As our population ages, many of us must face the possibility of long-term nursing care for ourselves, our parents and grandparents. Transitioning yourself or a family member into a nursing home can feel scary and stressful. As with most transitions in life, knowing what to expect can help ease concerns, fears and stress.
In Ontario, a person is eligible for nursing home care if they have a valid Ontario health card, are 18 years of age or older and have needs that cannot be met with community based programs. If you suspect someone you know needs nursing home care, the first step is to contact the Community Care Access Centre (CCAC). A representative of CCAC will assist you in understanding the process and will arrange for a physical, functional and social assessment of the person in need of care.
Once someone is found to be eligible for a nursing home placement, they will be asked to choose five nursing homes they prefer. When a bed becomes available at a nursing home on the individual’s preferred list, they will be notified by CCAC. The individual will have 24 hours to accept the offer. If the offer is not accepted the individual is removed from all waiting lists and must wait six months before they can apply again. Due to this process, individuals and their families are encouraged to do research about the nursing homes they are considering before submitting their preferred list of nursing homes. Tours at nursing homes can be arranged and past inspection reports completed by the Ministry of Health and Long-Term Care can be obtained from the home or online (http://publicreporting.ltchomes.net/en-ca/default.aspx).
Nursing homes can be owned by private corporations, non-for-profit organizations or the government. All nursing homes, regardless of who owns them, are governed by the Long-Term Care Homes Act (the “Act”) and Regulation 79/10 (the “Regulation”). The Act is intended to help ensure that residents of long-term care homes receive safe, consistent, high-quality, resident-centered care. The Act sets out the Residents’ Bill of Rights which includes sections dedicated to dignity and respect, prevention of abuse and neglect, care and services, consent and choices, minimizing use of restraints, and communications, concerns and complaints.
The Act and Regulation also sets out extensive requirements that the nursing home must meet. They include the following:
- Physical and environmental requirements designed to ensure a safe and secure home.
- Requirements regarding Care Plans and Plans of Care. This relates to the assessing and reassessing of residents as well as the planning, delivery and evaluation of the resident’s care.
- Requirements for mandatory programs regarding fall prevention, skin and wound care, continence care and bowel management, and pain management.
- Requirements that set out what preventative actions shall be taken to minimize altercations and other potentially harmful interactions between residents.
- Requirements for mandatory development and implementation of policies, procedures, and programs regarding nutrition care, dietary services, and hydration. These programs must include a system of monitoring and evaluating food intake, fluid intake and the resident’s weight.
- Requirements to protect the resident from abuse or neglect from the home or its staff.
- Requirements complaints and reporting procedures.
- Requirements regarding the home’s medication management system to ensure the medication needs of the residents are met in a safe and timely manner.
In an effort to ensure compliance with the Act and Regulation, the Ministry of Health and Long-Term Care performs unannounced inspections and orders enforcement measures be taken as required. The Ministry of Health and Long-Term Care investigates complaints, concerns and critical incidents. It also ensures that inspections are conducted at least once per year. Annual inspection reports must be posted in a conspicuous location so that all residents and family members can easily access and read the report. As noted above, these reports are also available online.
Nursing home residents are a vulnerable population. Their interests need to be safeguarded. They require protection and are often dependent on other people to advocate on their behalf. Because of this it is important that family members or close friends participate in the admission and care planning process with the nursing home. Be sure to provide as much information to the home about the resident. Request a copy of the care plan and follow up with the home to ensure that it gets updated as the resident’s needs change.
If you are visiting a nursing home keep an eye out for visible warning signs of substandard care in nursing homes. Those signs include:
- Unexplained weight loss, malnutrition, and dehydration.
- Withdrawn behaviour or unusual changes in
- Poor personal hygiene, including not being bathed, not receiving dental care, or wearing dirty clothes.
- Unsanitary conditions, including soiled bedding or clothing, dirty rooms, or bugs.
- Injuries from falls and the absence of a fall prevention plan.
- Lack of medical care, including failure to diagnose, treat, or make necessary referrals.
- Medication errors including missed dosages and failure to follow medication schedule.
- Inadequate supervision such as failure to check on a resident, leaving a resident unattended in a dangerous situation or in a public place, or failure to prevent wandering.
- Environmental hazards, such as unsafe mobility equipment, unsafe furniture, slippery or obstructed floors, or poor lighting.
If you have any concerns about the care someone is receiving in a nursing home, you should make a formal complaint to the home and the Ministry of Health and Long-Term Care. Complaints to the Ministry of Health and Long-Term Care can be made by calling the toll-free Long-Term Care Action line at 1-866-434-0144.
If a resident is injured or dies as a result of receiving substandard care while residing in a nursing home, a civil lawsuit may be started against the nursing home, and its doctors, nurses, therapists and/or staff. The nursing home, and its doctors, nurses, therapists and staff, owe a duty of care to the residents of the nursing home. Where the nursing home, and its doctors, nurses, therapists and staff, act in a manner that is below the standard that is expected of them, and that action (or in some cases inaction) causes injury or harm to a resident, the resident has a cause of action against them. This can include failure to comply with the Act and Regulation, to develop and implement an appropriate care plan, or to meet the standards of their respective professions.
by Kate Mazzucco – Toronto Personal Injury Lawyer – McLeish Orlando