75% of nursing homes cited for not meeting some provincial standards

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 subset of standards that ensure residents are well-fed, clean and free of pain and that dictate how homes care for incontinent residents and when they can use restraints.

And almost three-quarters of Ontario's 616 nursing homes that have their inspection results posted online violated at least one of the broader group of 400 general standards set out by the province — a proportion that 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 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 said that the vast majority of these violations have been addressed and that most are trying to combat a shortage of staff.

Standards are unrealistic, homes say

Long-term care homes are expected to satisfy 400 rules governing everything from what temperature food must be served at to cleanliness, safety and respect 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.

Aides said newly appointed Health Minister David Caplan couldn't immediately comment on the findings or the larger issue of conditions in nursing homes until he had a better grasp of his portfolio.

But Ontario's homes argue the government's many standards are unrealistic and are 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 that 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.

"The important thing is that the government and the public need to know whether these homes have developed a process for improvement," Rubin said.

Some regions have more violation-plagued homes than others. All of the 23 homes in the central-west region taking in Toronto 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.

Only one punished

Although inspectors have continuously cited certain nursing homes — some over a span of up to 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 for-profit homes.

But the consistently high number of violations raises some frightening questions about the quality of care Ontario seniors are receiving, experts said. The vast number of reported infractions is likely just the tip of the iceberg, Armstrong said.

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."

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."

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?"