Limitations Of Long-Term Care Homes In Ontario

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Abstract

Long-Term care facilities are residence-based health care establishments that are specifically designed for adults that require to be kept under observation for their safety and well-being, 24-hour on-site nursing care and help with the basic day to day activities such as eating, bathing, walking etc. All Long-term care homes are governed by the Long-Term Care Homes Act 2007 (LTCHA) and are approved and granted the licence to run and monetary funding by the Ministry of Health and Long-Term Care.

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The homes are run and owned by private or public companies, municipalities or even charitable organizations but term license and funding are obtained from the government. It is considered as the most reliable option for the elderly who are seeking support and care and much cheaper than the hospital. The government ensures compliance of long-term care homes with the required standards through unannounced inspections conducted by the Ministry of Health and Long-Term Care inspectors (Ontario Long Term Care Association).

However, all is not well with the long-term care homes in Ontario. The waiting list for admission to one of such facilities is quite a challenge in the first place. Further, there are numerous reports on how elderly patients are ill treated, neglected and even abused in such facilities. The staff in such homes is failing to abide by the required standards and in turn miserably unsuccessful to provide services to the frail and week elderly patients. In an utterly shocking report produced by a newspaper, Ontario’s long-term care system has been referred to in a huge crisis (CBC News, 2015).

Background

The Government of Ontario has facilitated several types of supportive housing services which cater to the needs of those who are unable to take care of themselves and need assistance with their daily chores. These are a perfect combination of housing as well as services. While it may appear that these amenities are exclusively for the elderly, it is not true. These are the provisions for any adult, i.e., anyone above 18 years of age who is debilitated, fails to take care of his or her health needs and faces serious challenges to a successful life. In addition to assistance in living, they provide dignity to adults to live in society. Supportive housing has helped provide shelter to homeless and care to the sick. Home and community care, retirement homes and Long-term care homes are such residential facilities offered for the elderly.

In Ontario, home care service is provided by the Local Health Integration Network (LHIN). This type of care allows seniors to continue to live in their home independently. A Care Co-ordinator who is appointed by the LHIN does an assessment of the senior’s care and assistance needs. A care plan is developed by the Care Co-ordinator and staff is assigned to needs of the elderly. Staff takes care of various needs of seniors such as personal support and care, home making services and most importantly, health needs, which are treated by skilled nursing staff.

Staff involve them in community support programs which offer them recreational and social services. This type of care has been subsidized by the provincial government. To be eligible to services, an applicant must hold a valid Ontario health card, must have needs that cannot be met in an out-patient clinic such as assistance in bathing, getting dressed etc., a medical condition that can be adequately treated at home and a need for at least one professional or personal support service.

Retirement homes are another option preferred by many seniors. In Ontario, these are not run by the provincial government and are privately owned. Retirement homes are a multi residence facility which provide accommodation, meals and housekeeping services such as cleaning and laundry. Some homes may offer basic health care but do not offer treatment. Residents don’t need to fulfill any eligibility criteria, but many retirement homes have a minimum age limit for admission. The residents are provided a single room or suite and have a common dining area, sitting lounge and recreational services. As no aid is provided by the government seniors must bear the entire cost for their living. The unit is to be paid for every month much like the rent of an apartment (Long Term Care in Ontario in 2017, 2017).

Nursing homes or Long-term care homes, as they are known in Ontario are the residential facilities that not only provide accommodation, meals and other services to seniors but provide a twenty-four-hour skilled nursing care. The provision of high level of personal support and care sets this type of care service apart from the rest. These homes are privately owned and run by non-profit organizations, private corporations, various faith or community groups, etc.

However, they are monitored and funded by the Ontario Ministry of Health and Long-Term Care which sets the fees and an eligibility criterion. Residents only pay for the accommodation and may qualify for a subsidy, if required. The eligibility requirements include possession of a valid Ontario Health Card and requirement of a level of care provided by the home such as the need for 24-hour supervision, frequent assistance with daily activities of living (Ontario Long Term Care Association, 2018).

Description of problem

The quality of life in long-term care facilities can be assessed not just by determining the objective and subjective aspects of the quality of life but by identifying the broader domains of life such as emotional health, physical health, comfort, security and wellness. According to Long-Term Care Home System Reports, Ontario Ministry of Health and Long-Term Care, October 2017, there are 625 approved and licensed long-term care homes in Ontario. Out of which 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal and 2% are run by other organizations (Ontario Long Term Care Association, 2018).Ever since Long-term care homes came into existence, they were considered to be a caring as well as a safe abode for people who suffer from notable health challenges and require twenty-four-hour supervision, care and assistance with their daily chores.

According to the Long-Term Care Homes Act, 2007, it is the responsibility of the Home to protect its residents from abuse by anyone and neglect by the staff and provide them with the much needed assistance. These Homes must prevent its residents from abuse of any kind such as physical, financial, verbal or sexual. They must also ensure a safe and secure environment for its residents (Section 5, Long Term Care Homes Act, 2007). However, various cases have come in light which made the safety of residents in these Homes questionable.

Many elderlies have reported that they feel uncared for and live in constant fear of abuse of some sort from the staff. There has been a case where a resident passed away due to physical abuse against him by a fellow resident and another case where a resident was not well fed that led to his demise due to starvation. These are few examples that have resulted due to the neglect and disregard by the staff of the Homes. Severe measures must be taken to prevent such incidents in future and those failing to abide by the Long-Term Care Act must be penalised.

The concern for safety of residents is not limited to just abuse but negligence on the part of healthcare providers. Wrong medication, failed supervision for dementia patients, and fall injuries are amongst the most common areas where improvement is needed. A conference held in 2001, in Atlanta, Georgia laid stress on exploring the cause of various infections such as pneumonia, urinary tract infection, skin and soft tissue infections in long term care facilities and discussed various options to overcome these.

Methods

This research project deals with exploring the limitations of Long-Term Care homes in Ontario. Aging is an alarming issue for the Canada. To do this, it is essential to inquire the reasons behind choosing a Long-Term Care Facility and then examining the state of such residential care. The census data released in May 2018 revealed that people over the age of 65 have outnumbered those under 15 in the country. Many over the age of 65 have needs that cannot be met at home and need supervision and assistance with their daily chores. The answer to this situation is a facility that will keep the seniors in a protected environment which will enable them to live a life with dignity and respect. The proportion of residents who require complete care has increased from 77% in 2011 to 85% in 2017, as produced in the report by Canadian Institute for Health Information. Moreover, the same report has also mentioned that the immobility among residents has also increased by 6 % in the 2011-2018 period.

This poses another challenge in the system of Long-term care delivery as the number of staff has not significantly increased to compensate the increased inflow of residents. The Long-Term Care Homes Act mentions the guidelines to be followed to protect and keep the residents safe. It was brought in force to ensure the residents receive uncompromised and high-quality care in a safe home that abides by the set standards of a long-term care facility. It can be verified by visiting the websites of such facilities whether these guidelines are being followed or not and whether enough efforts are being put by these facilities to abide by the rules of the Law.

The chosen method of research for this project is the analytical method, in which analysis is done of the information and data provided by different sources such as websites, online and newspaper articles, peer review journals, case-studies, qualitative and quantitative information provided by the research papers. Reviewing the articles in online journals and online reports on the overall limitations of Long-Term Care homes will play a huge role in providing information to develop my own conclusion about safety of residents in long-term care facilities. After analysing all the gathered information, a complete assessment of facts will be done to develop my own conclusion about safety of residents in long-term care facilities. The final target of this project is to devise and explore more options that will help in mitigating the existing problems in the Long-term care homes in Ontario.

Literature review

For the purpose of this paper I have reviewed many articles. Following are some of the articles with most relevant contribution to my paper. According to the article,’ Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America’, elderly who live in a long-term care setting are at a greater risk for abuse than those living elsewhere. The main reason is decreased cognitive function of brain and generalised physical weakness because of suffering from one or more chronic diseases. This leads to a debilitated lifestyle which is dependent solely on others for every chore and activity of living ranging from meals, bathing and to medication and care. This article also highlighted that many residents are unable to report any kind of abuse due to fear of retaliation and risk of not being given further treatment and care.

The authors of the article, ‘Elder Abuse in Long-Term Care: Types, Patterns, and Risk Factors’ have mentioned the various types of abuse and studied in detail about abuses on elderly living in nursing homes. They also brought into light the fact that among those elderly who have experienced one type of abuse, around 51.4% have also experienced another type of abuse in the nursing home. They have also highlighted the implications of such abuses on health care providers and public health policy makers. ‘Abuse and Neglect of Elderly Persons’ by Mark and Karl describes the physical as well as emotional abuse in detail and estimates the causes behind it. They also highlighted the neglect aspect of elderly care.

The neglect is described as failure of a health care provider to deliver services and meet the needs of care. It can be intentional (choosing to deliberately avoid their duties of providing care) or unintentional where such neglect stems out of mere ignorance towards an individual’s duties. To study the wandering of adults suffering from dementia in long-term care homes, I reviewed the Article,’ Dangerous wandering: Elopements of older adults with dementia from long-term care facilities’. This article mentioned how potentially risky wandering can be. Elder patients suffering from dementia or Alzheimer’s disease must be protected and supervised from wandering away. Many forget their way back home and risk their lives by being on the road. Some have also experienced serious fall injuries while wandering.

The safety of residents in Long-term care home must not be neglected and to have oversight, Long-term Care Homes Act is in place. This law has been my major motivation to start a research on the topic of resident safety in long-term care homes. As obvious as it may seem that residents in nursing homes are well taken care of and safe, it may not be the case in many situations. This Act has laid out guidelines as well as rules that clearly state what to do and what not to do. It helps to protect the elderly and aid in receiving the best possible care in a nursing home. In case of any maltreatment, neglect or abuse on the part of care givers, this law acts as a blessing in disguise as it protects the resident and helps to bring justice against any unfair practice. This act has been of major help to me to be able to differentiate between the right and the wrong practices that have been continuing in the long-term care homes.

01 April 2020

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