Making a complaint within a health care setting has always been a delicate process.
It used to be in home care the terms of your service suggested that if you complained too much, you could actually lose service.
This may not have necessarily changed. We recently heard from a reader who suggested that complaints he made about the rushed nature of his wife’s home care resulted in a scaling back of service. Suddenly the respite care they received was reduced from once a week to every other week. How any individual could ever reasonably prove such cause and effect remains an open question.
Similarly in Ontario’s nursing homes a complaint can affect the relationship a resident has with staff who do provide care. For the frail elderly, this can be intimidating. It is therefore surprising that more than 2,000 complaints come into the provincial hotline each year that require subsequent investigation by an inspector.
When the province introduced the Excellent Care for All Act in 2010, hospitals were required to put in place practices for handling patient complaints. That includes reviewing and resolving complaints made by patients and caregivers, recording and monitoring key information about the complaints, and informing the complainant of the results of such a review.
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The decision by Premier Dalton McGuinty to step down and shut down the provincial parliament leaves many questions about the future of Ontario’s health care.
With no parliament, there will be no review of the Local Health Integration Networks, a commitment that the McGuinty government wrote into the original Act that created the Crown agencies.
When the government wrote the Local Health System Integration Act in 2006, somebody forgot to calculate that a five year mandated review would take place just prior to a fixed date election. Whoops! McGuinty did suggest that such a review might not be necessary at all until someone reminded him that it was written into the legislation.
There was no way the government was going to undertake a review of the unpopular LHINs just prior to going to the polls. In recent months we had heard that such a review was finally going to go to committee. Now that won’t happen. That means it could be seven years before the five-year review happens.
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In BC they have a ratings system for residential care homes, or what we would refer to as “long-term care” homes in Ontario. The ratings look at complaints and critical incidents and determine whether a home is low, medium or high hazard. The hazard rating determines how often the home will be inspected. A high hazard home in BC can count on a surprise inspection about every three months.
In Ontario Health Minister Deb Matthews would simply rather not know.
She has too few inspectors, and the complaint and critical incident inspections are taking way too long – a point the Ombudsman made in 2010. The more in-depth resident quality inspections are taking so long it will take more than five years to fully inspect all the homes, that is “if” they get inspected at all.
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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.
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You might call it the McGuinty Liberals first campaign promise on health care. June 10 the government announced that it would regulate private non-emergency transportation that moves patients between hospitals and other facilities.
The private patient transfer service came under the microscope of the ombudsman’s office in January after Andre Marin said he received more than 60 complaints about the service.
Marin said that patients would be better off calling a cab rather than take one of these unregulated ambulances.
Ontario is the only province not to have regulated these transfers.
It’s allowed private companies to charge hundreds of dollars per patient for transports in old, beat-up ambulances operated by “kids” with no medical training, Marin told the Canadian Press.
“Our investigation uncovered serious issues, from a lack of infection control to unsafe vehicles and poorly trained staff,” Marin stated in a release last week. “These vehicles look like ambulances and are often transporting vulnerable patients. People need to know they can trust these services.”
The New Democrats were critical the Liberals for having waited so long to act. “Anybody who had the health file knew about this, and they did nothing for the eight years that they were in power,” NDP health critic France Gelinas told CP.
The McGuinty government said they would introduce legislation at the earliest possible moment – which at this point will be after the October 6, 2011 election.