«UNDERSTAFFED AND UNDER PRESSURE A reality check by Ontario health care workers October, 2005 UNDERSTAFFED AND UNDER PRESSURE A reality check by ...»
In 2001, a PricewaterhouseCoopers study ranked Ontario’s long-term care facilities at the bottom of the heap for any jurisdiction studied. It found that in the previous year, Ontario had the lowest levels of care coupled with the sickest and oldest residents. In part, the province’s disgraceful performance was due to the Tory government’s scrapping of requirements for minimum staffing levels.
Shortly after the Liberals took power in Sept. 03, the Toronto Star ran a series of gripping articles that revealed widespread neglect and inadequate care in Ontario’s 544 long term care facilities (it now stands at 597). Problems for the almost 70,000 residents included being left alone for hours in feces-filled diapers or urine-soaked clothing, untreated bedsores, or weight loss brought on by faulty diets, bad food, and short staffing.
In response, Health Minister George Smitherman promised a "revolution" in longterm care, and told The Star he planned to make fixing Ontario's troubled nursing home system his “top priority.”
- 39 The “top-to-bottom” review of this sector conducted by Smitherman’s Parliamentary Assistant Monique Smith, noted many important and urgent changes. But staffing and funding are still nowhere near the levels needed to meet the government’s stated goals of allowing seniors “to live in dignity with the highest possible quality of care.” Worse yet, the funding announcements have become little more than public relations opportunities. The public announcements are grandiose. In actuality, the government has yet to show that any jobs have been created from the almost $200 million that was announced last year! In part, this money was earmarked for 2,000 new staff, including 600 Registered Nurses and Registered Practical Nurses. The staff component is minimal. The hiring of 2,000 new staff will still not enable us to provide quality care.
Premier McGuinty and Health Minister Smitherman’s refusal to take action is producing crisis after crisis in this sector.
Owners and operators of private facilities have a scandalous record of using public money intended for staffing for many other things, such as paying off their deficits. For this reason, the government requires them to sign legal service agreements that spell out all the regulations that apply. They must agree to use funding to increase care hours for residents by hiring health care aides and registered staff.
This is a good idea. But given what took place at a Port Perry home in April 05, the Liberals’ commitment to their own initiative is, once again, seriously lacking.
That home cut back 111.25 hours of staffing/week in violation of the service agreement, even though it received $1,610.69/week more than in the fall of 2003, when the Liberals were elected. The government refuses to enforce its service agreement.
Meanwhile, residents’ care needs have increased. The number of multiple medical diagnoses has increased. Physician-ordered therapeutic interventions have increased, and so has the number of different prescribed medications that a resident must take daily. All of these indicators point to a much sicker and needier population.
Plagued with all of the old problems, and some new ones, this sector has declined even more. Some of the new issues are so serious that workers describe them as
inhumane. For example:
• So many psychiatric patients and cognitively impaired people requiring mental health support are being downloaded and off-loaded, long-term care facility workers now call themselves “McGuinty’s new psychiatric hospitals and mental health facilities.” They point to their lack of training in this area, danger to other residents, danger to themselves and “the inhumanity of treating these most vulnerable people in such a casual way.”
• Palliative patients are also being downloaded from hospitals, with one worker describing the situation as “horrendous.” “They often die within 24-hours because we are not set up for this, funded for it, or trained for it.”
• Employers continue their profit-making at the expense of residents. In particular, the disgraceful rationing of incontinent pads has propelled many workers to take matters into their hands and risk discipline or firing. You will read about their actions in the interviews that follow.
• According to the government, “retirement homes are designed for seniors who need minimal to moderate support with their daily living activities. This is such a scandalous misrepresentation of how desperately ill people are in
• Despite the McGuinty government’s announcement of two baths a week starting in Jan. 05, in many homes, this is not possible. In some cases, workers report that not even one bath can be guaranteed because of such short staffing. Other workers did not even know about the requirement.
The OFL meetings that took place in 17 Ontario cities produced information on disturbing, even frightening, trends and practices. Much of what we learned is borne out in the Casa Verde inquest that investigated the bludgeoning deaths of two residents by a cognitively impaired resident who was admitted earlier that day.
As this report is finalized, the government has still not acted on the jury’s recommendations.
Another similar death has now taken place in Kitchener at the Forest Heights LongTerm Care Facility. From 1999-2004, eleven residents met violent deaths at the hands of other residents in Ontario nursing homes.
Workers, residents, and their families deserve immediate action.
Understaffing is killing us In the evening, I’ve seen one girl on the floor with 42 patients. She was so scared for them she threatened to walk off job, so they sent in another one – just one – and then, there were two for 42. If you don’t think that’s stressful, it bloody well is. If families knew what was going on, they wouldn’t believe it. We need whistle blowing protection.
- 42 It’s scary. You can be as book-smart as you want when you get out of school but then this new reality hits and you say “Oh my God, this isn’t what they taught us,” and you want to get out as quick as possible. What they taught us at school is about care.
What’s going on here, well, let’s just say it’s about money. For us, it’s run, run, run all day, and it’s stressful. There’s not enough staff for these residents and if you leave it to these owners, there never will be.
I’ve seen girls go home crying because they feel so bad for the residents. It’s just ripping our hearts out.
Sometimes we are run off our feet. Today was an example. A palliative care patient turned sour on me and had to be shipped to hospital. I was checking on her but also had a load of other duties and by the time I got back to her, she was comatose. I got her stabilized and then sent to hospital. I mean there was just not enough time today to do it all and respond to it all.
We have one person on nights for 100 residents! That person has no medical training, so God forbid there is a problem, or worse, two problems. They don’t know how to triage and even if they did, they can’t be in two wings at the same time. They are running all of the time and it’s stressful for them.
We’re publicly owned and operated by a hospital. Get this. The staffing ratio here is often 1:96! There are two RNs during day, but after 3 p.m., watch out! Then, there’s only 1:96. We told the hospital that this is crazy – but they wouldn’t go for more staff, and the old just walk out. New people report to work, see the workload, and leave
I’m getting bladder infections because there is no time to pee. We have big trouble getting to the bathroom. I’m running all day. If you are on a water pill, if you hold it, you are much more prone to bladder infections. It’s not just me.
Residents in these retirement homes, well, it’s not a good situation. People off the street, call them Bobby or Sally, are now giving you shots and meds. Legally they are required to work under the guidance of a registered staff, but dream on. There is no RN on nights and so they are forced to do this. I mean anyone and their dog can be pressed into duties in Ontario retirement homes, no matter how untrained they are.
As full-time people left, they were replaced with part-time. This in part explains why our home was closed down to admissions. We had, and continue to have, a lot of unmet standards. They found odours, areas that were filthy and a management that wasn’t doing its job properly. Management is even planning the new building and guess what? They are actually planning it to be shortstaffed! We’re running all day and here they are making plans to get us to run even more!
Lack of staff is bad enough but there is absolutely no one to support me, and that makes the job even more difficult. RNs in nursing homes have to be able to survive on their own, make decisions on their own, and it really is quite stressful. We have 64 residents, many with more than one diagnosis, and one nurse. You can imagine my workday.
Before, if a resident was crying or had a blue day, we could take 10 minutes to chat, or you had time to have a two-minute conversation in the hall. Now, girls don’t have time and you’re not allowed to. It is so sad. It’s hitting us all really hard because we care a lot about our residents.
The short staffing in both retirement homes and nursing homes is leading to more worker injuries and a worse quality of life, or no quality of life. Our members are going home exhausted and stressed. They have no more energy or time to talk to their kids, spend time with their families. They just need to sleep and prepare for going back to work.
Things in the homes are going from bad to worse. We are seeing extremely heavy care. The public wouldn’t believe it. In fact, I challenge you to find a retirement home that doesn’t have a lock down ward for people with dementia. We see assaults. We see everything. It can be brutal.
Downloading and offloading It’s all trickle down in the nursing and retirement home sector. All the hospital cuts mean that we are getting really heavy care patients, and this is true not just in nursing homes, but also in retirement homes. The only thing that applies to Retirement Homes is the Landlord and Tenant Act and that’s just ridiculous. This is 2005 and you can’t treat people this way. It means bad working conditions, bad care and totally inadequate staffing.
Now, the hospital is even sending palliative patients here because it has to unload patients. It’s horrendous. They often die within 24-hours because we are not set up for this, funded for it, or trained for it. They should be in palliative care. If the government wants us to deliver this kind of care then they should give us the rooms, staff and funding, but they haven’t.
We have complex cases. They are compromised here and need more professional care. It is not unusual to see IV, peg tubes, dialysis, tracheotomies, high intensity dressing, and people with mental dementia. Many of these acute residents come from the hospital just a day after surgery.
- 46 We see aggressive residents that shouldn’t be here. There are people needing psychiatric care mixed with those needing medical care. There are no locked rooms for them, only geriatric chairs and when they are put in them, they scream and get very agitated and upset others residents.
Second bath? Liberal government policy vs. reality This second bath requirement from McGuinty is a joke. In our home, the bath girls are always being pulled because they are needed on a different floor. The home is so short staffed, residents feel it and so do workers.
We have only 3 of us for 66 residents and it’s deadlines, deadlines, and deadlines.
It’s a production line with 10-12 minutes per resident and that includes a bed bath. You can guess whether that means we can really get people clean. And now there’s these things “baths in a bag”. They’ll do anything just so they don’t have to give residents real people to help them – all these stupid and useless gimmicks.
The ministry doesn’t care if we don’t have time for residents. They make rules on two crummy baths as though that it is something to be proud of. No one can meet it but
Two baths a week? Oh, no. They don’t always get even one. They cut out one of the bath shifts because we’re down residents and the lady that is left that does the morning bath shift gets pulled if someone is sick. There are only two bath people left but they have just too much of a workload.
The new blue line We’re not allowed to change incontinent pads until they are 75% full, or at the blue line. Have you seen what incontinent pads look like at even 50% full? Our residents are people with dignity and they are forced to walk down the halls with these things hanging between their legs. It’s disgusting and inhuman, but this owner is cheap, cheap, cheap. They probably all are. Our girls feel so bad we take extra pads and hide them in the ____________, just so our residents don’t have to go through that. I think every government member should be made to wear incontinent pads and see what it feels like when it’s 75% full. It’s a disgrace.
They actually went into the garbage and weighed all the diapers to ensure we weren’t cheating and giving residents diapers before we were allowed. They are taking away the residents’ dignity and ours too. We aren’t trained to treat people like this – just the opposite.