Saturday, January 25, 2014

Fire in a retirement home – 'call to action' for some, more investments required

Home Care is one option
Many are on waiting lists
Yes, Quebec had a horrible fire last week. There are 30 seniors missing, family members waiting for crews to melt the coating of ice in order to recover bodies. It is a terrible situation. My condolences to family members who are in mourning.

Journalists, who are supposed to report the news, are waxing eloquently about a 'call to action', a 'wake-up call', 'just a matter of time', and other ridiculous, heartless statements for families to read.

Firstly, this journalist (ANDRÉ PICARD) makes blanket statements:
We have instead adopted a de facto policy of mass institutionalization – with 8% of seniors already warehoused and that number soaring.

Mass institutionalization does not equal 8%. Most seniors live at home. Only 1.6% of people between 65 - 70 live in a facility.
When you look at those 80 and above, the tide turns, and group care consists of more than half of this population. This will change, as we have reduced numbers of people with issues such as COPD, who refrain from smoking, exercise more regularly, and eat better diets make it to their golden years.

What are the barriers to preventing loss of life?

Firstly, one must remember the difference between retirement homes and long-term care (LTC). Retirement homes have different standards in many provinces compared to LTC. 
Theoretically, people in a retirement home are covered by the Landlord Tenant Act, rather than the Ministry of Health and LTC. 

Theoretically, people in retirement homes are ambulatory, and able to arrive, independently, for meals, and manage toileting independently. Sadly, this is no longer the case. Too many are
Palliative care is difficult in a retirement home
choosing retirement homes since they are less expensive, with lower levels of care, fewer staff. 

Too many retirement homes assure resident's families that they are able to manage a palliative resident, when, in fact, they cannot. I complained about one such situation. The family was in denial, the one elevator broken, the resident unable to feed himself. The retirement home was unable to find staff to feed him. They called in CCAC to provide care to feed him breakfast, and dress him, put him in his wheelchair, then another came to get him back to bed and feed him dinner. They contacted my volunteer agency, to ask for a volunteer to feed him lunch and take him outdoors. They failed to tell the family about this change in care. They were angry when I phoned a family member and suggested he was not getting the care he deserved, as a WW II veteran. The nurse attached to the facility, didn't darken the doorway for the 5 hours I was with this client, two days in a row. It was shameful.

I complained to the Retirement Homes Association [Ontario's Retirement Homes - a profitable mess], but they did nothing. His room was filthy, his sheets and clothes were not changed enough. The Association said if the family was aware, and weren't complaining, they would do nothing, despite having their logo and stamp of approval on the door of the residence.

What do families want?

Fully-subsidised healthcare, for free. Residents want Home Care, and to die in their own homes. Something has to give. Many middle class families have come to expect a full range of services. They want 24/7 home care. There isn't that much money available for such care. We are short-staffed personal support workers (PSWs), and when something like a flu bug hits, or during summer vacations, part-timers who are available for relief, are working 2 or three jobs. 
We are short nurses, as well. The addition of Nurse Practitioners has eased the burden of care, but nurses are in short supply, as well. 

It is the PSWs who provide the assistance with activities of daily living (ADL) in group care. They are the ones on duty, at night. With a gr.12 education, and a certificate in order to qualify in many places, and a pay scale that ranges from minimum wage in Ontario ($10.25/hr) to $20/hour in larger, unionized employees, in, for example, hospitals. 
PSWs, also, must be cognisant of their Scope of Practice

Barriers to swift evacuation

  1. Staffing levels
  2. Inability of residents to hear a fire alarm
  3. Lack of mobility of residents
  4. Vision impairments
  5. Mental health issues
  6. Cognitive impairments
    My friend, Mary, she's a great-great-grandmother.
    She has a walker and a wheelchair.
  7. Power outages

My conclusions

  1. We must be careful the type of residence and institutional accommodation we choose.
  2. Taxpayers must be prepared to further subsidize for-profit retirement homes and LTC, to ensure that they can afford retrofitting with items like sprinkler systems. Many do not have the capital funds for this.
  3. Minimum staffing ratios 24/7.
  4. Regulate PSWs, provide better, more standardised training.
  5. National Fire Code 
  6. Higher staffing levels for facilities
  7. Ensuring that residents in Retirement Homes are in suitable placements
  8. Ensuring that residents in LTC are fully staffed year-round
  9. Coroners' inquests recommendations are enforceable laws and regulations

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