CBC News reported this week on the unique challenges faced by long-term care homes in rural and northern Ontario. According to recent data from the Ministry of Health and Long-Term Care, more than 50% of long-term care facilities with the highest rate of abuse were in small towns. Between 2011-2016 the number of reported cases of abuse have been on the rise.

However, these homes often face unique challenges that may not be an issue in facilities in larger or more populated centers, and are often struggling to maintain proper staffing levels to deliver the highest possible levels of care to residents.

Staffing and Funding Challenges

Long-term care homes in smaller or rural communities typically face the same challenges, mainly around staffing.

Candace Chartier, the CEO of the Ontario Long Term Care Association, which represents 70% of homes in the province, told CBC News that “[there could be] a shortage of staffing, but also a lack of specialized staff” in long-term care facilities in smaller or remote communities, as well as less access to funding and resources.

Homes in rural areas of the province struggle with attracting personal support workers, particularly as the demand for such workers is high province-wide and they can choose to stay in larger towns or cities. It is especially challenging to attract staff that focus on behavioural supports for residents with cognitive disabilities, such as dementia.

Homes in smaller communities note that the Ministry of Health and Long-Term Care’s provincial funding model for long-term care homes does not provide special consideration for the particular requirements of small-town centres. The only Ministry requirement around staff to resident ratios requires that every home have one registered nurse (RN) on shift at all times. This is more challenging to fund in smaller homes with less beds.

Two Case Studies

Two homes were featured in the CBC News story, one in North Renfrew, Ontario (population just over 8000, about 200 kilometers north-east of Ottawa) and one in Bourget Ontario (also outside of Ottawa, population approximately 20,000).

In the Bourget home, specially trained staff are only available for six days every two weeks. A spokesperson for the Bourget home notes that the home would benefit from a full-time team, and that “there is a definite lack of specialized psychiatric and geriatric services in Ontario, especially in rural areas”

In the North Renfrew home, a specially-trained staff person is on site one day per week. The long-serving administrator of the home notes that the home has never had any reports of physical abuse or sexual abuse. Instead, any reported issues are subtler and often involve situations that can be considered verbal abuse. The administrator recalled, for instance, the situation of a resident who wore the same plaid shirt daily. Every evening the home’s staff would sneak into his room, take the shirt, launder it, and return it by morning. When a new staff member started working at the facility she was unaware of this protocol, and instead informed the man that he stank and had to wear a different shirt. The incident was reported to the Ministry as a possible incident of verbal abuse.

The home’s administrator admits that such a situation is “absolutely unacceptable” and was an affront to the resident’s dignity. She notes that most of the cases of reported resident abuse at her facility involved verbal abuse, including using a negative tone of voice when speaking to residents. Due to the home’s small size and “close quarters” she can pay closer attention to what staff are doing and will know if they are “slipping”. Reporting of any abuse, including verbal abuse is mandatory for homes.

What Is Being Done to Address Concerns?

The Minister of Health and Long Term Care has previously vowed to improve the access that homes have to staff trained to provide particular behavioural supports. We will continue to follow any developments in this regard, and will provide updates as they become available.

If you are the owner or operator of a long-term care home and want to ensure that you are complying with your legal and other obligations, contact Wise Health Law. Our team of knowledgeable health lawyers provide our clients with respected, expert advice on health law, regulatory, and related matters. We help long-term care home operators run their facilities in the best interests of the residents, advise them on managing their risk, proactively address issues or concerns where they may arise, and represent them in litigation if needed.  With offices in both Oakville and downtown Toronto, we are easily accessible. Contact us online, or at 416-915-4234 for a consultation.

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