Posts Tagged Long-term care
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Health Care on Sunday 22 September 2013
This story has been bouncing around the Canadian media since last May. Camille Parent, the son of a nursing home resident, set up a hidden camera in his mother’s room for four days after she (the nursing home claimed) was assaulted by another patient. The results were appalling. Watch here:
The nursing home immediately fired the four staff members seen in the video; the contract of the director was not renewed. The police, however, have decided not to prosecute; the legal case for pressing assault charges, they said, is a lot narrower than what you or me would consider abusive.
That the standards in this nursing home are so abysmally lax is nearly beyond comprehension. Just after this particular facility opened about ten years ago, I accompanied a friend on a tour of the place. I remember thinking at the time, “If I ever need supportive care, this is where I want to go.” They had an exemplary care model, good staff/patient ratios, and a well-designed environment.
For me, it was interesting the reflex reaction of the director was to axe the employees involved, because as we all know, the best way to address issues in any health care institution is to fire employees.
Voilà! Problem fixed!
The problem with this hypothesis (i.e. the Rogue Employee Theory) is that four employees in four days with one patient displayed behaviours that were, um, sub-optimal.
No, sorry. You can’t just blame the employees, though they need to be accountable for their actions. The administration of the nursing home needs to take some (most?) of the responsibility for permitting an institutional culture where waving faeces-soiled wash cloths in patients’ faces, and canoodling in patients’ rooms is acceptable behaviour.
Let’s take a look at the Mission and Values statement of the nursing home:
St. Joseph’s at Fleming is a non-profit long term care health provider committed to excellence in the delivery of quality care and services to persons of all faiths. Continuing the legacy of the Sisters of St. Joseph of Peterborough, the Home takes pride in a model of care distinguished by compassion, dignity, respect and integrity.
Leader and valued partner in long term care through the use of innovation and best practices in living, learning and caring.
Our Core Values
St. Joseph’s at Fleming is committed to creating a healthy living and working environment that:
[. . . ]
• Treats people with fairness and social justice
[. . . ]
St. Joseph’s at Fleming is committed to creating a unique learning environment for Residents, families, staff, volunteers and students that:
• Promotes innovation and best practices
[. . . ]
• Develops leadership and promotes teamwork
St. Joseph’s at Fleming is committed to providing exemplary physical, emotional and spiritual care to our Residents, their families, staff and volunteers. Our philosophy of care:
• Engenders trust, healing and wholeness
• Integrates best practices and innovative solutions
• Promotes individuality as well as personal and spiritual growth
• Is characterized by compassion, respect, dignity and the sanctity of life
All of which is very good, anodyne and even commonplace, and I am sure it looks very nice hanging in the front lobby. It’s pretty easy to point out where the nursing home and its employees betrayed its own mission and values, so obviously, it’s not enough. If I were the provincial investigator looking at this nursing home, my very first question would be, “How are your values exemplified in how you provide care?” In other words, how do you ensure institutional values — all those warm fuzzies listed above — align with the personal values of the staff? (Clearly, they didn’t in this case.) And also: what policies and procedures do you have in place that address abuse? What education do you give staff around patient abuse, or the issues that surround the care of cognitively impaired patients? How do you evaluate the effectiveness of that education? How do those in leadership positions role model behaviour? What processes do you have in place to care for demented patients? How do front line staff participate in the development of such processes? How do you reward/celebrate excellence? And so on.
I’m guessing the answers to most of such questions would be “a little” or “not at all.”
So who should be held accountable?
The front line staff?
The leaders, the managers and the administrators?
Yes. Probably more so.
So what do you think? Who is to blame? Staff or administration or both?
I asked Jenn Jilks, a long time reader and commenter here, to write a few words on nursing homes, and the sometimes disgraceful care they provide for residents. The problem isn’t that nursing home operators “try hard”, or “do the best they can with limited resources”; the real issue is the lack of accountability inherent in the system, whether its unlicenced and unregulated care providers, the lack of stringent provincial standards for nursing home care, or the larger questions of a government which believes the minimal standards are good enough, or of taxpayer subsidies to a profitable industry.
My mother died at home and my father died in a long-term care (LTC) facility. I became heavily involved, as I wanted to have some influence. As things progressed I did a bit more research. Having been a caregiver in Mom’s home, I saw both sides of the coin. I have many issues with for-profit LTC.
- In Ontario, over 500 of the 600 LTC institutions are FOR-PROFIT.
- Food in LTC is appalling.
- Most of the care in LTC is provided by unregulated, non-professionals with a gr. 12 degree. Some have a training certificate.
- The disparities between rural and urban care continues.
- The highly-touted Aging at Home Project did not create many jobs, and failed to find more staff for under-staffed institutions.
I met a lot of people in these homes. Calling the patients residents is a bit disingenuous. Those with strokes, or comatose, spend their days horizontal. Many I met were unable to make their way around their homes any more. Some were tired. With incredible life stories, now wheelchair bound, they spend their days waiting by the dining room in preparation for the next meal. Many use the retherm method, simply reheating food you cannot recognize as food. Spareribs with no bones and veggies with no life. If you’ve ever fed pureed food to a frail senior, you will know how difficult this is. What I wouldn’t have given to see my father eat an apple or a banana.
In the meantime dividends are sent to shareholders of the for-profits.
Now, these places have intense programs, with activity directors who set up many activities. There are volunteers who spend time feeding, fundraising, or entertaining those in the residence. For the most part, the homes I visited in Muskoka were places where a harried crew of people worked hard to ensure that these people, who are loved by someone, can spend their days clean, busy, well-fed and engaged. Many are in pain, however, and lonely.
Personal support workers (PSWs) are involved in the intimate care of these people who cannot care for themselves. Some call them Health Care Personnel (HCPs), to my mind they are interchangeable, but not all are equal. Caregivers can range from the very competent, to those incapable of finding a kind word for a resident and barely literate. They are running, most of the time, trying to find another staffer to move a resident from bed to wheelchair or toileting. Some work for private agencies, some work for profit agencies, called in to LTC or retirement homes to supplement staff. There are huge inconsistencies. Who dares complain?
With only a minimum grade 12 education, a short number of months at a college, PSWs find themselves wiping the most intimate of areas, and doing things for our elders that was formerly done by themselves independently and alone. Some try to diagnose for resident’s families. The college certificate required by some for-profit institutions is inconsistently provided. None are followed long-term by the nursing departments who supervise them. Especially in the north, where workers are in high demand, the poor ones quit and go private. In the meantime, we spend big bucks advertising to promote an awareness of elder abuse.
We cannot call them nursing homes much anymore, as much of the ‘nursing’ is done by non-professionals. I’m not talking about medications, or more complex care. Most of the time there is a Charge Nurse on the floor. She spends time handing out meds or sorting out treatment plans and the paperwork that engulfs all professionals. There are never enough PSWs to do the lifting, transfers, changing of incontinence products or feeding required. As for physicians. . . they are few and far between. It took me two months to get adequate pain meds for Dad. No one recognized his signs of pain: singing, fussing with clothes, agitation, and it is my endless regret that I did not fight harder.
In my experience poverty leads to institutionalization, rather than disabling diseases. Many seniors would rather die in filth, alone, than suffer the embarrassment of giving up their independence of their own homes. The government does not pay enough to truly support our elders. Nursing homes are staffed according to the number of residents, not the severity of their illnesses, those with chronic disorders and/or mental illnesses cannot get the individual care they merit. Our tax dollars go to subsidize the residency of the old and frail in LTC who cannot support themselves in their homes due to failing health, failing eyesight, or failing bank accounts. The shame of it is we do it so poorly.