Nursing homes unsafe for residents?

In this series, we explore the nursing home predicament that besets our country and see the second-rate living conditions that are common in too many homes. Last week we began to follow Edward Monaghan’s experience as he visited his wife Jackie in a nursing home where she will likely live the rest of her life. He found it disturbing. This week we explore that environment further.

Institutional neglect and abuse
With professional and personal staffing at ridiculously low levels, it’s created an unsafe environment for nursing home residents. This was brought to light in an influential 2001 report called The Shame of Canada’s Nursing Homes, which highlighted many staggering examples of neglect and abuse taking place in nursing homes across Canada.

Produced by the Alberta-based Families Allied to Influence Responsible Eldercare (FAIRE), the report compiled complaints made by family members who had loved ones residing in LTC facilities. The appalling litany of abuses included: residents forced to wear adult diapers wther incontinent or not; infrequent change of incontinent wear meant a high occurrence of urinary tract infections among residents; poor oral hygiene leading to tooth loss, disease and thrush; residents confined indoors to their wheelchairs or beds for long periods of time; residents left in food-stained or incontinent-stained clothing; residents tranquilized or restrained against family’s will; residents overmedicated, causing loss in ability to walk or resulting in severe falls.

And those weren’t the worst. Some families even reported that their loved ones had become severely dehydrated or malnourished, simply because short-staffed homes had neglected to ensure that residents drank enough water or finished all their food. Are these charges isolated or sensationalized? No chance. In fact, they eerily echo a 1988 Quebec study that revealed 74 per cent of the 1,000 residents in 16 nursing homes in Hull, Que.,  suffered moderate to severe malnutrition. And studies performed in U.S. and U.K. nursing homes have produced similar results.

Few safeguards
The Shame report was intended to serve as a wake-up call to governments, says Bev McKay, FAIRE’s founder and president. McKay charges that by ignoring what’s going on in nursing homes, provincial governments are denying frail seniors their human rights. “There are no safeguards for these vulnerable people,” she says. “Nor is there anywhere for them to go when they’re abused or neglected.”

Nurses and health-care aides who look after the elderly have a difficult job. Each day, they have a set of duties to perform and only a certain amount of time and resources in which to complete it. So if it means assembly-line feeding, overmedicating difficult patients or propping them in front of the television, they’ll do whatever it takes to finish the job. But that doesn’t sit well with McKay nor the families who must deal with it.

“You have to look at the way people are dehumanized in institutional settings — if they’re being treated as less than human, then it’s abuse,” she says. “If a health-care worker fails to offer a resident enough water or nourishment, that’s abuse. If a patient who is able to walk but is chemically or physically restrained in their wheelchairs all day, that’s abuse.”

Next page: Who’s to blame?

Too few beds
Another major headache Monaghan encountered was getting Jackie into a nursing home in the first place, a task that often becomes a long and draining process as anyone who has gone through it will attest. In most regions across the country, there are long waiting times — sometimes up to two years — to get a nursing-home bed. This situation has eased somewhat in two of the more overburdened provinces, with British Columbia and Ontario committed to developing 5,000 and 20,000 new LTC beds respectively. Ontario is also refurbishing 16,000 existing beds to bring them up to today’s standards. Observers hope this will shorten waiting times, providing the facilities are built in the areas where there’s the greatest need.

In most provinces, applications to nursing homes are handled by a social worker from a regional health authority. On your behalf, the social worker will assess the patient needs and handle the application to the homes you’ve chosen. (In most provinces, you’re limited to three choices.) Acceptance isn’t guaranteed — only if there’s a bed available at the home you’ve chosen and you’re at the top of the list. This lottery-type policy fails to ensure that the seniors who need beds immediately will get in before others who may have less urgent need. It also means that wait times will be longer at the better-run, better-equipped homes. In Monaghan’s case, he needed a placement without delay, but a bed wasn’t immediately available at either of his top two choices. So in the end, he had to settle for his third option, just to ensure Jackie did get placed.

Who’s to blame?
Monaghan doesn’t blame any of the system’s failings on the nurses, health-care aides or administrators who run his wife’s nursing home. He’s thankful that Jackie has a roof over her head and, all things considered, is receiving more nursing and personal care that he could ever afford or provide at home. But he still feels we should be doing much more for seniors who’ve paid their dues to society and wonders how it got to be this way.

Perhaps part of the blame can be placed on the prevailing attitude society has of our fragile elderly. This subtly ageist philosophy suggests: “They’re old and on they’re way out. Why should we spend our valuable resources on them? Let’s save our money for the young and able.”

Another factor, however, can be traced to the way the nursing-home sector has developed over the years. Years ago, when our loved ones became ill or demented, they were cared for at home by a saintly relative, usually the daughter. As a last resort, they’d be placed in a nursing home where they’d live out their remaining days.

But with smaller families and more women in the workforce, not to mention a growing elderly population that’s also living a lot longer, we’ve become increasingly reliant on LTC facilities. However, government funding of the long-term care sector has been slow to adapt to this new reality. 

Moreover, we’re dealing with a new set of patient needs. Not only are the elderly living longer but they’re coming into these homes with advanced medical complications, and many of the older facilities just aren’t able to respond. “The needs of residents over the past 10 years have become far more complex,” says Donna Rubin. “Hospitals now discharge patients (to long-term care) faster than ever before. We’ve been caught trying to care for many more people with advanced needs, and government funding hasn’t kept pace.”

And until governments realize that the landscape has changed, and dedicate more funding and increase the standard of care, Canadian families continue to rely on a long-term care system that just isn’t delivering the goods.

Next week in our Health section our series continues with a look at nursing homes that are getting it right.