Ontario’s scandalous non-care for the elderly
TheStar.com – /news/canada/politics
Published On Wed Jul 27 2011. By Thomas Walkom, National Affairs Columnist
On paper, Ontario’s system for taking care of old people looks superb.
The law sets out what appear to be strict standards for the province’s more than 400 long-term care homes that serve the elderly.
There is even a bill of rights for residents of these nursing and old-age homes.
But a story last week in the Star underlines how very fragile these standards can be.
It detailed the horrifying story of a 75-year-old woman who, after breaking her leg earlier this year in a Niagara-on-the-Lake old-age home, endured 24 days of excruciating pain before seeing a doctor.
Sylvia Bailey eventually died March 30 from sepsis, an infection of the blood.
Bailey’s last weeks at the Upper Canada Lodge sound unbelievable.
She wasn’t examined by a doctor until the physician under contract to her home returned from holiday — almost a month after her accident.
Until then, she didn’t even get an X-ray.
Bailey’s story may be an extreme variant of a far too common tale.
Anecdotal evidence suggests that the medical care provided for the frailest of the elderly in Ontario nursing homes does not live up to government billing.
By law, long-term care homes are required to provide around-the-clock medical care. And, indeed, all do have registered nurses on staff.
But when it comes to doctors or nurse practitioners — the only caregivers authorized to, say, order an X-ray — the law becomes vague.
Regulations to the long-term care act require every old-age home to enter into a contract with a physician.
These physicians are paid retainers to “attend regularly at the home.” But they don’t necessarily have to show up every time a resident needs a doctor. They merely have to “participate in the provision” of such on-call or after-hours services.
What does this mean?
In some homes, it means the doctor of record rarely, if ever, makes unscheduled house calls. Instead, an elderly resident who, say, breaks a limb is sent by ambulance to the emergency ward of the local hospital.
There, he or she will be deposited in the waiting room, alone and without food or water, to wait his or her turn.
In one case reported to me, an elderly patient suffering from dementia waited a total of 17 hours.
During that time, this frail individual is effectively no one’s responsibility. The home has handed him off. But to the hospital, he is just one of many emergency patients.
It is perhaps not surprising then that many long-term care homes are reluctant to seek unscheduled physician services for their residents.
Yet for doctors contracted to the homes, there is little material incentive to do more.
The Ontario Long-term Care Physicians association posts telling figures on its website.
A doctor can earn $97.20 per resident from OHIP by visiting a nursing home just twice a month and checking the medical status of his or her patients.
In a 100-bed institution, this works out to $9,720 for two days work.
But if that same doctor makes a house-call to see just one patient, he earns only $56.40 — which may barely cover the cost of gasoline.
So, in practice, it’s usually the nursing homes themselves that decide what to do when a resident appears sick or injured. In some cases, the patient will be shipped off to emergency. In others, nothing will be done.
True, some may die from lack of immediate medical care. But except for rare cases — like that of Sylvia Bailey — no one pays much attention.
After all, they’re old. And better care would cost taxpayers money.
< http://www.thestar.com/news/canada/politics/article/1030841–walkom-ontario-s-scandalous-non-care-for-the-elderly >