Presentation to the Kingston
Nancy Finnegan, RN
Representative of the Ontario Nurses' Association Board of Directors,
February 22, 2001
- Good evening. I would like to address the forum
tonight not only as a representative from this region on the Ontario Nurses'
Association's Board of Directors, but as a front-line nurse and patient
advocate in this province.
- The Ontario Nurses' Association represents more than
45,000 front-line nurses and allied health professionals in this province.
Many of them work in long-term care and home care, the two sectors most
affected by this proposed legislation.
- I have listened carefully to what my members are
saying. They believe amendments to long-term care legislation will be
disastrous to their abilities to provide safe, quality patient care to some of
the most vulnerable people in our community: the frail elderly.
- Please allow me to take a few minutes to detail the
current working realities of my members in the long-term care and home care
The Problems - Nursing Homes / Homes for the
- Let me begin with my members who work in nursing
homes and homes for the aged in Kingston and area. They tell me they have
excessive caseloads and are unable to deliver sufficient patient care.
- That's because patient acuity has increased since
1996, not decreased. These nurses are dealing with increasingly complex cases
that require more of their time.
- The fact is there aren't enough of them to deliver
quality patient care. This is largely thanks to inadequate funding for
long-term care and the government's elimination of the minimum standard of
two-and-one-quarter nursing hours per patient per day.
- On top of that, patient acuity has increased since
1996, not decreased, meaning these nurses are dealing with more complex cases
that require more of their time.
- These are the kinds of problems that should be
exposed by inspections of long-term care facilities by the Ministry of Health
and Long-Term Care. However, we know that these inspections don't occur that
- And for the inspections that do occur, the ministry
doesn't require inspectors to consult with front-line care professionals or
order the correction of any problems identified with the provision of care and
accommodations. So, necessary changes may never be made.
The Problems - Home Care
- Unfortunately, my members report that the situation
in the home care sector is no rosier. Again, funding does not ensure that
community care access centres, which coordinate home care services, have
sufficient resources to provide adequate patient care.
- Along with that, many community care access centres
pay their employees according to the number of patient visits they make. That
certainly doesn't permit the front-line provider to spend as much time with
the client as needed.
- The ministry requirement that community care access
centres use a competitive bidding process to award contracts to provide care,
called Request for Proposals, is another big concern with my members.
- As a result of this harmful process, we are seeing an
increase in the number of for-profit home care agencies, while cherished
non-profit agencies such as the Victorian Order of Nurses, are forced to shut
their doors. We know that all too well in this area. The home care patients of
Kingston were one of the first to fall victim to this process. But I guarantee
they won't be the last.
- That's largely because the bottom line becomes the
deciding factor in awarding a contract - more important than quality patient
- Our nurses also tell me they are concerned about the
lack of continuity of patient care under such a system. Patients may see a
different nurse every time a contract is up. That's just not good for them,
and is a very troubling concept for nuses who so desperately want to provide
Problems Common to Both Sectors
- But far and large, the biggest threat to our
long-term care and home care sectors - and indeed all health care sectors - is
Ontario's nursing shortage... a shortage that grows with each passing day.
- We can't retain the nurses we have, many are within a
few years of retiring, and many more are heading to greener pastures in the
United States, where they are more appreciated, better compensated and are
offered incentives for furthering their education.
- And because there simply aren't the nurses available
in our system to pick up the slack, the working conditions are becoming
steadily worse for those who remain.
- It is not surprising then that more and more seniors
are being sent to emergency rooms because nurses are unable to deal with them
in nursing homes and their own homes. There simply aren't enough nurses.
- Also, the compensation and benefits for nurses in the
long-term care and home care sectors are substantially less than what nurses
receive in hospitals, making it harder to attract nurses in these sectors.
- Nurses are deeply concerned that this situation will
only worsen. Hospitals are releasing patients "quicker and sicker," meaning
more will require care in their homes. And the government says it is creating
an additional 20,000 long-term beds.
- Where will the nurses come from to care for the
patients who will require home care and occupy these additional long-term care
beds when the government to date has not provided incentives to bring nurses
to long-term care and home care?
- Now, the government seeks to make the situation even
worse with its proposed amendments to long-term care legislation. My members
have problems with that. I have a big problem with that! Here's why.
- Currently, funding to a long-term care facility is
increased once annually if there is evidence of additional patient care needs.
But the proposed legislation will limit the care given to residents to the
amount that an operator can provide based on funding it receives from the
- So, if the government underfunds the operator of a
long-term care facility, the residents of that facility will be provided with
even less care than they receive today.
- The legislation also proposes a reduction in the
number of municipal homes for the aged. This is frightening because homes for
the aged have historically had higher standards of care than nursing homes and
have been the model that nursing homes have been pressed to measure up to. So
the proposed legislation will reduce the current standard. Our senior citizens
- As well, the elimination of municipal homes for the
aged will remove millions of municipal dollars from the funding of long-term
facility care, but will the provincial government replace that money? I doubt
it. Instead, the government may privatize. Look around you. You will see
examples of where privatizations has already crept into our system.
- If there is no increase in funding, this legislation
may also impact home care as care in that sector is already rationed.
- If this is allowed to continue, the only alternatives
for residents of this province who are denied access to sufficient care in
nursing homes and publicly funded home care are to pay for the care privately
or impose this responsibility on unpaid family members. That's just not fair.
And that's just not right.
- We consider these proposed changes unacceptable -
unacceptable for our patients and unacceptable for front-line caregivers.
- Nurses believe there are some elements that
absolutely must be incorporated into any amendments to long-term care
legislation to guarantee quality, safe patient care.
- First and foremost, we believe the government must
be made accountable for providing adequate funding to the operators of
long-term care facilities so that all patients can receive the care that they
- That means one registered nurse at all times - at the
very least. The number of RNs and registered practical nurses must be tied to
the care needs of residents and their levels of acuity.
- The legislation must restore what this government
removed from long-term facility care: the minimum level of care that each
resident receives per day to two-and-one-quarter hours. But I emphasize this
is just a minimum.
- The government must also be made accountable for
replacing lost municipal funding of long-term facility care should municipal
homes for the aged be eliminated.
- The legislation must require that ministry inspectors
conduct at least one surprise inspection of each long-term facility in the
province once a year. Inspectors must consult with front-line professionals,
and reports from these inspections must be subject to appeal from any resident
or employee of the home if the report doesn't order the correction of all
- The government must provide more money for
compensation for nurses who work in the home care and long-term care sectors.
- The government must stop its Request for Proposal
process. But at the very least, legislation must ensure that home care
agencies who win contracts to provide care employ the front-line staff who
previously delivered the care along with the same compensation and other terms
and conditions of employment.
- Lastly, and apart from these amendments, we must see
real commitments from the government on the nursing shortage - not just empty
promises. Otherwise, our other recommendations are all for not.
- On behalf of the members of the Ontario Nurses'
Association, especially those in the long-term care and home care sectors, I
would like to thank you for listening to our concern.
- We view this forum as an important step in getting
the attention of the public and the government on the problems in long-term
care and home care and the measures necessary to rectify them.
- Such action will assist us in providing a quality of
care that we can be proud of to the deserving patients of our province. After
all, that's all our members want to do.
- Thank you.