Category Archives: Ontario Health Coalition

“Care as a relationship” is key to good long-term care: research

What are long-term care residences around the world doing right?  That’s the question an international research team travelled across North America and Europe to find out.

Led by Pat Armstrong and Donna Baines, researchers visited nursing homes in Canada, Germany, Norway, Sweden, the United Kingdom and the United States, looking for practices that make long-term care centres feel like home to their residents.

diablogue fotoTheir findings won’t surprise long-term care workers. Good long-term care means building strong care relationships between residents and their care providers. Strong staffing levels, good working conditions, secure jobs, proper levels of public funding, full-service kitchens with in-house food service staff, and sensible standards – not onerous bureaucratic one-size-fits-all rules – lead to excellent care for residents.

The research by Armstrong and Baines resulted in a highly-readable, information-packed book called Promising Practices in Long-term Care: Ideas Worth Sharing (2015). A collection of short and moving vignettes from 13 long-term care homes is accompanied by solid statistics and eight recommendations for promoting care as a relationship. (Download it free here.)

Removing private profit leads to better care

The researchers found that non-profit nursing homes with adequate public funding were more likely to have better working conditions.  The links between good working conditions and strong care relationships with residents are obvious:

  • Adequate staffing levels ensure that staff have time to interact with residents;
  • Permanent, secure jobs with stable work schedules help residents get to know regular staff who care for them at predictable times;
  • Paid sick leave allows staff to rest when sick and avoid infecting residents at work;
  • Good wages, hours of work, benefits and pensions reduce staff turnover, which ensures continuity of care;
  • De-emphasizing excessive paperwork and charting allows staff more time to interact and socialize with residents;
  • Offering staff continuing education increases their ability to provide quality care for residents;
  • Having all services provided by in-house staff instead of contracting it out (e.g. food service, cleaning and laundry) results in better quality and more personalized care for residents.

These findings are in line with a recently-published study by the Journal of Post-Acute and Long-Term Care Medicine showing that for-profit nursing homes in Ontario have 16 per cent higher death rates and 33 per cent higher hospitalization rates than non-profit facilities.  For-profit homes also have higher rates of falls, incontinence, and use of restraints.

Focus on good food

The way to our hearts may not be solely through our stomachs, but good food makes a big difference to quality of care, Armstrong and Baines found.  Many of the promising practices in their book revolve around food.

Time and again, they found that long-term care residences where all meals are prepared, cooked and served onsite by their own staff provided much better meals, and better overall care for residents, than those who contract out food services.

When food is cooked onsite, residents can smell it cooking. It stimulates their appetites and makes them look forward to meals. Directly-employed food service staff get to know individual residents’ likes and dislikes. They interact with residents at meal and snack times, creating another continuous care relationship.

When food service is contracted out, strict meal times must be observed because contractors enter and leave at set times. But when in-house food service staff have food available all day long, or even 24 hours per day as it was in one residence in the book, there is no pressure for all residents to eat at exactly the same time.

This takes a lot of pressure off of other care staff as well. Care relationships are built through conversations and exchanges during and in between routine care tasks. In homes with flexible meal times, personal support workers don’t have to rush through care routines to get residents to the table by a set time.  That leaves time for relationship and trust-building.

In a care home in Germany, residents were even encouraged to help with the food preparation as they were able, with food service and personal care staff nearby to assist when needed.  This created a social atmosphere between residents and care staff, and fostered residents’ independence.  In a residence where food preparation and service is contracted out to private companies, this kind of interaction doesn’t have a chance to happen.

Time to care: Relationships over bureaucracy

Decreasing staffing levels lead to lower quality care, which then leads to bureaucratic rules requiring excessive documentation and the regulation of what should be common sense.

Personal support workers in Ontario often have to do well over an hour of routine charting every day – time they could spend assisting and interacting with residents.  In contrast to this, one Manitoba nursing home visited by the research team “charts by exception” – in other words, they only document occurrences that are out of the ordinary or things they specifically need to track.  This gives them time to build care relationships with residents.

In the nursing homes visited in Germany and Sweden, there was a greater focus on putting “more life into days than extending the days of life.”  A certain level of risk is accepted in exchange for quality of life.  Residents engage in activities that encourage independence, like food preparation using knives, or walking about instead of being pushed in wheelchairs. Residents with dementia who wander are watched and redirected by staff instead of being restrained or locked in. Staff have time to sit and talk with residents, meeting their socialization needs, not just their personal care needs.

But these practices require a high ratio of staff to residents.  The German nursing home above had staff to resident ratios as high as 1:3. In Ontario, there are no regulations for minimum staffing levels to ensure that other regulations are met, such as the provision of toileting assistance, repositioning, and other types of assistance.  Some Ontario PSWs are responsible for up to 42 residents at a time.

Good care also requires more staff time per resident. On average, residents in long-term care homes in Ontario currently receive the following:

This is well below the four hours of direct care per day that the Ontario Association of Non-Profit Homes and Services for Seniors recommends.

According to Armstrong and Baines, high quality long-term care could be the norm instead of the exception in Canada, if we had the desire and political will to make it happen. It will require a culture shift – a move from thinking of care for seniors in terms of a business model, to thinking about what long-term care residents need in order to live fulfilling, dignified lives.

Relationship-building cannot be legislated.  But we can create the conditions under which care relationships can thrive by setting minimum staff ratios and care hours per resident, creating better working conditions for staff, committing to strong public funding and removing the profit motive from long-term care.

Today’s big demonstration at Queen’s Park

Picture of an OPSEU flag at a rally.

Wouldn’t it be great to tell your grandchildren you played a role in protecting Canada’s Medicare system? Come to today’s rally at Noon and stand up for public health care.

Today will likely be the biggest Ontario Health Coalition demonstration at Queen’s Park since 2008.

Across Ontario seniors groups, union activists and family members frustrated with their own access to care will be boarding more than 40 buses, some in the pre-dawn darkness on an abnormally cold November morning.

The coalition has spent weeks organizing the day’s event to convince the Wynne government that privatizing more hospital services is not the road to good quality care or sustainable long term costs.

When: Friday, November 21 / 12 Noon
Where: Queen’s Park and University Avenue

Last spring the government was set to begin competitions for hospital services. Theoretically these competitions were to be between not-for-profit private clinics and the public hospitals, although the reality is there are very few not-for-profit clinics in the province. You might say most people were thinking of the not-for-profit edict with a wink.

Hospitals complained that it made it difficult for them to plan when their services would be left up to the caprice of the market.

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Thanksgiving: Here’s to our allies working for the public interest

Photograph of coalition march from 2008.

Marching on Queen’s Park in 2008. OPSEU remains proud to be one of the founding organizations behind the Ontario Health Coalition. This weekend we give thanks to our allies who have kept the public interest at the center of the health care reform debate.

Recently the UK Guardian reported on Sweden’s rejection of tax cuts and privatization by returning the Social Democrats to power. Eight years’ experience with privatization of public services didn’t leave Swedes feeling confident about the broadening control of public services by private interests.

“For years, people had been accusing schools run by private equity of pocketing the state’s money and putting it into their offshore bank accounts,” said one education stakeholder, “but now it looked like these companies weren’t even capable of running a business properly.”

Facing a similar choice in Ontario’s last general election, voters also rejected Tim Hudak’s promise of more tax cuts and more job cuts and privatization in the public sector.

There is no question that there is an ideological conflict going on over the future of health care delivery in Canada.

Public and private spending on health care across the country is about $200 billion. That’s a very attractive target for those who recognize that even shifting a small share of that pie from the public to private sphere can result in very handsome profits.

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Problems at clinics should prompt rethink on competitions for hospital services

Photograph of table with thousands of cards on it while an unidentified person speaks at a nearby podium. July 8 the Ontario Health Coalition brought more than 80,000 signed cards to the Ontario legislature opposing the transfer of clinical services from hospitals to private clinics.

July 8 the Ontario Health Coalition brought more than 80,000 signed cards to the Ontario legislature opposing the transfer of clinical services from hospitals to private clinics. (Photo courtesy the Ontario Health Coalition)

The media is applauding Health Minister Dr. Eric Hoskins this week for promising greater transparency around private clinic inspections that had previously been kept secret by Toronto Public Health and The College of Physicians and Surgeons of Ontario (TCPSO).

Tom Closson, the former President and CEO of the Ontario Hospital Association, suggested in the Toronto Star last week that “bringing out-of-hospital clinics up to the same standard as hospitals regarding transparency would increase public confidence in the care they are seeking.”

Ontario’s Action Plan for health care includes systematically taking clinical services out of public hospitals and transferring them to a sector that has a history of two-tier medicine, questionable user fees, unnecessary up-selling, significant quality control issues and too little transparency. The latest revelations, particularly around infection control at several private clinics in Toronto, may have persuaded the government not to carry out spring and summer competitions for selected hospital clinical services – at least for now.

They may have learned from the Ottawa Hospital’s ill-timed decision early in 2013 to divest 5,000 endoscopies to the private sector at the same time the TCPSO was making public the list of clinics that failed inspection public – including one Ottawa endoscopy clinic that may have exposed patients to HIV, hepatitis B and hepatitis C from equipment that may not have been properly sterilized.

This spring the Ontario Health Coalition collected more than 80,000 postcards expressing opposition to the transfer of services from public hospitals to private clinics. Without any clear indication from government whether the competitions are on hold, the coalition is now working towards a November 21st mass rally in Toronto to push further on the issue.

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Auditor’s Report — Warning flags about diagnostic self referrals

Today’s release by the Ontario Health Coalition regarding the 2012 report by the Auditor General of Ontario: 

Toronto – The Ontario Auditor General’s report released today raises warning flags about inadequate access to care and the perils of for-profit privatization.

The Auditor General found wait times for long-term care that are extraordinary. Crisis clients are waiting more than three months for placement and wait times have tripled. The provincial Ministry of Health response did not mention the lack of long-term care beds, only its plans to download patients into home and community care where funding per client is lower than it was a decade ago.

In Ontario’s privatized clinics (Independent Health Facilities) the Auditor found inadequate monitoring, poor inspections, a lack of financial oversight and inequitable access to care. This is of significant concern as the government is moving more and more services out of hospitals into privatized clinics.

 Among the Auditor General’s key findings:

  • Waits for mammography are up to ten and a half months in some areas of Ontario (page 47) but mammography screening, particularly in smaller hospitals has been closed down and centralized out-of-town.
  • Almost one-third of patients who require follow-up colonoscopies are not receiving them within prescribed wait times, and wait times remain too long.
  • Wait times for long-term care placements have tripled since 2004, with median wait times at 98 days in 2011/12 (page 186). In March 2012 people in crisis waiting for long-term care placements had waited a median of 94 days up to that point; moderate-needs clients had waited 10–14 months; and most other eligible clients had been on the wait list “for years”. Further, during the 2011/12 fiscal year, 15% of clients died before receiving LTC home accommodation (page 187).

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Are health services really shifting, or is the health minister being shifty?

OPSEU's Rick Janson joins OHC Director Natalie Mehra for the release of the coalition's "Austerity Index."

OPSEU’s Rick Janson joins OHC Director Natalie Mehra for the release of the coalition’s “Austerity Index.”

We can all relax now. All those hospital cuts we’ve witnessed recently – Health Minister Deb Matthews says they are not happening.

She says these services are instead being shifted. Evidently we are all fools for not realizing that the 22 beds cut at the Chatham Kent Health Alliance just represent a transfer of services to entities like the Erie-St.Clair Community Care Access Centre, which is itself cutting $8-$10 million after the LHIN refused to allow them to run a $5.2 million deficit.

Hamilton Health Sciences says $25 million in cuts are planned and expects 140 jobs will be impacted. Perhaps Ms. Matthews can tell us where these 140 jobs are re-emerging in the Hamilton Niagara Haldimand Brant LHIN? And while she’s at it, where did the LHIN reallocate the 69 beds the Niagara Health System cut in the fall of 2011 and spring of 2012? We can’t seem to find them anywhere. Neither can the hospital, which had to cancel or postpone 758 surgeries due to “bed pressures.” Maybe those beds were needed after all.

Perhaps she can tell us where the after-hours clinic, pain clinic, audiology clinic and cardiac rehabilitation program closed by Toronto’s St. Joseph’s Health Centre shifted to? We can’t find them. Can she?

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10 Insights from the Action Assembly Weekend

“Either I pay taxes or have my mother live with me,” said Neil Brooks with a sly smile. Brooks, co-author of The Trouble With Billionaires (with Linda McQuaig) underlined the value of taxes during the keynote address at this year’s Ontario Health Coalition (OHC) Action Assembly Weekend.

Brooks said that as we shift the line between what’s public and what’s private, the cost to individuals rises as government services become far more expensive to replace privately.

The Action Assembly is the OHC’s annual meeting to plan priorities for the coming year as well as review the victories of the previous one.

November 17-18 the meeting hall at the University of Toronto’s Hart House was packed as health care activists travelled from across the province to meet.

Here are 10 insight moments from this year’s 2-day meeting:

1. Switzerland is a criminal state. Neil Brooks, a tax law professor at Osgoode Law School, said governments have begun to recognize how much money they are losing to tax havens that protect the wealthy from paying their fair share back in their country of residence. It is estimated that $20-$30 trillion is salted away in tax havens, resulting in the loss of billions of dollars to public treasuries. Brooks says more money is leaving Africa for tax havens than all foreign aid coming to the continent.

Neil Brooks, law professor and author.

Neil Brooks, law professor and author.

2. Actor Michael Caine says increasing taxes on the wealthy amounts to government interference. But Brooks suggests that Caine is overlooking the copyright laws passed by the same government that secure his wealth. When it benefits the wealthy, it’s not interference or big government. As top marginal tax rates dramatically decreased in the last 30 years, so did the spread between income growth between the wealthy and the rest of us. Brooks says that with the massive number of films Caine has made, the odds would suggest some of them had to be good.

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