Monday, May 11, 2009

New Ontario Health Care Legislation

Here we go. Magnificent improvements to health care! City news provided the earliest coverage. In a grandstand celebrating guidelines, the press is quite anticipatory. CBC quotes him: "McGuinty said 50 per cent of what a family doctors does can be done by someone else."

This is true. I know that improvements, over 30 years in the area of midwifery has improved the care provided to pregnant women pre and postpartum. My daughter's care was magnificent, with the midwife giving her tips, arranging for tests, test results, and providing excellent advice on breast feeding, for example. But this was about a year and a half ago!

CBC reports: Ontario Health Minister David Caplan called the new rules "momentous." They provide an intersting response from Doris Grinspun, the head of the Ontario Registered Nurses' Association.

Grinspun said the legislation lags behind what nurses can do in other jurisdictions in North America. That said, how many nurses are trained in senior health? We still fight this in the system: staff who fail to understand the needs of ailing seniors.

The act, they say, would also improve patient safety and strengthen the health care system by:

  • Requiring health colleges develop common standards of knowledge, skill and judgment.
  • Making team based care a key component.
  • Requiring all regulated health professionals to have professional liability insurance.
  • New drug prescribing powers: Pharmacists could soon renew prescriptions.
  • Physiotherapists would be able to order X-rays.
They say that nurse practitioners, dieticians, midwives, respiratory therapists and dentists, will also be affected by the changes. I hope it will be for the good of all. But I am dubious.

From Ontario Health Care - for those over 50

My father was in pain for weeks. The doctor was unavailable. I could not convince the nurse in Long-Term Care that my father was in pain. There was little understanding and many myths around this topic. Without more education how will this improve?

We really have to stop calling them 'nursing homes'. There is little nursing done, mostly it is the PSWs who do the work. With a ratio of 1 nurse to perhaps 200 residents, and physicians who visit once a week we have people with polypharmacy. In my father's LTC home 90% of residents had power of attorney with alternate decision makers. These people cannot visit every day and see what is going on. It is crucial we train caregivers adequately.

They are untrained and many are ignorant of geriatric psychosocial issues. They are given no training in psychology. We expect more of our children's caregivers: in a nursery school they are required to have a two-year degree, not a simple certificate that a PSW in LTC or in retirement homes will now posses.

It is excellent legislating nurse practitioners, but we are short of those, too. We are short doctors with any geriatric training. Seniors are a very difficult complex case many with chronic disorders and multiple issues.

The abuse stories are appalling. It boils down to little or no training, insufficient staff, and ignorance around the issues of geriatric care. Elder Abuse is caused by poorly trained health care workers at all levels of the health care system: private or family caregivers, PSWs, nursing staff, physicians.

More news reports on this topic

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