A new way to look at nursing homes

High rates of depression reported in Ontario facilities

Residents of Ontario nursing homes are among the most depressed in Canada, according to new research.

A web tool, unveiled Wednesday by the Canadian Institute for Health Information (CIHI), shows 25.9 per cent of Ontario long-term care residents reported worsened moods from symptoms of depression in 2013-14, a rate deemed “significantly higher” than the national average of 23.8 per cent.

“It is certainly something that would be cause for further investigation as to what is going on,” said Brent Diverty, CIHI’s vice-president of programs.

Depression is just one of nine indicators that CIHI assessed at 1,269 long-term care homes across the country. This represents 57 per cent of homes. The performance reporting tool, known as Your Health System, includes all 628 Ontario homes.

Diverty said the tool is “unprecedented in the world.”

There is no other national reporting system of this scale, he said, adding that the interactive tool is publicly accessible to anyone shopping for a long-term care home.

Ontario also underperforms relative to the national average for patient mobility. Some 35.8 per cent of residents suffered from worsening physical functioning, a measurement that looks at whether they are having more trouble or remain completely dependent on help, for example, in getting out of bed and going to the dining room. That compares to a national average of 34 per cent.

Diverty said when residents are not moving around or interacting, their health could be deteriorating.

On the upside, Ontario performed above the national average on use of physical restraints. Where 9.6 per cent of Canadian nursing home residents were in daily restraints in 2013- 14, 8.9 per cent of Ontario residents were. Ontario’s performance on this score has been steadily improving since 2010-11 when 16.1 per cent of residents were in daily restraints.

The use of restraints is controversial. While they may be used to protect confused residents from hurting themselves, some homes are forced to use them because they are understaffed.

The province’s nursing homes performed better than other provinces and territories when it came to helping residents manage pain. Where 10.2 per cent of nursing home residents across the country experienced pain, 7.9 per cent of those in Ontario did.

In Ontario, 14.2 per cent of residents experienced falls during a 30day assessment period, lower than the national average of 14. 9 per cent.

Candace Chartier, CEO of the Ontario Long Term Care Association, said she is buoyed by the fact Ontario performed either above or on par with the national average on six indicators, given that the sector is underfunded compared with most other provinces.

Because of underfunding, many homes are understaffed, she noted. With more funding, homes could dedicate more staffing and resources to helping residents with depression, she noted.

The sector has been under increasing stress because residents are older and sicker when they are admitted than they were even just a decade ago. There are also many more residents with dementia.

Chartier pointed out that while indicators can be helpful when researching homes, “they are not the whole picture.” While measurements have been risk-adjusted to enable more comparison of homes, variances in outcomes are nevertheless affected by such factors as differences in populations, she said.