Presentation to the Kingston LTC Forum

Presentation to the Kingston LTC Forum

Nancy Finnegan, RN
Representative of the Ontario Nurses' Association Board of Directors,
Region 2
February 22, 2001

Introduction

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 sectors.

The Problems - Nursing Homes / Homes for the Aged

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 frequently.
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 care.
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 quality care.

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?

The Legislation

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 government.
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 deserve better.
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.

The Solutions

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 need.
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 problems.
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.

Closing Remarks

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.