Long-term care homes not up to minimum standards: report
Staffing levels an issue at 232 government-funded facilities
The vast majority of governmentfunded long-term care homes for seniors in B.C. do not meet Ministry of Health staffing guidelines.
The Residential Care Facilities Quick Facts Directory, a report released by the Office of the Seniors Advocate, compiles staffing, serious incident reports and other quality-of-life measures for all publicly funded seniors homes in B.C. in 2014-15. Of the 292 governmentfunded facilities, 232 did not meet the ministry’s staffing guideline, a recommendation of 3.36 hours of care per senior every day. This includes help with tasks such as toileting, feeding and bathing. Just 17 fa- cilities were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.)
The directory’s data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.
Of the 232 government-funded seniors homes below the staffing guidelines, 74 per cent were owned and operated by private businesses instead of health authorities or by a non-profit group, such as a church. All but two of the 25 care facilities providing the lowest number of staffing hours were in the Vancouver Coastal Health Authority.
Isobel Mackenzie, the B.C. Seniors Advocate, and Jennifer Whiteside of the Hospital Employees Union, which represents care aides in long-term facilities, are calling on government to legislate minimum staffing levels instead of leaving it up to facility operators.
“We regulate the staffing ratios in child care, why don’t we regulate it in senior care?” said Mackenzie. She said she was surprised to learn how many seniors homes fall below provincial guidelines.
“Your questions show we have some work to do here,” she said. “I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here’s how many of your facilities are at that or under that.”
Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication.
She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy.
Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.
“Anecdotally, everyone was saying hours (for staff ) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let’s have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first,” said Mackenzie.
Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years — that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.
A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia.
“There’s simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors — many of whom are frail,” said Whiteside.
Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines.
“The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It’s not the kind of system to have for frail seniors. It’s quite shocking to think this is the system we have for them,” said Whiteside.
A Vancouver Sun request to interview Health Minister Terry Lake was not granted.
However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used “as a starting point for planning decisions,” the email said.
“The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient,” the ministry email states.
“Direct care hours are dependent on the individual’s needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs.”
Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government’s contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn’t enough to reach this level.
“We can only do what we are funded to do,” said Fontaine. “While the government and health authorities are trying to bring those on the lower (staffing) levels up, it’s been a slow process.”
One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said.
Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care.
“Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass),” she said. “Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staff at this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come.”
We regulate the staffing ratios in child care, why don’t we regulate it in senior care? ISOBEL MACKENZIE, B.C. Seniors Advocate