Nursing homes must now report bedsores
New reporting requirement kicked in Tuesday
The Department of Health has begun requiring every licensed nursing home in the province to report the incidence of bedsores.
Homes were notified last week, according to Tracy Barron, who speaks for the department. The new reporting requirement for bedsores, also known as pressure ulcers or pressure wounds, kicked in Tuesday.
The province hasn’t decided yet whether the new measure will be permanent.
“At this stage, we are requiring immediate mandatory one-time reporting of all pressure wounds, and then ongoing reporting of stage 3 and 4 pressure ulcers in real time,” Barron said in an email Tuesday.
Stage 3 is where there is a hole opening in the flesh. Stage 4 is where the wound is so deep the muscle or bone is exposed.
“This will allow for better tracking and oversight of wound care in long-term care facilities,” says Barron.
The province is also standardizing the rules around wound care to “provide consistency” and replace the do-it-yourself protocols it entrusted each facility to put in place two years ago.
The actions are being taken after revelations that three residents of three separate Shannex homes went into septic shock and were taken to hospital with Stage 4 bedsores. All three residents subsequently died. The first, Lorna Jones, died three years ago in Dartmouth. John Ferguson died this past January in Sydney. The third and most recent, 40-year-old Chrissy Dunnington, died in Halifax on March 22.
Benchmarking is a good first step, according to Kimberley LeBlanc, who runs a nationally certified program for registered nurses specializing in wound, ostomy, and continence care.
“If you don’t know what your problem is, how can you fix it?” said LeBlanc. “For example, if I know my home has a 26 per cent prevalence of pressure wounds, and I know that the national average is 13 per cent, I’ve got a problem. To fix it, you need more nurses as well as nurses specialized in pressure injuries who can come into the home and assist with prevention and management.”
Shannex operates 16 long-term-care homes in the province. The privately owned company started by Joseph Shannon 30 years ago houses and cares for 4,000 residents — more than half the 7,000 people in this province who live in nursing homes. Medical experts say pressure ulcers are “highly preventable,” if staff frequently check and re-position people who lack mobility.
SHANNEX SPEAKS
This past winter, the company began requiring each of its homes to report the incidence of bedsores on a daily basis, says Catherine MacPherson, Shannex’s vice-president of operations enhanced care.
Previously, it had required monthly reporting, using its internal, electronic health record system. That information remained in-house but will soon be shared with the Department of Health.
“That is not a current requirement, but we know that it is coming soon and we look forward to that and think it’s the best way for the data to be collected and shared,” MacPherson says.
Hospitals report the prevalence of bedsores, and those numbers are available to the public through the Canadian Institute for Health Information. But nursing homes in Nova Scotia have not been required to do so. In Ontario, an agency at arms-length from government called Health Quality Ontario makes informa- tion about the rate of bedsores among residents for each nursing home available to the public.
Shannex president and CEO Jason Shannon says he’s not willing to make such information publicly available at this time, but, “will follow the lead of the Department of Health.” Health Minister Randy Delorey wasn’t available for comment by deadline. Barron says some information around bedsores will be made public, but so far, details on how that will be reported have not been ironed out.
Meanwhile, a question for Shannon is who’s accountable for what has happened in the past? And why did it take three years for Shannex to address such a serious issue?
“We care about every one of our residents as if they were family and we respond in the best way we can,” says Shannon, who side-stepped those questions. “We have a huge responsibility to make sure our people are well-equipped and provide great quality of care. So none of these stories go by without each of us taking the time to reflect: what can we do better? I’m proud of the team and how they respond to these challenges.”
On May 25, Shannex sent a letter to staff and families of residents announcing a Quality Improvement Plan to stepup what Shannon describes as “ongoing efforts” to prevent and treat pressure ulcers. Besides more diligent daily checks and more communication with families, they include bringing in RNs specialized in wound, ostomy, and continence care to educate front-line care givers, such as the CCAs and LPNs. STAFFING CONCERNS Part of the problem, however, according to all three families who filed negligence complaints on behalf of deceased Shannex residents under the Protection of Persons in Care Act, is their belief the nursing homes simply did not have enough adequately trained staff on duty.
As to whether Shannex would provide better care if it received more money from taxpayers, MacPherson’s reply was, “We do the very best we can with the resources we have.”
Shannex’s largest group of employees is the continuingcare assistants, who help residents with bathing, feeding, and toileting. The company says it currently employs 160 registered nurses (four years of training) and 250 licensed practical nurses (two years of training) to care for the 4,000 men and women in its long-term care homes. On paper, that works out to about one nurse for every 10 residents.
The Department of Health funds nursing homes based on a formula where each resident is supposed to receive four hours of care per day, including one hour from a registered nurse or licensed practical nurse. In 2016, a report prepared for the Nova Scotia Nurses Union entitled Broken Homes was critical of the provincial government for not auditing whether residents are actually receiving that amount of care. In fact, two-thirds of the 250 nurses who participated in a survey for that report said they “always” or “often” worked in short-staffed situations.
It’s impossible to know whether staffing concerns are real or not, given the current state of data gathering and public disclosure. Semi-annual inspections of nursing homes don’t address staffing, and the regulations related to staffing in the Homes for Special Care Act haven’t been updated in decades — a period in which the proportion of frail, older people and disabled adults with higher needs has increased. Also missing is any requirement for nursing homes to have defibrillators in case of a life-threatening emergency. The operations vice-president for Shannex confirms defibrillators are not on site at any of their facilities.
“We have a huge responsibility to make sure our people are wellequipped and provide great quality of care. So none of these stories go by without each of us taking the time to reflect: what can we do better?”
Shannex president and CEO Jason Shannon