Monday, February 25, 2013

How do we improve long-term care?

Most long-term care in Ontario is for-profit. Most lack the money to invest in infrastructure as they pay dividends to stock holders. The bad ones take taxpayer dollars, at the expense of the frail, impoverished, and ill, without accountability to taxpayers.

Not all LTC is bad, not all homes are bad places. There is much to learn from the good ones. Many are homey places, with caring professionals.

1. Listen to family members: ensure that situations are reported and action is taken. (See below. The paper trail is extensive, the results horrible.)

2. Demand Healthcare Primary Care Performance:
  •   Have PSWs not only register, but demand upgrading, investigate their qualifications, demand college degrees. 
  • Force GPs to upgrade and be accountable: require they give dementia tests for at-risk patients, recommend driver testing, take information on Advance Care Directives.
  • Pay geriatricians more. It is a complex speciality. Geriatricians are few and far between, seldom darken a door.

3. Violence in LTC: Swift, fair treatment of violent residents to protect potential victims. Create a protocol, and locked facilities for the severely mentally ill, with highly-trained caregivers.

4. Accountability: Ensure that poor PSWs, nurses, physicians are counselled and/or banned. 

5. Demand Quality Care: Swift and effective correction of major defaults, not slaps on the wrist. Ensure that facilities are accountable. View Reports on Long-Term Care Homes / Locate a Home.

6. Communication: Include the family, not just patients. Demand family members attend meetings. Speak to them regularly, with regular case conferences. 

7. Staffing: Increase the number of staff, more trained nurse practitioners, more staff on duty at night.

8. Nurse Practitioners: Every LTC should have one, at least part-time. They should be pain management specialists.

Complaints about long-term careIf a senior is in Long-Term Care the government has rules and regulations that abound. Long-Term Care homes in Ontario have a strict complaints process. If there are complaints, and there are enough, then they go on warning and are said to be non-compliant. As a Transfer Payment Agency, they must fulfill the obligations of their mandate.
Year 2012

Inspection TypeInspection Date
Complaints InspectionSep 17, 2012
Critical Incident InspectionSep 17, 2012
Follow-Up InspectionSep 14, 2012
Follow-Up InspectionApr 25, 2012
Critical Incident InspectionApr 25, 2012
Complaints InspectionFeb 08, 2012
Critical Incident InspectionFeb 08, 2012
Can you imagine being rated this way? 
The facility is clean and well maintained.3.5/10
The facility feels 'home-like' (not institutional).2.3/10
The facility is free of any offensive odours.4/10
There are many activities for residents which cover a broad range of interests.3.6/10
Rooms are spacious and comfortable (Bedrooms, Dining Room, Common Areas).4.2/10
The building is safe, secured, and monitored for unwelcome guests.3.2/10
The food is of good quality and appealing.4.5/10
Medical care (i.e, physician) is accessible and treatment is provided in a timely fashion.2.8/10
Staff respond to residents’ needs in a timely fashion.2.8/10
Staff are friendly and approachable.3.6/10
Staff treat residents with respect and dignity.3.6/10
I would recommend this facility to others.2.6/10
Staff are quick to update me on the condition of my loved one.3.7/10


Karen said...

Thank you for this posting Jen. It came at very critical time for our family as we try to find a LTC home for our father. The link to check out reports was a real eye opener. Sadly, the LTC home that is prepared to take our father in the immediate future has a horrific history of situations.
Back to square one I guess.

Jennifer A. Jilks said...

I'm so sorry to read this, Karen. The bad ones give a bad name to the good ones.