Slow fix at nursing homes

Posted on July 9, 2008 in Child & Family Debates, Governance Debates, Health Debates – – Slow fix at nursing homes
July 09, 2008. Moira Welsh, Staff Reporter

Elderly residents of a fast-growing private nursing home chain lived with substandard care and dirty conditions for years while health ministry inspectors hit the homes with hundreds of violations, according to government documents.

Provincial inspection reports describe Leisureworld residents living with untreated pressure ulcers, lax infection control, improper use of restraints, meagre food portions and, in a few cases, accidents that left them with head injuries or broken bones.

After several years of intense ministry scrutiny, Leisureworld homes are improving, though difficulties persist. The experience of the chain – third largest in Ontario serving more than 4,000 seniors – shows that much government action is needed to make improvements. Even now, Leisureworld’s rate of violations remains above the provincial average and one home, O’Connor Gate, remains under suspension (new residents can’t be admitted) because violations of the Nursing Home Act have not been fixed.

Leisureworld’s chief executive officer, David Cutler, acknowledged problems. “We are not perfect,” he told the Star. “We do have issues that we have to deal with in different homes at different times. There are many, many, many standards that have to be met.”

The Star took a hard look at the chain after the death last month of two residents. Florence Coxon, 87, was left alone and choked to death on her restraint. Three days later, Wally Baker, 67, died after falling from broken lift equipment. Both lived at the O’Connor Gate location in the east end of Toronto.

Leisureworld’s problems shine a light on Ontario’s cash-strapped nursing home system, long plagued by staffing shortages that place the elderly at risk. Residents need complex medical attention, yet Ontario’s 628 homes provide one of the lowest levels of care in Canada.

Andre Marin, Ontario’s ombudsman, is probing the ministry’s regulating practices. While some nursing homes complain of too many rules, Marin calls that a “fight against accountability.”

“Part of our process right now is to investigate whether those controls are vigorous enough,” Marin said.

“There are millions of (government) dollars going into these organizations. This is not free money. There should be strings attached to it. It strikes me that the government needs to be aggressive with these facilities.”

The ministry oversees nursing homes with roughly 400 “standards of care,” monitoring nursing, personal care, diet, environment and safety.

Early this year, the ministry approved Leisureworld’s purchase of seven homes, most in the GTA, making it the third-largest nursing home chain in Ontario. A ministry spokesperson said approval was given after previous compliance issues were raised and discussed.

Leisureworld now has 26 homes, caring for 4,378 residents, and is awaiting ministry approval to buy the 64-bed Good Samaritan home in Alliston.

The Star obtained inspection reports for 18 Leisureworld homes from 2005-07. Some had few violations. Others had dozens.

In 2007, two homes – Scarborough and Gravenhurst – were under months of “enforcement” monitoring because many problems had not been fixed. Scarborough’s admissions were also suspended.

Among the ministry findings:

In 2007, Leisureworld’s Gravenhurst home broke safety regulations in the “unexpected” death of a resident. Residents were unnecessarily put in restraints. Usually “seat belts” on wheelchairs, restraints are to be used only for those at high risk of falling.

Residents were messy and fed meals half the standard size. Extreme staffing shortages were noted. (It is a system-wide problem. Many nursing homes pay lower wages and benefits than hospitals.)

In 2007 at the Scarborough Midland Ave. home, a resident with a gaping pressure ulcer on the tailbone did not receive proper care. A diabetic did not get insulin as ordered. Frail residents who needed extra food did not receive it. Others were served three-quarters of a sandwich instead of the full size – “unacceptable,” said Cutler.

The enforcement on both homes was eventually lifted. Other homes within the chain were scrutinized through increased monitoring.

Leisureworld’s downtown Toronto St. George location was the focus of special visits due to recurring violations. In 2006, inspectors found feces on the floor of the television lounge. The facility had the “strong pervasive” odour of feces and urine. Residents were dressed in soiled clothes. One suffered broken bones because staff pushed him improperly in his wheelchair.

Ministry data show extra scrutiny paid off. Over the last three years, Leisureworld’s overall violations of the Nursing Home Act have dropped by nearly 50 per cent, even though they remain above the current provincial average of 5.28 violations per 100 beds. In 2007, it had an average of 6.21 violations.

“You can see a consistent improvement and I think that is the sign of a good organization that is able to take steps to remedy and fix problems,” Cutler said, adding a higher rate of violations in 2005 was due to industry-wide staffing shortages.

He said at least 50 per cent of Leisureworld’s individual homes have lower than average violations.

When the many examples of care violations were put to Cutler he said, “The record is the record. I am not going to debate that with you.”

Cutler said Leisureworld has worked hard to fix the problems, regularly educates its staff and has its own monitoring system. He said in 2005 homes struggled to find staff because of the expanding nursing home sector.

The troubled St. George location recently emerged from a ministry inspection with only one violation, he said. “It does not pay Leisureworld not to look after our people properly. That is not our goal.”

Cutler said the ministry has many regulations requiring busy staff to spend time on documentation (such as food intake or medication) instead of providing bedside care. He said many of Leisureworld’s violations fall under this category.

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