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Canada Nurses union calls for independent inquiry into long-term care sector

04:05  16 october  2020
04:05  16 october  2020 Source:   cbc.ca

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Long - term care home workers take part in a moment of silence and rally in front of Midland Gardens The union is calling for : A public inquiry by the provincial government into the rising number of 91 recommendations. Ontario's long - term care sector was the subject of recent inquiry into their safety

The union called to extend the payment to all workers in residential care and consider extending its The ANMF submitted that as early as 4 March it warned the government the aged care sector was “Consequently the document fails to address staffing requirements for residential aged care in the

a close up of a person holding a cup: Many nursing homes are 'suffering from an erosion of regulated care professionals, inadequate funding, and a lack of oversight by government, which has led to a continued decline in care,' says Paula Doucet, president of the New Brunswick Nurses Union. © Lighthunter/Shutterstock Many nursing homes are 'suffering from an erosion of regulated care professionals, inadequate funding, and a lack of oversight by government, which has led to a continued decline in care,' says Paula Doucet, president of the New Brunswick Nurses Union.

The New Brunswick Nurses Union is calling on the Higgs government to order an independent inquiry into the long-term care sector, citing the "growing severity" of several issues, including low staffing ratios, residents sometimes going without care, such as toilet use and bathing, and an increase in violence.

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Leading the call was Assemblyman Richard Gottfried, who said that the already-announced inquiry into the deaths by state Attorney General Letitia James is An independent probe is needed to get to the bottom of what role Gov. Andrew Cuomo’s policies played in the coronavirus deaths of more than

Most long - term care falls into the category of personal or custodial care , rather than medical or skilled care . Long - term care insurance policies vary, but they typically pay a specific daily amount for skilled Call a few communities in your area and ask about their costs. Our directory makes finding

In a report released on Thursday, the union describes the system as being "in desperate need of reform."

Nearly half of the province's nursing homes failed to meet their minimum safe staffing ratios in 2019, according to the report, entitled The Forgotten Generation: An Urgent Call for Reform in New Brunswick's Long-Term Care Sector.

In some cases, one Registered Nurse (RN) took care of as many as 200 residents. In other cases, not even one RN was on duty.

"Overwhelming evidence supports that safe staffing ratios lead to reductions in resident mortality, fewer medication errors and improved resident outcomes," the report states.

Many crucial care tasks are being left undone, according to a survey of the 505 unionized RNs who work in the province's 68 non-profit and private nursing homes.

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The COVID-19 pandemic has impacted long - term care facilities and nursing homes around the world. Thousands of residents of these facilities, who are a high-risk group, have died of the disease.

Soldiers were called into the facilities as part of an effort to backstop the provincial system, which has been overwhelmed by novel coronavirus cases. A military report on Ontario long - term care homes battling COVID-19 details devastating flaws and lapses, some of which may predate the pandemic.

Sixty-three per cent of roughly 130 respondents said the job of toileting residents, for example, is being left undone sometimes (32 per cent), often (22 per cent) or always (nine per cent), while 58 per cent reported that bathing residents is being left undone sometimes (31 per cent), often (18 per cent) or always (eight per cent).

"Unacceptable delays in care tasks like toileting or bathing could be seen as neglect serious enough to constitute abuse," the report states.

The province has seen 16 reports on seniors and long-term care since 2004, but nurses union president Paula Doucet said this report 'must not - will not - become yet another volume on the government's shelf.' © Ed Hunter/CBC The province has seen 16 reports on seniors and long-term care since 2004, but nurses union president Paula Doucet said this report 'must not - will not - become yet another volume on the government's shelf.'

Meanwhile, accepted workplace violence claims by nursing home employees more than doubled between 2013 and 2018 to nearly 80. That's more than double those from employees of prisons, according to the union.

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Long - term care strategies in industrialized countries: case-studies of countries with and without national LTC legislation. In some societies, the principal alternative to informal care is primarily institutional care , especially nursing homes, which have a reputation of poor quality care .

Long - term care ( LTC ) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods.

"Sadly, what our report makes clear is that — when it comes to long-term care — Government has floundered to find solutions," president Paula Doucet said in a statement.

The nearly 200-page report, which took almost two years to complete, involving investigations, interviews and surveys, also "raises serious questions about transparency, accountability and Government's duty of care," said Doucet.

It should serve as a "wake-up call," she said. "Our most vulnerable seniors are at risk."

The report makes a total of 38 recommendations to both the provincial and federal governments, covering everything from long-term care governance to nursing shortages and finances, to transparency and accountability, and violence in the workplace.

Premier Blaine Higgs, who has rejected repeated calls for a public inquiry into the justice system, did not respond to a request for comment.

Transfer oversight, end privatization

The union argues the province should transfer oversight responsibility for nursing homes from the Department of Social Development back to the Department of Health, where it was prior to 2000.

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More than 2 million Americans live in long - term care settings, including the nation’s approximately 15,600 federally-regulated nursing homes and Stratmann said the company would be “looking into what happened” at Green Park and making changes to ensure residents and families are kept informed.

Another name for a long - term care ( LTC ) facility is a(n). A) Nursing home B) How does home health aide care differ from nursing assistant care ? A) Home health aides do not A program of care given by a specialist or a team of specialists to restore or improve function after an illness or injury is called .

"Resident acuity, governance capacity, effective oversight, medical expertise, efficiency and national standards are just some of the many reasons such a change should be made immediately," the reports states.

New Brunswick is the only province in Canada where the care of seniors in nursing homes remains overseen by anything other than a department of health, it adds.

The report also calls for the government to "immediately and permanently halt efforts to privatize" the nursing home sector.

"The introduction of for-profit nursing homes in New Brunswick has not solved the problems it was meant to address," the report alleges.

And a survey of 500 New Brunswickers found 55 per cent of respondents are either moderately or extremely concerned about "the introduction of a profit motive" into long-term care, it states.

In addition, the union claims for-profit long-term care homes provide "significantly less care to residents and produce substantially worse outcomes."

Consider COVID, says minister

Social Development Minister Bruce Fitch, who only took over as minister a couple of weeks ago, said "a number" of reports on senior care have been done over the years — 16 since 2004, according to the union.

"I think it's time for some action on some of these things and I've asked the department to do a significant drill down on these recommendations," Fitch told CBC News.

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He said he needs more time to review the report to better understand where the data came from, and how it was interpreted, before he can comment on any specifics, suggesting "some of these items could be already looked after."

But Fitch did say he thinks keeping long-term care under Social Development is best, at least for now, during the COVID-19 pandemic.

a person sitting on a chair in a room: Eighty-nine per cent of the 134 Registered Nurses surveyed said that providing nursing home residents with exercise is being left undone sometimes (18 per cent), often (50 per cent) or always (21 per cent). © Roger Cosman/CBC Eighty-nine per cent of the 134 Registered Nurses surveyed said that providing nursing home residents with exercise is being left undone sometimes (18 per cent), often (50 per cent) or always (21 per cent).

Two special care homes — the Manoir Notre-Dame in Moncton, and Manoir de la Sagesse in Campbellton — are currently dealing with COVID-19 outbreaks. Earlier this year, several residents and staff at the Manoir de la Vallée long-term care facility in Atholville tested positive for the respiratory disease during an outbreak in the Campbellton region, including the province's two fatal cases.

"If we start taking staff and resources away from dealing with COVID, that outcome may not be as positive as what we're experiencing right now," Fitch said.

The budget for long-term care, including home support and senior care support, totals about $550 million, he said.

Earlier this week, Prime Minister Justin Trudeau said he thinks it's time to develop national standards on long-term care, as the number of COVID-19 cases continues to rise in Canada.

Under the Canadian constitution, health care is a provincial jurisdiction and the federal government plays only a limited role.

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"I think no Canadian wants to see their parents, their grandparents, their loved ones not well cared for in facilities across the country," Trudeau said, adding that there should be no regional disparities in the level of care.

New Brunswick Health Minister Dorothy Shephard did not respond to a request for comment. When she was previously the minister of Social Development, she opposed the idea of transferring the file to Health.

Increase care hours, focus on 'lax' standards

The union recommends the provincial government should incrementally increase the number of care hours provided to nursing homes residents from 2.89 to 4.1, including 45 minutes per day with an RN.

Research indicates that 4.1 hours of care per resident per day is a threshold beneath which "negative outcomes can be expected," the report states.

The government should also add contracted nursing home inspectors, overseen by an experienced compliance specialist, for at least three years, to "restore acceptable levels of accountability" in New Brunswick nursing homes.

Standards and compliance have become "lax, and must be strengthened," according to the report.

As of Spring 2020, for example, seven of the province's 68 nursing homes still didn't have their 2019 inspection reports posted online.

Mandate RN-resident ratios

Similarly, the report recommends the government check compliance with minimum Registered Nurse staffing standards in every nursing home and establish penalties for violations, rather than just issue non-compliance notices.

"It is clear from the evidence presented in this report that New Brunswick nursing homes are either unwilling or unable to meet their current RN staffing ratios and — in some cases — the requirement for maintaining even one RN on duty," it states.

Nearly one-third of all RNs in New Brunswick's long-term care sector left their positions in 2017.

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In 2019, 31 nursing homes received non-compliance notices for violations of staffing ratios, including every home in the Restigouche region and the Acadian Peninsula, "yet these trends continue unabated."

New Brunswick should follow the lead of Australia, California and Quebec by implementing RN-to-resident care ratios to "ensure resident safety is never compromised by economic pressures."

Mandated RN-resident ratios in other jurisdictions are between 1:20 and 1:44, depending on the time of day, according to the report.

Track violent incidents

The province's annual nursing home inspections should include a review of violence, tracking totals found in major incident reports and elsewhere, and require that every nursing home in New Brunswick complete its annual workplace violence assessment, the union recommends.

As it stands, nearly one-quarter of all WorkSafeNB claims for workplace violence come from employees of nursing homes, but evidence suggests that much of the violence goes unreported.

In 2018, three-quarters of nursing home RNs surveyed said they had experienced a violent incident.

Sixty-five per cent reported that the violence originated with residents, while the rest involved family members of residents, co-workers, or employers according to the union.

"Perhaps most worryingly, 45 per cent of RNs surveyed said they made no attempt to report the violence against them," the report states.

"Government, employers and public sector unions should convene a roundtable on aggression, violence and sexual aggression in the long-term care sector, to review best practices, and to develop and adopt common policies and/or collective agreement language that provides a comprehensive response to these trends."

Seeks studies by auditor general and seniors' advocate

The union wants the Higgs government to create an independent and non-partisan commission to examine the status of long-term care in New Brunswick.

The commission should be named no later than the first 2021 sitting of the legislature, and must have the authority to send for persons, papers and records and to examine witnesses under oath, the union said.

In the interim, it recommends cabinet ask the auditor general to conduct an investigation into the issues raised in the report, and make sufficient funds available.

The Office of the New Brunswick Seniors' Advocate should also undertake a funding review of the long-term care sector, based on a recent similar review by its counterpart in British Columbia, the report recommends.

These two investigations should inform the work of the independent commission, the union said.

The commission's recommendations should then inform a revised Long-Term Care Strategy for New Brunswick and a revision of the Nursing Homes Act.

a group of people standing in a room: Nursing home employers should adopt key-performance indicators, reviewed quarterly by their boards, that measure improvement in the total number of violent incidents reported by employees, including verbal abuse and harassment, the union recommends. © Ed Hunter/CBC Nursing home employers should adopt key-performance indicators, reviewed quarterly by their boards, that measure improvement in the total number of violent incidents reported by employees, including verbal abuse and harassment, the union recommends.

The act should be revised to include evidence-based staffing standards, violence-prevention mechanisms, and "demonstrable commitments to public reporting, accountability and transparency," according to the report.

These two revised documents should then form the foundation of future long-term care in New Brunswick, it recommends.

"These recommendations are not presented as a menu from which Government may pick or choose. The serious challenges facing New Brunswick's long-term care sector are multi-faceted, and only a comprehensive multi-faceted approach can make inroads into dealing with them," the report states.

The government has "routinely ignored" many of the suggestions made by previous reports about long-term care, including those of its own auditor general, according to the union.

As a result, the union plans to publish a report card on the recommendations in its report by the fall of 2023.

Act now to address nursing shortage

Among some of the other recommendations, nursing homes should make immediate arrangements, in co-operation with the government, to increase the amount of full-time permanent positions being offered to nursing home RNs, targeting a ratio of no more than two casual job offers for each permanent offer.

The reliance on casual staffing in many nursing homes has risen to "unacceptably high levels," according to the union.

"Absent financial incentives, offers of full-time permanent employment — with their accompanying pension and benefits — are one of the few tools available to nursing home employers when navigating a highly competitive job market, especially in rural areas," the report states.

a person sitting on a bicycle in front of a window: The union plans to publish a report card on the 38 recommendations in its report by the fall of 2023. © CBC The union plans to publish a report card on the 38 recommendations in its report by the fall of 2023.

In 2019, the Horizon Health Network and Vitalité Health Network reported a need for an additional 520 Registered Nurses a year for the next five years.

The government should "immediately move" to address the nursing shortage by taking the University of New Brunswick up on its offer to expand its four-year Bachelor of Nursing program by over 300 seats, according to the union.

It should also ensure that the University of Moncton's ability to recruit into its Bachelor of Nursing programs is strengthened, the union said.

New Brunswick's Nursing Strategy, published last year, called for increased promotion of the RN profession among K-12 students.

The government should also require that a percentage of nursing student work placements take place within the long-term care sector to help expose students to possible careers within the system, the union said.

In addition, the government should make a "determined and adequately funded effort" to recruit more internationally educated nurses, with a goal of registering 50 per year in the long-term care sector, the report recommends.

Transparency and accountability

To increase transparency and accountability, the government should undertake a review of the Right to Information and Protection of Privacy Act and the systems that support it, with an eye to making information on government partnerships more accessible to New Brunswickers, the union said.

The public should have "easy access" to information regarding how much the government spends on the province's vulnerable seniors, the staff who care for them and the buildings that house them, it contends.

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