tried to get this information for 20 years.

Further, CE LHIN CEO Deborah Hammons told her board that the province was pressuring them to keep long term care performance requirements to a minimum for now. The LHINs are interested in the rate of referral of residents in the homes to hospital emergency rooms.

Barker said the industry was opposed to the addition of 20,000 new beds built by the McGuinty government. They were worried the new beds would result in their occupancy rates falling, leading to cuts in funding from the province.

Barker says the concern over occupancy rates led homes to fill their beds with healthy individuals who would not normally be admitted. The impact of the new beds was nullified by this action. Given seniors usually divest themselves of their residences prior to entering a nursing home, there is no way to now clear these beds for more acute residents waiting for access.

Now the LHINs are engaged in a game of “chicken” with the nursing homes. Without signed accountability agreements, the LHINs would be within their rights to stop public funding to these homes. However, at a time when nursing homes in the LHIN are at maximum occupancy, the industry maintains the upper hand.

Given the cheques flow from the Ministry, not directly from the LHIN, it is doubtful whether Queen’s Park would be willing to turn off the funding tap if the LHINs did ask.

Meanwhile, new regulations are expected to “rectify” the spousal reunification policy, pushing spouses further down on the waiting list for beds. The previous policy often admitted spouses before more acute patients in need of a bed. The new regulation is expected to come into effect July 1st.

The Central East LHIN reports that the lack of long term care beds is the biggest driver in high numbers of “alternate level of care” (ALC) patients residing in the region’s hospitals. Peterborough’s new hospital is reported to have the highest number of ALC days while Campbellford has the highest percentage of ALC patients taking up beds at the hospital. The Central East LHIN has the second highest percentage of residents over 75 in Ontario.

The Central East LHIN acknowledged lengthening wait lists for long term care, but said these long waits were only for patients waiting at home. There was no wait for patients being transferred directly from hospital, they said. Given the LHIN has a “home first” policy; many of the patients waiting at home would likely have come from the hospitals.

At the beginning of the June 15 board meeting, Peterborough-area board member Stephen Kylie tried to introduce a motion to require the LHIN to do a comprehensive analysis on the long term care situation given the pressures on his local hospital. Board Chair Foster Loucks persuaded Kylie to treat the initiative as a notice of motion to be dealt with at the next meeting.

Despite its significant impact on the lives of seniors, Ontario’s new Retirement Homes Act took a little over 60 days from introduction to passage through the legislature June 2nd. In the rush, only one day of hearings was set aside to listen to citizens concerned about its impact. When OPSEU presented, the committee appeared distracted to the point of MPP Paul Miller having to assure our presenters that the politicians were, in fact, listening.

Despite a last ditch effort to encourage MPPs to vote down the bill and take the time to get it right, both the Tories and Liberals voted to pass it this week, with only the NDP casting votes against it.

Bill 21 is about saving the government money. Unlike long term care homes, the care in retirement homes is not paid for as part of our Medicare system.  The only exception to this is for alternate level of care patients transferred from hospitals. These patients are still effectively covered under the more extensive rules governing nursing homes.

Retirement homes were intended to be rental accommodations for seniors who are able to manage and pay for their own care. They are mostly designed for seniors who need minimal to moderate support with their daily living activities.

More and more our OPSEU members in these homes are telling us that the level of acuity of these residents is on the rise, requiring much more intensive levels of support they simply cannot provide. Increasingly, those who cannot find a bed in a nursing home are winding up in these facilities.

Instead of drawing a line in the sand, the new Retirement Homes Act essentially opens the door to retirement homes becoming a second tier of nursing home care. If you are rich, you can pay for enhanced services and find a bed right away. If you are of more limited means, the financial burden may be crushing and the level of care can be completely inappropriate.

We reported here yesterday that the North Simcoe Muskoka Local Health Integration Network has said there are no plans for new nursing home beds in that region despite a 98.8 per cent occupancy rate.

Why is that? If seniors are kept on long waiting lists for nursing home beds, cannot get access to adequate home care, and are pressured to leave a hospital anxious about the number of “alternate level of care patients” (ALC) occupying scarce beds, families are more likely to pay for that second tier of accommodation in a retirement home if they have the means. The average total monthly cost is $2,750 for a standard retirement space and $3,440 for a heavy care space.

What they get will be a crap shoot. With the new legislation, retirement homes do not face the same level scrutiny nor have the same level of regulation as a government-funded long term care home.

According to the Ontario Health Quality Council, wait times for long term care have tripled since 2005. The average wait is 105 days. Those waiting for placement from home are averaging a wait of 173 days – or about six months.

The new oversight body created under Bill 21 will not be much help. The Retirement Homes Regulatory Authority is not a government agency, but a third-party primarily made up of major stakeholders in the retirement home industry. Given it will be self-appointing, there is little doubt the group will represent the interests of providers, not consumers.

The new legislation may actually backfire on the province. With more than half of the present long term care nursing home beds being provided by for-profit corporations, there will be much incentive to turn these homes into lightly-regulated retirement facilities.

While Ontario continues to maintain it doesn’t need staffing standards in its nursing homes, yet another jurisdiction has recognized the need to increase staffing standards to ensure the safety and good care of its residents.

The State of Illinois has announced it will increase nursing home care from 2.5 hours per resident per day to 3.8 hours by 2014.

Illinois has also doubled the number of inspectors — hiring 180 more for the 800 nursing homes in the State.

In Ontario, seniors advocates and labour unions have long campaigned to establish a standard of 3.5 hours of care per resident per day. In the last election then Health Minister George Smitherman had promised a staffing standard was coming. During an election forum, Smitherman said St. Elizabeth Healthcare CEO Shirlee Sharkey had been appointed to make recommendations around what that level should be. Consulting with stakeholders, including the for-profit industry, Sharkey instead recommended against bringing in such a standard.

Ontario has historically had among the worst nursing home staffing levels in North America, leading to numerous scandals and coroner’s inquests.

The Ministry of Health is launching a system funding review for long term care homes. In a communiqué distributed through the Local Health Integration Networks, the Ministry reports that the review will address “many historic issues that require complex solutions rather than ad hoc adjustments.” The Steering committee for the review is co-chair by Deborah Hammons (CEO, Central East LHIN) and Cristina Perez (Director of the Investment Planning and Management Branch). Issues include clarifying definitions around existing funding envelopes, examining the impact of changes to accommodation charges, and finding a way to amend the existing funding system in the short-to-medium term. While the review claims it has representation from stakeholder organizations, there is no representative of front-line staff on the committee. The review is taking place at a time when the homes are also establishing accountability agreements with the LHINs.

The Ontario government’s plan to increase staffing levels in the province’s long term care homes cannot achieve its goal says two U.S. experts in an upcoming report commissioned by the Ontario Health Coalition.

The Ontario government reneged on its promise to bring in staffing standards after the last election, instead hiring Shirley Sharkey, a home care CEO, to make recommendations for the nursing home sector.

Sharkey’s May 2008 report, People Caring for People: Impacting the Quality of Life and Care of Residents of Long-Term Care Homes, suggests increased funding and voluntary staffing standards to be established by each home.

Toby Edelman, a senior policy attorney with the Washington-based Center for Medicare Advocacy, and Charlene Harrington, professor emeritus of sociology and nursing at the University of California, will argue in their report that such voluntary reimbursement-based approaches have been tried in their country for more than 20 years without success.

The full report is expected to be publicly release soon.

In December OPSEU members joined the Ontario Health Coalition in meetings with members of the McGuinty cabinet, bringing with them advance copies of the report.

Despite a series of well-publicized incidents that had the public calling for tighter regulation of Ontario’s long term care homes, proposed regulatory change has mostly involved the loosening and removal of many such regulations.