Increase funding and staffing in Ontario's long-term care facilities
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On March 16, it was made public that the Ontario provincial government would be cutting staffing hours and funding, including Registered Practical Nurses and personal support workers at what is already an underfunded and under staffed long term care facility located in Paris, Ontario.
The Long-term care facility, Parklane Terrace, is home to 132 residents including seniors with dementia and Alzheimer’s. The facility is owned by the Schuller Family and operated by APANS Health services of London, Ontario which states its code of ethics of care as involving: "...quality, compassionate care in a nursing home like environment that promotes honesty and integrity while respecting the rights of each individual."
However, the reduced funding, intended to roll out in April and effect a total of five nursing homes throughout Ontario operated by APANS Health Services will be equivalent to the reduction in hours of 2.5 full-time personal support workers and three full-time registered practical nurses at the Paris facility alone. In order to accommodate these reductions the long-term care facility is planning on terminating positions and forcing staff to choose new schedules based on seniority. This in turn will impact all front line staff and compromise resident safety and overall quality of life and care. The resident's, many having lived at the facility for years rely on the front line staff to provide compassionate, quality care and assistance with daily living that they would otherwise not have access to at home due to age and health co-morbidities.
For example, individuals living with Alzheimer's and dementia in the facility, will largely be affected by this change in staffing as studies have proven that consistent continuity of care from front line staff, as well as a daily routine has been shown to reduce hospitalization, anxiety, behaviors and aggression.
Overall, a reduction in front line staff throughout the facility will place residents at risk for patient neglect and poor quality of care - resulting in malnourishment, risk of falls and injury, skin breakdown, poor hygiene, risk of aspiration and medication error. The reduction in turn will impact the amount of time that staff can offer each patient and as a result may increase the risk of confused residents leaving the building unsupervised. This is largely a result of staff reductions as registered nursing staff and personal support workers will be spread even more thinly across the facilities units, thus also placing units at an increased risk of patient-to-patient violence. Not only will residents be affected by this reduction in staffing, but since staff-to-resident ratios will increase as a result, front line staff will now be at an increased risk for burn-out and compassion fatigue, stress and injury as staff members are forced to relocate throughout the facility. The change in staffing whom many families have come to know and trust will now worry about whether their loved ones are receiving the same care that they once were, thus causing unwarranted stress and anxiety.
The home currently operates with one Registered Practical Nurse (RPN) on each unit of 25-30 residents and 1-2 personal support workers (for a staffing ratio of approx. 1 to 10 residents when fully staffed), these staffing ratios are even further reduced on holidays and night shifts, and does not take sick calls into consideration. There is one Registered Nurse (a.k.a., charge nurse) on 24 hours a day for 7 days a week, while the RPN is responsible for medication administration, charting, assisting the charge nurse, wound treatment, patient assessments and care.
The Ministry of Health and Long-term care recently completed a Resident Quality Inspection with Order(s) of the Inspector on February 16th, 2018 for Parklane Terrace, which found the following (but not limited too):
1) Failure to comply with skin and wound care: facility failed to ensure that a resident who exhibited altered skin integrity received a skin assessment by a member of the registered staff upon return from hospital.
2) Failure to comply with nursing and personal support services: the facility failed to ensure that there was at least one registered nurse who was an employee of the licensee and a member of the regular nursing staff on duty and present at all times.
3) Failure to comply with policies: facilities "Head Injury Routine" (HIR) , which directed staff with nursing interventions (i.e., neurological vitals) following a residents injury, where they had hit their head was not initiated or documented which led to the resident being transferred to hospital.
4) Failure to comply with medication incidents and adverse drug reactions: including failing to report medication errors involving residents, to the resident, substitute decision maker(s), physician and registered nurse.
6) Failure to comply with infection prevention and control programs: facility was found to have improper signage outside resident room(s) including inadequate protective wear for staff and visitors.
7) Failure to ensure that the care plan set out in the plan of care was provided to the residents as specified in the plan: facility failed to ensure that there was a written plan of care for each resident and that there were clear directions to staff and others who provided direct care to the resident. This resulted in an improper transfer of the resident(s), inadequate oral care, and an increase in falls and injury.
The above report makes it quite obvious that the facility was already struggling to maintain expectations set out by the Ministry of Health and Long-Term care despite previous staffing ratios, which in the most recent inspection resulted in them being issued non-compliances. The current decision by APANS health services, the provincial government and Parklane Terrace to reduce staffing will result in the potential for negative patient outcomes including neglect and mortality. The government of Ontario currently charges anywhere between $1800 per month (for a basic shared accommodation with a bed, which may include a shared bathroom between 4 residents) and upwards of $2600 per month for a private room. Daily allowance for food is $9 for three meals and snack(s)… and just to put this into perspective, it is LESS than Ontario inmates who have a larger daily allowance of $9.73.
According to Ontario’s Long-Term Care Association the following are facts regarding long-term care residents:
- 97% of residents need help with daily activities such as getting out of bed, eating, or toileting. 1 in 3 are highly or entirely dependent on staff
- 97% of residents have 1 or more chronic conditions
- 90% have some form of cognitive impairment. 1 in 3 are severely impaired
- 46% exhibit some level of aggression related to their medical condition
- 61% take 10 or more prescriptions
- 58% use a wheelchair
- 40% have a mood disorder such as anxiety, depression or bipolar disorder
- 38% need monitoring for an acute condition
(Long Term Care Act, 2016)
As outlined in the above, it is clear that the Ontario long-term care facilities need improvements and increased funding not cuts. Our seniors and medically unwell loved ones need long-term care facilities, personal support workers and nurses that are capable of meeting their needs and that are able to provide safe quality care when they need it most – This includes staffing ratios and living standards that are capable of meeting provincial standards of care. If Ontario’s government and privately funded health services are capable and willing to decrease staffing in homes that already run below standards just imagine what the future will look like for ourselves and our loved ones in the end stages of life. At some point we must take a stand and acknowledge these cuts and lack of funding in facilities for what it is – elder abuse. Reducing staffing and funding is NOT the answer!
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