Thursday, March 6, 2014

What is wrong with LTC? Minister Deb Matthews says we can fix it with 75 NPs!

Leave it to the government to only appear to have solutions. Yes. Ontario is getting 75 more NPs, to
Dying in a retirement home,
they assured the family they were able to provide adequate care
divvy up between 630 LTC homes!  That's 1026 beds/patients per practitioner! I blame the physicians, who are not doing their best in long-term care.

The province is running up a huge debt, currently an $11.7 billion amount, and politicians are going to spend $14 million on this initiative over a 3-year period. Of course, the blame is directed towards the federal government, which has cut $641 million in transfer payments to Ontario.

That statistics speak for themselves:
  • There are 77,000 beds in LTC.
  • Ontario has 630 long-term care homes
  • Dementia symptoms are present in about 60% of residents
  • Almost 50% of those with dementia demonstrate aggression (35% moderate behaviour; 11% severely aggressive)
  • Since 2001: 27 homicides in LTC in Ontario
  • Training and hiring of 200 personal support workers to manage aggression (for 77,000 beds)!
  • PSW wages: it is paid according to where you work (gr. 12 & certificate: $12 - $23.00)
  • There are  ~90,000 personal support workers in Ontario with about 57,000 providing care in long-term care homes and 26,000 in home care through community health agencies. 
  • About 7,000 personal support workers provide care in hospitals. 
    Clean bathroom, assistive devices

What does a PSW do?

The work of personal support workers ranges from assisted daily living tasks (such as personal hygiene, transferring clients between bed and chair, taking medication and doing light housework) to delegated health procedures (such as changing dressings, tube feedings and oxygen therapy).

The barriers to excellent care?

  • Poorly trained and uneducated support workers (PSWs = no regulation)
  • PSWs paid not according to their education and experience (PSW wages) but their employer's budget
    Living in filth, with 2 PSW each here
    for 5 hours every day. I ended up cleaning it myself.
  • Private and home care staff are largely unsupervised; they tend to casually diagnose, and can overextend their Scope of Practice (mission creep)
  • Shortage of staff: How to find, train, adequately pay, and fund more staff: nurses and PSWs and geriatricians
  • Individuals who are unaccountable for mistakes, incompetence (at all levels of healthcare), poor supervision of staff
  • Too many for-profit LTC (over 500 / 630 homes in Ontario)
  • Successful, exemplary practices and success stories in healthcare (not just media horror stories)
  • How to find more funding for hospitals and home care
  • How to manage the new system of patient-based hospital funding
  • How to address the disparities in healthcare between rich and poor
  • Caregivers who are unable to stay at home with loved ones (due to finances)
  • This man belonged in hospital.
    There was a needle under his bed.
    He lived in filth.
  • Caregivers who experience caregiver stress, further confounding the system
  • How to address an $11 billion operating deficit, a $260 billion debt in Ontario healthcare
  • Permitting patients to go home, when they are entitled to a bed in a hospital, and they receive appalling care
    • The work of personal support worker

Ontario seniors’ homes to get more nurse practitioners

Ontario’s health minister has announced that 75 nurse practitioners (NP) will be hired for long-term care (LTC) homes. In doing so, Deb Matthews acknowledged that’s not enough for the woefully understaffed seniors’ facilities, and promised more will come.

Learning the lessons of the deadly Sunnybrook blaze

Former hospital CEO Tom Closson recalls 1997 tragedy, pushes for long-term-care homes to have sprinklers and a plan for aggressive residents

Call for more funding:

Scope of Practice

Donna Rubin, CEO of the Ontario Association of Non Profit Homes and Services for Seniors (OANHSS), last month warned a legislative committee at Queen’s Park that long-term-care homes lack the funding to hire enough staff to keep residents safe.
Matthews made the official announcement today at Toronto's Belmont House long-term care home, saying funding will be made available to place nurse practitioners in 75 long-term care homes over a three-year period beginning with 15 this year, 30 in 2015 and 30 more in 2016.
For Doris Grinspun, RNAO's Chief Executive Officer, the announcement represents the kind of system change the association has long been advocating for, citing the advanced education and experience of NPs to diagnose and treat common illnesses as well as their expanded scope of practice to order most lab tests and prescribe medications.

Ontario's Action Plan for Seniors

Seniors' Secretariat
Ontario has developed an Action Plan for Seniors that will address the needs of seniors and their families. 
  • Designate 250 long-term care beds as short-stay beds
  • Improve access to home care by expanding personal support worker services through community support agencies for low-needs patients. 
  • Create as many as 75 Health Links — networks of linked health care providers — to encourage greater collaboration and co-ordination in patient care for high-needs seniors.
  • Encourage primary care physicians to provide about 30,000 more house calls per year and expand the service to include other health providers, such as nurse practitioners.

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