A BROKEN SYSTEM
Which long-term care home to choose is a game of Russian roulette, writes retired nurse Dorothy Asselstine, 82. She has shared a room with her ailing husband, Dean, 79, at a retirement home in Maxville since 2009.
I didn’t think that a lot could go wrong when my husband and I moved into a long-term-care home in 2009. Call me naive, but being a retired nurse and living in Canada I thought we should be OK. Which home to choose turns out to be like a game of Russian roulette. The home may have a polished website that showcases an array of activities and amenities, but in reality there may be troublesome shortcomings. Fortunately our choice led us to one of the best among approximately 600 homes in Ontario. I can say this with confidence as I have researched the results of inspections throughout the province.
In 2015-16 the Ministry of Health and Long-Term Care carried out detailed inspections of more than 600 homes. Their benchmark was the LTC Act of 2007. It is a very detailed piece of legislation and faced a lot of opposition, especially from owners and operators. Covering all of the homes was a gigantic operation and garnered a wealth of information, highlighting pockets of excellence as well as other results that should make you very angry. This information is available by browsing online at publicreporting.ltchomes.net.
I discovered that within a radius of 50 to 100 kilometres from where we live, the following conditions were found in various long-termcare homes: a lingering odour of urine, dirty and torn furnishings, residents receiving fewer than the stipulated two baths per week, faulty door alarms, no registered staff on duty, privacy not respected, critical incidents (i.e. where there is injury or abuse) are not reported by the administrator or the director of care in a timely fashion to the ministry, and poor pain management. All of these conditions may not exist in the same home but any one of them could significantly impact your quality of life.
There are several large chains of homes operating across Ontario: Extendicare, Caressant, Schlegel, Rivera as well as non-profit organizations. It seems to make little difference which one you choose because they each have homes that perform poorly.
Any home that registers more than 20 areas of non-compliance under the Long-term Care Act should probably not be attempting to provide care to some of Ontario’s most vulnerable citizens. This is a multibillion-dollar business subsidized by our tax dollars. I don’t profess to understand all the financial and political ramifications, but I do recognize a broken system when I see it.
What makes the difference between a good home and a bad home? I am convinced that the answer lies squarely in the realm of accountability. There needs to be more supervision of how care is being delivered in all departments; e.g., nursing, personal support workers, food service. We need a clinical instructor in each home encouraging a high standard and demonstrating by hands-on example.
Exceptional results often filter down from a team of engaged managers. Too often in inspection reports you will read that the administrator or director claims to be ignorant of some part of the legislation. How can they not know what they are supposed to be doing when it involves such vulnerable people, and when so much trust is invested in them? The medical directors need to become more involved and show some outrage when their homes are cited for disgraceful circumstances.
Some form of “public shaming” is called for in cases where homes have a large number of infractions. After all, the reports are supposed to be public. Do the good people of Brampton, Sudbury and London not deserve to be able to make an informed choice for their loved ones? Each of these cities had a home with troublesome inspection reports. Let’s suppose that the report, good or bad, is included in the monthly billing to each resident’s family, as well as being aired on the local TV and published in the newspapers, and, of course, on Facebook.
The 2015 inspection reports showed that the majority of homes were achieving a respectable standard. Nevertheless, there are residents in homes across Ontario living in squalid conditions, where understaffing is the norm and the administration is not sufficiently engaged to know what is going on.