The Ontario Ombudsman, André Marin, announced on July 16 that his office would be undertaking a six-month review of how long-term care in the province is managed by the provincial Ministry of Health and Long-Term Care. The Ombudsman is not empowered to investigate the facilities directly, and this move is seen as a clever end run.
Not surprisingly, everyone seems to be welcoming the review, though they do not agree on the root of the problem. The National Union of Public and General Employees (NUPGE) blames low staffing levels, while the Ontario Long-Term Care Association (OLTCA) cites a lack of flexibility and local planning.
In June 2008, a government report was released entitled People Caring for People by Shirlee Sharkey, president of Saint Elizabeth Health Care. Its mandate was to “provide advice on the development of a comprehensive framework for determining human resources implications related to quality of care and to the quality of life experienced by residents living in Long-Term Care (LTC) homes in Ontario.”
This report follows the argument of the OLTCA and cautions against re-establishing the minimum staffing levels earlier abandoned by the Conservatives. Rather, it endorses increased funding, coupled with local staffing plans developed in consultation with stakeholders. As well, the report calls for “accountability for care outcomes.” It does not define these outcomes, suggesting measurement tools and surveys would have to be developed, but does argue that their achievement should form the basis for funding levels.
NUPGE’s own 2007 study, entitled Dignity Denied, concentrates more on the funding aspect of long-term care, the structure of the industry and measures to hire, train and retain employees. Among its recommendations for funding are increasing per diems to reflect the cost of all health care and reducing fees paid by residents for drugs, glasses, hearing aids, etc.
In terms of structure, the report urges passage of a single statute in each province to regulate all aspects of long-term care, including standards for staffing and hours of care. Further, not-for-profit facilities would be encouraged and for-profit facilities phased out, and government supervision would be strengthened. The final topic, staffing, included recommendations for better wages and benefits for long-term care staff and improved opportunities for training.
The Sharkey report clearly supports the views of LTC home operators and came in for much criticism from unions in that sector when it was released. However, in the interval between that release and the Ombudsman’s announcement, there were media reports claiming that over 60 per cent of Ontario LTC homes were violating provincial standards.
In this environment, it will be difficult for the province not to act on a call for stricter enforcement, especially if Marin is able to come up with horror stories. That does not, of course, translate necessarily into staffing standards and hours of care standards. The cost of the union’s chosen route has not been investigated and it may prove a difficult sell with other healthcare demands competing for the same dollar.
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