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Care homes fail standards: audit

Patient-care plans among deficiencies highlighted

By: Bruce Owen

26/11/2009 1:00 AM | Comments: 7

MANITOBA'S auditor general says the province has to provide better information about nursing home wait times and get its inspectors to conduct more unannounced visits.

"It's one thing for the department to say it's fine," Carol Bellringer said Wednesday. "It's another for you to say, 'Show me.' "

Bellringer's audit, done between April 1, 2006 and Dec. 31, 2008, found more than half the care homes did not meet four of the five core standards. While most met safety and security standards, many did not meet standards for patient-care plans, the use of restraints, pharmacy services and staff training. An example where a standard was not met includes the use of a pencil or whiteout on a patient-care plan.

The province brought in personal care home standards in 2005 to be consistent with other provinces. According to that audit, there were 1,137 seniors waiting for a personal care home.

Bellringer said the audit was not launched because of any particular concern about personal care homes.

She also said Manitoba Health should bring in a system of monitoring personal care homes on a provincewide basis rather than relying on the 11 regional health authorities to monitor care homes in their jurisdictions. Such a move would make it easier to compare Manitoba's care homes to those in other provinces. The audit also recommends RHAs and the province track wait times to allow for better planning of personal care home capacity.

Bellringer also said inspections of care homes should be more risk-based with inspectors targeting specific areas to look at and then do a followup inspection to ensure compliance.

Bellringer said for the most part, the province keeps track of what's happening in the 126 care homes in Manitoba -- it's just that it could be doing it better.

"They are doing them," she said. "It's not as if the whole thing is being ignored."

Health Minister Theresa Oswald said the province knew the standards brought in four years ago would take a period of time to be adopted.

"We knew it would take a shift in culture," she said.

She added the province is changing how it inspects nursing homes, including inspection of interim nursing home beds in hospital settings and more unannounced inspections.

Progressive Conservative health critic Myrna Driedger said she was shocked to see things have moved so slowly since the new standards were introduced.

She said she expected the province to move more quickly on inspections and getting nursing homes to follow the rules.

"That's a disservice to seniors and the families," she said.

Driedger added the province is also dealing with a shortage of health-care aides to staff care homes and is doing little to keep an earlier commitment to train more people.

The audit found that as Dec. 31, 2008, only $5.2 million of $40 million earmarked by the province a year earlier, to be spent over four years on hiring staff, had been spent.

bruce.owen@freepress.mb.ca

 

 

The greying of Manitoba:

 

The number of seniors 75 and older is projected to increase to more than 157,000 in 2036 from 82,000 in 2006, a jump of 91 per cent. Most of this growth will happen after 2017.

The average age of a person going into a personal care home is 83. The average length of stay is 2.7 years.

There were 1,137 seniors waiting for a placement in a personal care home in Manitoba as of Dec. 31, 2008.

There were 126 personal care homes with 9,832 beds in Manitoba as of March 31, 2008.

Manitoba has roughly 116 personal care home beds per 1,000 persons 75 and older. The Canadian average is 90.

The estimated cost for a personal care home bed in 2007 ranged from $176,000 to $210,000.

The province spent about $290 million to operate personal care homes in 2007/2008. In the same period, care- home residents in for-profit centres paid about $142 million in fees.

Republished from the Winnipeg Free Press print edition November 26, 2009 A3

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7 Commentscomment icon

Only 5.2 of 40 million earmarked by the province for hiring staff over 4 years had been spent.

Are people not applying. The training is not that long or hard so maybe some that complain about welfare rates being too low might consider a position as a health care aide as an option.

There is a reason so many of us care workers refer to seniours residences as "Jail for old people". Even when a care centre is strictly following the guidelines set out by the province they still lack any respect for individuality or quality of life. This is not to say that there are not many very caring people that work in the field, but is to say that the system is not organized in such a way as to provide any quality to the mere existance that seniours in these homes are exposed to. Using whiteout on a chart is extremely wrong, but I think that issues such as forcing seniours to bath at 3 in the morning, or force feeding a seniour who has chosen to stop eating because they are tired of their non-existance should be more bothersome to the writers of this article? How about forced nap times when it has been proven that the older we get the less sleep we need? Or maybe forcing all seniours to get up starting at 6 am 7 days a week? Have they not earned the right to sleep in? Yes this all happens here in our city!

I have been working in a personal care home for over 16 years. Each year I see great strides toward making these places the residents "home" not just our workplace. These standards are put in place for a reason, but with increased levels of care and not enough staff, it is really difficult to follow through with these standards. ie (restraint policies) When you have residents that are unsafe to be walking on their own, but only 2 health care aides for 16 residents, It's very hard to keep them safe at all times. When they do fall you're buried in paperwork. And way worse than that, a broken hip quite often means that resident never recovers. If a restraint is used, they have to be monitored every 30 mins. Restaints have proven to be quite dangerous. Bottom line, to ensure standards are met and our Elderly get the care they deserve and are paying for, more funding is needed to ensure adequate staffing! What the government deems as adequate also doesn't cut it! I'd like to know the percentage of pencil pusher's at the WRHA have ever spent more than 10 mins in a Long Term Care facility? Do they even have a clue?

The public should also be informed as to how many of those 1100+ awaiting a PCH bed are in hospital. In order to fast-track individuals into PCHs, homecare coordinators and doctors will place them in hospital beds so they get priority when a bed becomes available. In my region this still takes 3 months to 1 year if in hospital. If not in hospital, the wait list for a PCH bed is 1 to 3 years. I know that this happens in Winnipeg as well and wait times are similar. What is the provincial average wait time for a PCH bed?

The province has got to priorize senior housing availability and long-term health care now. We are already nearing crisis point, what happens in a decade or two? PCHs and appropriate housing are not built overnight. We have got to have a long-term plan over the next 2 decades to address the impending aging population and their needs. Is the province addressing this?

And pentax99, as per yesterday's comments on this issue, I entirely agree with you.

Kta3, if you don't know why you should only use pen - and not use white-out - you must not do any charting of patient records. That is such a no-no that anyone who would do so should have his or her license pulled. The reason you use pen - and a single line to cross out mistakes - is so that records aren't "magically" updated later on, depending on circumstances. These documents are essentially for charting patient care and history, and it's essential they are tracked correctly. While I agree that a person can chart incorrectly and provide good care, it's harder to chart correctly and provide bad care.

My wife is a social worker who works with the elderly and I have seen the facilities where she works and it is shocking what passes for "care". In too many situations "warehousing" would be much closer to the truth.

Introducing random inspections is LONG overdue. I question what happens when a facility fails its inspection? Nothing? Not good enough. A small fine - again, not good enough. Care plans are often not done for residents in a timely manner - if they are done - because that takes time out of the day for nurses, social workers, and other care providers. These facilities need more staff, and they need the carrot and stick approach from the government to improve patient care.

I do agree with your comment that neither my wife or I would ever live in a nursing home. I'd rather die than face a life like that. It's time these places were fixed up properly.

Failing a standard because of using pencil not pen. What has that got to do with how a resident is cared for? I work in a care home and I know I will never live in one, as long as I have a choice. It is true people are living (if you can call that living)much longer because of advances in medicine. We need to consider quality of life also. There should be other choices put in place before the crunch comes. (babyboomers aging) I totaling agree with pentax99.

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As our population of the elderly rapidly expands, issues with personal care homes must be addressed soon. Statistics relating to the number of required spaces can be easily compiled. Government predictions for funding and space requirements in these privately owned facilities is likely intentionally underestimated. This is typical of government to hide looming hefty tax increases. The advances in medicine have found ways to keep people alive much longer with pharmaceutical and mechanically assisted methods. Some people can establish a relatively normal life with these interventions however many people don't. There are many people like myself who would choose death before being forced to live in a personal care facility. The only option now is personal suicide. Governments need to address this now and allow those who will soon be affected to have the greatest input in future decisions. I mean individual input and not religious or right to life lobby groups. They don't speak for most of us. We want a choice and there is no practical reason to deny our wishes.

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