Standard needed at nursing homes

Posted on June 21, 2008 in Governance Debates, Health Debates – comment/editorial – Standard needed at nursing homes
June 21, 2008

George Smitherman ended his tenure as health minister much as he started it: by pledging to improve the quality of care in Ontario’s nursing homes.

On Tuesday, just three days before being sworn in as minister of the newly merged energy and infrastructure portfolio, Smitherman released a long-awaited report by nursing home CEO Shirlee Sharkey that sets out a strategy for enhancing care in the province’s 600-plus long-term care facilities.

The thoughtful report, which Smitherman commissioned last year to help develop regulations under the new Long-Term Care Homes Act, urges a broad approach, including: “guidelines to support annual funding” to boost care for the province’s 75,000 nursing home residents to a provincial average of “up to” four hours per resident per day over the next four years; strategies to increase staff recruitment, retention and professional development; local human resource planning to ensure the right staffing level and mix; and measuring health outcomes and resident satisfaction.

But what was missing was what many residents and families sought, concerned as they are about infrequent diaper changes and poor supervision in some homes: a regulation (as opposed to mere guidelines) that would require an average number of hours of hands-on care per day, adjusted to the needs of each resident.

In the Legislature this week, Smitherman agreed that “more staffing in long-term care is the answer,” but he added: “The report says that a number alone doesn’t cut it. It encourages us to be more sophisticated. … We can bring in a minimum standard, but that alone is not the best way to the quality that we all seek.”

Fair enough. Sharkey’s report makes clear that staffing long-term care homes is a complex process that defies easy solutions. But in the interests of ensuring frail and vulnerable elderly people live out their last years in dignity, surely a good starting point would be establishing a care standard to which Queen’s Park could be held.

The problem, of course, is that if the government were to set such a standard, it would have to fund it. And that would be an expensive proposition, especially as the population ages.

The government may also be trying to confuse the issue by playing with the numbers. The report says long-term care home residents now receive an average of 3.1 hours of care per day, and that budgeted staff increases will increase that to about 3.5 hours. But those numbers are based on “paid” hours, as opposed to “worked” hours, the standard widely used in the sector. They also factor in dietitians, social workers and other staff whose services are crucial but who do not do the hands-on work of bathing, toileting and feeding frail residents.

Despite throwing hundreds of millions of dollars at the sector, Smitherman’s promised “revolution” in nursing homes will remain incomplete without a regulated care standard. It will be up to his successor, David Caplan, to take up the gauntlet.

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