By Lise Cloutier-Steele
Since my 83-year-old father’s admission to a long term care facility in May 2007, I have had first-hand experience with the adverse effects of staff shortages and excessive workloads on dependent residents.
My father is more fortunate than most in that he resides in a home with an outstanding reputation where the staff is genuinely caring. The problem is that there aren’t enough of them to meet the individual and basic needs of all the home’s residents.
According to Statistics Canada, Ontario has the second worst long term care staffing levels in the country. Not only are staffing shortages epidemic across the province, but the provincial government has yet to act on the Provincial Auditor’s criticisms regarding the lack of accountability and the lack of connection between assessed needs and care levels. In other words, the current situation in nursing homes is detrimental to the welfare of its residents, and no one is reacting to it.
The inconsistency in the number of staff working in long term care facilities can lead to mistakes and potentially harmful oversights. For example, recently a personal support worker neglected to empty my father’s urine bag during her entire shift. It was over the 750 ml mark when I got to the home early one evening, and if he had needed to urinate one more time, there would have been no place for it to go except back in. People who must wear a catheter on a permanent basis are subject to bladder infections that are difficult to treat. In addition, the medications required to rid the patient of these infections can cause unpleasant side effects. Although neglect in this regard is never purposeful, it’s still hazardous to my father’s health.
Sadly, there are other residents at the home whose basic needs can’t be met, and who don’t have any regular help or visits from family members. One non-nursing employee confided that incontinent residents are often left in their soiled diapers for too long – an event often resulting in skin disorders and painful bed sores.
In the May 2008 report of the Ontario Health Coalition (OHC), similar observations were highlighted, and the urgent need for additional staff clearly identified. One registered nurse shared that it was ridiculous to wait until a diaper is 90% full before changing it when we don’t do that to babies. But minimum staffing levels, high patient-to-staff ratios and lack of funding for incontinence supplies have that adverse outcome.
The administrator of the home where my father resides said that the nursing budget is always in a significant deficit. She stressed that this is not due to inefficiencies or mismanagement, but is rather a direct result of chronic and sustained under-funding on the part of the Ontario Ministry of Health and Long Term Care (OMHLTC). It is not a case of home administrators not spending the full amount allocated by the Ministry for nursing services, and re-directing those funds to other departments or pocketing them as profits. This would not be possible, as any unspent nursing funds are automatically returned to the Ministry. In fact, this year’s nursing budget is subsidized by $330,321 from other funding envelopes within the home’s overall budget.
The home’s administrator also pointed out that staff can become fatigued, which should be no surprise given the increasingly higher number of residents with dementia, behavioural problems and more serious chronic diseases. This reality was just another important issue raised in the OHC’s report. Unfortunately, the current system continues to be ill-equipped to cope with staff burnout and excessive workloads for which adequate funding and educational resources would be required.
The shortfalls persist despite the compilation of many comprehensive reports, audits, media exposés and submissions from family members and caregivers on the serious problems regarding basic care to residents in LTC facilities.
The provincial government’s response was to commission another review led by Shirlee Sharkey, President and CEO of Saint Elizabeth Health Care. Sharkee’s June 2008 report makes 11 recommendations to strengthen staff capacity, and establish a strong foundation for better quality of care and accountability for resident outcomes. One of the most important recommendations was the call for provincial guidelines to support funding increases designed to raise the level of care from 3.5 to 4 paid hours per resident per day over the next four years.
These recommendations may be on target, but there are no guarantees that all will be implemented and sustained without further debate and study. And what of the immediate need to provide regular and consistent basic care like toileting twice daily?
Residents of long term care facilities across the province don’t deserve to be put on hold any longer. They were there for us once, and now it’s time to return the favour with action and dollars.
Lise Cloutier-Steele is the author of Misinformed Consent, and Living and Learning with a Child who Stutters. Currently, she is working on a book featuring the contemporary paintings of Blair Thomas Paul, to be published by Penumbra Press of Manotick in 2009.
