Press Release
Ottawa Health Coalition
The recent decision by the Ontario Ministry of Long-Term Care to create a new website and search tool on long-term care homes in the province should have been a welcome announcement for residents and families. Instead, it reveals that the Ford Government is not doing enough to protect residents in long-term care.
The new website makes available in one location information regarding inspections and waitlists in long-term care, among other things.
Students in the Bachelor and Masters Programs from the School of Social Work at Carleton University joined the Ottawa Health Coalition to research and analyse the data with specific attention on two important aspects:
Inspection Reports
WaitlistsThe researchers reviewed the public data available for 47 of the 90 long-term care homes in Eastern Ontario with particular emphasis on homes in Cornwall, Kingston and Ottawa. The research project was overseen by Associate Professor Susan Braedley, a long-term care researcher.
“As the next generation of workers who can help fill extreme staffing shortages across this sector, these students were keen to apply their training in research and gerontological social work to this project with the Ottawa Health Coalition. Their discovery of the big difference between long-term residential care policy promises and actual practice was disheartening for them. At the same time, I think it has made them even more determined to contribute to quality care”, says Doctor Susan Braedley, of the School of Social Work at Carleton University and supervisor of the research project.
The Ford Government has come under scrutiny for failures to conduct Resident Quality Inspections (RQI) in long-term care. Until 2018, the then Ministry of Health ensured that all long-term care homes received an unannounced and thorough inspection on an annual basis. The aim of the Inspection Program is to protect the quality of care and quality of life for residents.
Thirty homes were inspected in 2018. This fell to only six in 2019. In October 2021, the Ontario government announced a replacement to RQI inspections to be called “Proactive Compliance Inspections” (PCI). Only two (2) homes in Eastern Ontario have been inspected under the new criteria.
The team also looked closely at Critical Incident and Complaints inspections in the last six months.
The team examined waitlist data for long-term care homes in Eastern Ontario. It noted that non-profit and municipally owned and operated homes have the longest waitlists and that private homes had the shortest lists. “This shows that people seeking care clearly prefer a non-profit option”, says Elaine MacDonald, Co-Chair of the Cornwall Health Coalition. Despite the clearly expressed wishes of the population, the Ford Government continues to show a bias in favour of private companies, often not based in the province, for funding of new and upgraded beds says Betty Yakimenko of the Ottawa Health Coalition.
“What is troubling about the website, is that the Ford Government’s so-called plan to fix long-term care is not as evident as they claim”. Says Joan Jardin, Co-Chair of the Kingston Health Coalition.
Long-Term Care Inspections in Ottawa, Cornwall and Kingston
A report on findings from a review of Quality Ontario data
This project was completed by Lu Chen, Samantha Eady, Rosina Molloy, Sharah Mar-Kaminsky, Megan Gow*, Dr. Susan Braedley, Ed Cashman and volunteers from the Ottawa Health Coalition.
The Ford Government has come under scrutiny for failures to conduct Resident Quality Inspections in long-term care homes. As the Ontario Health Coalition noted in 2020, until 2018, long-term care homes in Ontario received an unannounced, thorough inspection annually. The aim of the Inspection Program is to protect residents’ quality of care and quality of life by safeguarding their rights, safety, and security as well as ensuring that homes comply with legislation and regulations. RQI inspections were quite comprehensive and examine a wide range of issues.
While many RQI inspections took place in 2017 and 2018, the Ontario Health Coalition indicated that resident quality inspections took place in only 9 Ontario long-term care homes in 2019.
Six months ago, the Ontario government announced a replacement to RQI inspections, called “Proactive Compliance Inspections” in October 2021. These inspections look to be almost identical to the inspections that were ended. The proactive inspections program assists the government and long-term care homes in identifying and resolving problems to improve the quality of care provided to residents, with unannounced annual inspections that, according to the Ministry, take “a resident-centred approach by allowing for direct discussion with residents, to focus on their care needs as well as the home’s program and services”. The proactive inspections program focuses on: residents’ rights, infection prevention and control, plans of care, abuse and neglect, nutrition and hydration, medication management, policies and directives, and dining observations.
There are two other kinds of Quality Ontario inspections in long-term care homes. One is Critical Incident Inspections, and the other is Complaint Inspections.
A critical incident inspection happens when the long-term care home itself submits a report about an incident or problem that is identified in Section 107 of the Long-Term Care Homes Act (2007). Critical incidents could be an outbreak, improper care for a resident that resulted in harm, or abuse to a resident.
A complaint inspection is made when the Ministry of Long-Term Care receives a complaint from a family member, a resident, or other concerned person about harm, neglect or danger to residents or less serious complaints related to diet, activities or care.
Given the long-term care tragedies and problems that have become public during the Covid-19 pandemic, including that some long-term care homes had many more deaths and illnesses than others, resident quality inspections could be an important tool to assess how the sector is doing now, support organizations to make quality improvements, and help restore public trust.
*We are students in the Bachelors and Masters of Social Work at Carleton, Our professor at Carleton’s School of Social Work, Dr. Susan Braedley, is a long-term care researcher. She is our instructor in a course on Social Work and Aging where we learn skills and knowledge about gerontological social work in many settings, including long-term care. Dr. Braedley was aware that the Ottawa Health Coalition was looking for volunteers to help sort out what was happening to Long-Term Care Home inspections in Eastern Ontario, given the Covid -19 pandemic and the many problems in long-term care homes. She asked us if we would like to get involved. Five of us said, Sure!
What did we do?
- We each conducted research on a short list of homes, using Quality Ontario publicly available information about Ontario long-term care home inspections. We collected information about long-term care home inspections of all kinds that had taken place since 2017 in Ottawa East, Ottawa West, Cornwall, and Kingston.
- Lu Chen and Samantha Eady put together the information we collected with the information collected by other volunteers from the Ottawa Health Coalition. There are 90 homes in the Eastern Ontario region, but we collected information about those in just these major centres, which totalled 47 homes.
- Lu ran some basic quantitative data tests to see if there were significant correlations within the data. Dr. Braedley checked to understand bed distribution related to populations over 65.
What did we find?
Findings:
- Resident Quality Inspections: In the 47 homes we included in this investigation, all were inspected between 2017 and 2019, but the majority have not inspected since 2018 or earlier.
2017 – 9 homes last inspected
2018- 30 homes last inspected
2019 – 6 homes last inspected
Proactive Compliance Inspections. There have been two to date in the Ottawa area: at Extendicare West End Villa and the Royal Ottawa have had this inspection since October, 2021.
We were surprised that so few Proactive Compliance Inspections have been completed! If these are supposed to be annual inspections, six months in, we would have expected that closer to half of the homes in Ontario had been inspected. Of our 47 homes, only 2 have had these inspections.
- Next we looked closely at Critical Incident and Complaints inspections in the last six months.
Complaint Inspections versus Critical Incident Inspections –
Across 47 homes, we had 55 critical incident inspections and 37 complaints inspections in the last 6 months. For profits had 27 critical incident inspections and 13 complaints inspections. Not-for-profits had 28 critical incident inspections and 24 complaints inspections. Almost every home in the region had a critical incident and complaint inspection, as would be expected by anyone who understands this sector and reporting requirements.
We decided to look at ownership type, as for-profit homes have come up repeatedly as poorer quality in the literature. In terms of these inspections, we saw no significant difference. There was a rate of 1.78 critical incident and complaints per home in the for-profit sector, and 2.18 in the not-for-profit sector, which is not statistically significant.
We also did not see much difference in who received infractions.
These numbers are often misunderstood. Some homes are more scrupulous on reporting critical incidents, and typically this has been in not-for-profit homes.
In terms of whether or not infractions were issued, there was no pattern discernible by ownership type.
City Profiles
There were some big differences among the areas we investigated. Keeping in mind that we investigated the long-term care homes that were within the cities of Kingston and Cornwall, and were also within the regions of Ottawa East and Ottawa West ( but excluding the large rural areas included in the City of Ottawa borders), here are our results.
CORNWALL:
According to our analysis, in Cornwall, there are 552 not-for-profit beds and 505 for -profit beds. The waiting list for not-for-profit beds is 930 people, and 485 people for for-profit beds. 1.7 people are waiting for not-for-profit beds and nearly 1 person for every for-profit bed.
In the 2016 census, Cornwall had 10,625 people 65 years of age and older. The ratio of long-term care beds to this population, which we are using as a proxy measure to compare long-term care bed availability in each area, was 10:1. In Cornwall, there is one person on the wait list for every 7.5 people 65 and older.
All but one long-term care home in Cornwall had either a complaint inspection or a critical incident inspection in the last six months. There were no significant patterns among these inspections or their outcomes, with some incidents receiving infraction notices and others not. There were no homes that had many more infractions than any other, and the home with no inspections is one of the smaller homes in the region.
KINGSTON:
In Kingston, there are 815 not-for-profit beds and 1,050 for-profit beds. The waiting list for not-for-profit care is 1,783 people, and for for-profit care is 1,812 people. There are 2.2 people waiting for each non-profit bed, and 1.7 people waiting for for-profit beds.
In the 2016, Kingston had 22,680 people 65 years and older. The ratio of long-term care beds to this population is 12:1, or a lower supply per population than Cornwall. The waiting list, unsurprisingly, is higher than Cornwall. There is 1 person on the wait list for every 6.3 people over 65 in Kingston.
Ottawa:
For Ottawa, there were 1967 not-for-profit beds and 1635 for-profit beds. The waitlist for not-for-profit beds is 5, 640 people, and 571 people for for-profit beds. Note that there are 5x the number of people who have asked for a bed in a not-for-profit home. There are 2.9 people waiting for each non-profit bed, and .34 people waiting for each for-profit bed in the city.
In 2016, excluding the large rural areas incorporated by the city in the 1990s, Ottawa had 130, 285 people 65 and older. The ratio of long-term care beds to population is 32:1. There is one person on the waiting list for every 20 people 65 years old and older.
