Chinta Puxley, THE CANADIAN PRESS
TORONTO - The majority of Ontario's nursing homes have failed to meet basic standards set out by the province to preserve the rights of elderly residents, with some failing to bathe residents even twice a week, others leaving seniors sitting for hours in soiled diapers and still others unnecessarily restraining those in their care, an investigation by The Canadian Press reveals.
Just over 60 per cent of homes across Ontario - and up to 91 per cent in some Toronto suburban communities - have been cited for violating some of the specific set of standards that ensure residents are well-fed, clean and free of pain, as well as dictating how homes care for incontinent residents and when they use restraints.
Almost three-quarters of Ontario's 616 nursing homes that have their inspection results posted online violated some of the 400 general standards set out by the province - a proportion which hasn't changed significantly since 2004 when then-health minister George Smitherman promised a "revolution" in the province's long-term care.
"We're talking about the majority of people not getting the minimum standard of care," said Pat Armstrong, York University professor and one of 12 national chairs in health services and nursing research. "In a sense, we've abandoned them."
Many workers are embarrassed about the level of care they're able to provide because they know it's sub-standard, she added.
"They're saying . . . don't put your mother here because the quality of care is so bad."
Provincial inspection reports, from April 2007 to March of this year, analyzed by The Canadian Press show some long-term care homes were cited repeatedly for failing to provide a minimum of two baths a week while other residents were found not to own a toothbrush.
At St. Joseph's Manor in Elliot Lake, inspectors on one visit found residents in soiled clothing and "heavy, bulky foul-smelling" diapers, while homes across Ontario were cited for restraining residents without trying other alternatives first.
At Tullamore nursing home in Brampton, inspectors reported "16 residents were identified with their restraints applied incorrectly" and said one resident had "slid down in the chair with the seatbelt choking her."
Inspectors said residents at Banwell Gardens in Tecumseh who were unable to feed themselves had to wait up to an hour at a dining room table before staff were able to serve them breakfast, while one inspector at Caressant Care nursing home in Fergus reported watching a resident dump hot oatmeal in his lap and then try to eat it with his hands without staff intervention.
Those homes say the vast majority of these violations have been addressed and most are trying to combat a shortage of staff.
Long-term care homes are expected to satisfy 400 rules relating to everything from what temperature food must be served at to ensuring a clean, safe and respectful environment for residents. Many of the province's standards relate to documentation and paperwork and more than one-third of Ontario's homes have been cited for administrative infractions.
Newly minted Health Minister David Caplan said the province has increased the number of inspections it conducts since 2004 and the actual number of total infractions across the province has been decreasing.
"We're very committed to transparency," said Caplan, noting his Liberal government is responsible for making the inspections public in the first place. "We're working hard to build on the progress that has been made but of course, there is always more to do when it comes to our most vulnerable, no matter where they are in the province."
The Liberals have increased funding for long-term care and will continue to look at ways of boosting staffing, he added. The government's focus is on the infractions that directly affect resident care and those are corrected quickly, he added.
But Ontario's homes argue the government's many standards are unrealistic, often more concerned with whether forms were filed correctly than with the actual quality of care residents receive. They say the province has set up a "quasi-police state" with its numerous standards which focus attention on minutiae rather than the larger, more important issue of resident care.
Donna Rubin, CEO of the Ontario Association of Non-Profit Homes and Services for Seniors, said if a toothbrush isn't labelled with the resident's name, it counts as an infraction.
"When you are living in a quasi-police state, you're just focusing on keeping your nose clean and documenting rather than doing what's important," she said. "We've got a culture that is . . . focused on fear and making sure you check boxes."
Instead of focusing on whether water is served at the wrong temperature, Rubin said the government should come up with a better set of standards that would help crack down on repeat offenders.
"Bad things will happen because staff aren't perfect. You can have poor performers, you can have incidents where things go wrong," said Rubin, who represents 180 non-profit homes.
"The important thing is that the government and the public need to know whether these homes have developed a process for improvement."
Some regions have more violation-plagued homes than others. All of the 23 homes in the central-west region taking in Toronto's suburbs including Brampton and Orangeville violated some of the province's standards in inspections last year. All but two of the 27 homes in the Mississauga-Halton region were cited for infractions.
Long-term care facilities in Ontario's north-west region also appear to have difficulty meeting the province's standards with all but one of the 19 homes there being slapped with violations.
At Birchwood Terrace in Kenora, an inspector found several residents who were "unshaven with long and/or dirty fingernails, greasy and unkempt hair, food-soiled clothing, wearing socks without shoes and/or slippers."
The home was cited four times last year for not giving residents a minimum of two documented baths a week. The home blamed a chronic shortage of staff which it said it's addressing through recruitment drives.
At the bottom end, just over half of the 67 homes in the central-east region, including Peterborough and Cobourg, were cited for violations.
Although inspectors have continuously cited certain nursing homes - some over as many as five years - the number of homes that have been punished by the governing Liberals dwindled to only one last year.
Janet Lambert, executive director of the Ontario Long Term Care Association, said the inspection reports are only a snapshot and don't reflect what steps homes have taken to correct the situation. Homes that are cited during annual inspections have to give the ministry a plan to fix the infraction and are subject to follow-up visits, she said.
It doesn't make sense to sanction a home just because a few residents - who may have dentures - don't have a toothbrush, she said. In some cases, she said a home may be giving residents two baths a week but just not documenting it properly.
"If a personal support worker is having a cup of coffee with a resident - rather than sharing that time together - the personal support worker must go and document somewhere that the resident just had eight ounces of coffee," said Lambert, whose association represents 430 of the province's homes.
But experts say the consistently high number of violations raises some frightening questions about the quality of care Ontario seniors are receiving. The vast number of reported infractions is likely just the tip of the iceberg, said Armstrong.
The York University sociology professor, who has conducted several studies on conditions in Ontario's long-term care facilities, said workers are often warned about "surprise" inspections before they happen and many of the infractions don't get officially recorded.
Lois Dent, with Concerned Friends of Ontario Citizens in Care Facilities, said the inspection reports suggest thousands of seniors are living in sub-standard homes.
"Many of these are minimal standards," said Dent, whose organization voluntarily monitors the provincial inspection reports. "There is still this small core of homes that have a lot of problems. They're not performing as well as they should and this continues year after year."
The province seems to be "too reticent to crack down" on homes that are repeatedly cited for violations, Dent said.
"They're not moving fast enough and strongly enough to sanction those homes that really need to pull up their socks," she said of the governing Liberals. "They're being a little too patient."
Standards of care at Ontario's nursing homes came under fire recently following two deaths at a Toronto home. Resident Wally Baker died April 30 after an accident involving a lift device, and fellow resident Florence Coxon died three days earlier after choking on the restraint that held her in her wheelchair.
In that case, media attention prompted the province to bar the Leisureworld Caregiving Centre's O'Connor Gate residence from accepting new patients until it proves it is complying with Ontario law. The home is still under sanction but Leisureworld CEO David Cutler said they are making "progress."
For some depending on a long-term care home to care for a loved one, the conditions come as a shock.
Ottawa resident Lise Cloutier-Steele, whose 83-year-old father is now in a home, said she is sometimes thankful that her father's growing dementia often prevents him from caring that he sometimes goes unshaven and smells of urine.
"I just know that if my father was well, he wouldn't want to smell of pee," she said. "It seems like a very basic thing."
The home, which has relatively few violations on paper, is full of people who work hard and truly care about the residents, Cloutier-Steele said. There just aren't enough of them, she said.
Her father's floor houses about 40 people but there are only two or three personal support workers responsible for their care, she said. It's no wonder residents can't even get their diapers changed or their catheter bags emptied, Cloutier-Steele said.
"They need more people."
Ontario has the second worst long-term care staffing levels in Canada, followed only by British Columbia, according to Statistics Canada.
There are currently about 28,900 personal support workers and 10,650 licensed nurses to care for about 75,000 residents in Ontario. The average resident is 83 years and more than 85 per cent of them need constant supervision and help with basic tasks like dressing and going to the bathroom.
Eulalee Thompson, a personal support worker in the Toronto area, said she is usually responsible for a dozen residents when - ideally - she should be caring for half that many.
At the end of the day, Thompson said she goes home exhausted, knowing some tasks have fallen by the wayside.
"It's really hard," said Thompson, who has been working in long-term care for 25 years. "We are tired of doing six people's jobs . . . We're exhausted, we're burnt out, we're tired. It's really tough but what can you do?"
The Canadian Press, 2008
