Room for improvement in nursing home care

Lise Cloutier-Steele

Let’s face it, change is difficult for many among us, but probably more so in a nursing home where an administration is set in its ways. If an organization is reluctant to change, it makes it all the more difficult to come up with solutions to improve unfavourable conditions.

There’s no denying that nursing homes are understaffed, but based on my experience there are other significant reasons why seniors continue to suffer greatly from systemic and other forms of abuse and neglect while residing in long-term care facilities.

One reason which tops my list is that some caregivers, mostly the more elderly, are afraid to report negligence to nursing home management or to the compliance team of the regional office of the Ontario Ministry of Health and Long-term Care (MOHLTC). They have reason to be afraid, because of the culture of reprisal which exists in some nursing homes. In fact, fear of reprisal and threats of visitation bans following an official complaint were among the findings uncovered by the Ombudsman for Ontario during his 2008-2010 inquiry into the monitoring practices of the MOHLTC.

Another factor is that the Long-term Care Homes Act (2007) is dated, and provides Ministry of Health officials with limited authorities to investigate both sides of issues presented in complaints. The work of nursing inspectors is at times further hindered by personnel of long-term care facilities who may not recall events reported in complaints, or refuse to be interviewed, which can interfere with the implementation of corrective measures to benefit residents. But if caregivers or power of attorney authorities take the extra step of assuring themselves that their concerns are recorded in their loved one’s medical chart, it would help a nursing inspector verify claims of negligence or abuse such as bruises and bed sores left untreated. Caregivers should also ask to review the medical chart to make sure that his or her observations are in fact recorded.

Caregivers who visit their loved ones only occasionally may unintentionally give nursing homes carte blanche to neglect a resident. Some members of home personnel are quick to assess who among the residents have no one to speak on their behalf, as they are to notice at which time, and on which days caregivers visit a particular resident. I almost always faced a problem related to my father’s care when I started alternating my visiting times. Keeping home staff guessing is a good tip; it might even be key to ensuring greater consistency in the provision of basic care for a loved one.

One nursing home director of care once told me that she couldn’t get anyone, let alone anyone good to come work in a long-term care facility. An old adage comes to mind: You get what you pay for, and this rings true in the case of agency workers called in to replace overworked and often absentee personnel.

I learned that various personnel agencies bid for annual contracts to supply health care workers to nursing homes on an as-needed basis. If a home goes with the lowest bid, it would explain why some of the replacement personnel may provide a lower standard of care. It’s likely that a home may not have the budget to hire agency personnel who take great pride in their work, but in doing so, it fails to meet the needs of its residents and their basic right to adequate care. If more efforts were made to brief and train agency workers, regular staff members could benefit from the type of assistance they really need, and the residents would in turn receive better care from a worker they may never see again.

If the administration of a nursing home has a long standing practice of hiring family members, this too may interfere with any plan to make improvements in the delivery of care. At the home where my late father resided, there was an unusually high number of employees who were related to one another. Clusters of three or more family members were employed in various positions, and there were also cases of workers who were related to caregivers. Hiring family members may be ideal for the administration of a home to ensure subordination and compliance from those employees, but in some instances, it can be detrimental to the quality of care provided to the residents. For example, if a caregiver filed a complaint with the Ministry of Health, against a home employee with three other family members working at the same facility, this employee would be even more reluctant to be truthful with an inspector. The employee would not only be afraid of jeopardizing his or her job, but those of other family members as well.

Often in death notices, families will thank a home for its care of their loved one, whereas in many cases the level of care was sub-standard. Unfortunately, undeserved expressions of gratitude only solidify the culture of cover-up in some homes, and they are also a deterrent to much needed improvements. As in the case of misleading mission statements posted in nursing homes, published undeserved thanks can also lead to unrealistic expectations of outstanding care that most homes can’t deliver, as confirmed by the findings of numerous inquiries and media exposés of recent months, including CTV’s W5 investigative report by Sandie Rinaldo on March 31, 2012.

Health care aides can’t be expected to shoulder all the blame for sub-standard conditions in nursing homes. One nurse, and nursing home employee, had this to say: “Problems in long-term care facilities are a sad event. Some places are poorly managed, understaffed, and the existing staff, however willing, is overworked.” And when staff is overworked, oversights and mistakes can happen, which is why a caregiver’s direct involvement can be crucial to the welfare of a loved one in a long-term care facility.

At the annual general meeting for Ottawa’s Family Councils Network in March 2012, Chantale LeClerc, the recently appointed chief executive officer of the Champlain Local Health Integration Network said that organization is key to better senior care. According to CEO LeClerc, it’s not the lack of options for seniors but poor organization that makes health care services difficult to navigate. She was referring of course to in-home services that could keep seniors in their own homes instead of in long-term care facilities, but better organization may prove equally beneficial in the daily operations of a nursing home.

The best approach to effect change and improvements may be to complain about sub-standard care more frequently and in larger numbers. In her media interviews during the month of November 2011, Minister of Health and Long-term Care, Deb Matthews, urged caregivers and any other individuals to report abuse and neglect by calling the Ministry’s hotline number posted in all nursing homes across the province. Matthews stressed that official complaints can only help her Ministry improve conditions in nursing homes, so all it takes is a phone call.

But, as with other large organizations, the complaint process of the Ontario Ministry of Health may not be flawless. If at first you don’t succeed in getting a Ministry inspector to address and resolve a justified complaint, you should try again. Your loved one would probably want you to.