Retirement Home Questionnaire
SEIU Local 1.ON Canada Response to Ontario Government 2007
With over 700 retirement homes in Ontario selling accommodation to 41,000 Ontario seniors, in terms of resident population, retirement homes will soon equal the resident population of nursing homes.
The average age for retirement home residents is now 83.
The Service Employees International Union Local 1.on represents 2,500 employees at retirement homes across Ontario. Before commenting on the specific questions asked by the Retirement Homes Project, Ontario Seniors Secretariat, SEIU Local 1.on wants to point out that the tone of the questionnaire is already biased toward self regulation of the retirement home industry.
If it is the government’s intent to enforce already feeble industry standards to be adopted by a third-party regulatory agency, this exercise will be an absolute failure.
Frail and fragile seniors do not always have the ability to speak up for themselves, or have a family member or a power of attorney to act in that capacity. It is essential retirement home residents have ability to enforce their rights by law and independent of a third party regulatory agency.
Regulation of retirement homes must be province wide and consistently enforced.
The retirement home industry must be regulated through a specific act (not unlike the Long Term Care Homes Act.)
Q. 1& 2 How should “retirement home” be defined? Occupancy Levels?
A. Retirement Homes should be defined as any home where a group of seniors (three or more and an age of or greater) purchase care services, over and above a basic rental accommodation contract. Care services are to be defined as housekeeping, laundry, dietary, transportation and medical services limited to the administration of drugs, rehabilitative and therapeutic services and monitoring of the overall health conditions of the resident.
Whether it is a large institution or a small home, all seniors requiring care must be assured the same basic standards of care.
SEIU Local 1.on recognizes that larger homes may be able to achieve greater economies of scale. Nevertheless, uniform standards must apply across all sizes of homes.
Legislation or regulation may require homes to be classified as to the amount of care they provide such as class I, II or III.
Retirement homes attached to nursing homes may be able to provide greater services than small stand alone operations.
SEIU Local 1.on recommends that the Ontario government introduce an Act (e.g. Retirement Homes Act) before drafting regulations governing the industry.
A key component of that Act must be a Resident’s Bill of Rights including residents’ councils; operation and staffing requirements; licences including background checks of owners, administrators and staff; enforcement provisions including fines for non-compliance.
Nothing in the questions posed suggests the government wants to move toward licensure. SEIU Local 1.on recommends the government do exactly that.
A criteria for licensing and licensing requirements must be set in legislation.
Q. 3 Care Services Defined.
A. There must be a clear demarcation of services offered by a retirement home and those more appropriately provided by a nursing home. Seniors requiring wound care, complex nursing care or persons suffering from dementia belong in a facility that has the ability to offer 24/7 care.
Retirement homes can not be quasi nursing homes.
Government should not subsidize retirement home operations of any kind. All retirement homes are private facilities. Municipalities do offer a daily subsidy for individuals deemed to be come under the “Rest Home” provision, but this should be the extent of any public subsidy.
CCACs determine the level of care seniors may require.
Retirement home administrators must be compelled to monitor the physical and mental health of residents. If a resident presents health indicators above a determined level or criteria the CCAC must be contacted for an evaluation of the resident’s condition and a determination made whether to move the resident to a facility offering greater care (nursing home).
Retirement homes should not be able to decide solely the role they wish to play in the long term care continuum of their residents.
Each resident may have a different set of needs. Although there cannot be an average amount of care regulated for each individual, there should be a minimum of care standards developed based on resident population for a retirement home including a 24/7 Registered Practical Nurse requirement.
To this extent SEIU Local 1.on favours the definition of senior living in a retirement home to be one where the individual continues to be able to manage their own health care plan and live independently.
Services outside of a personal care envelope should be subject only to contractual agreements between the resident and the retirement home.
Q. 4,5,6 Provincial standards governing employers, complaints, resident councils standard contracts, current legislation.
A. In order to protect the tenant consumer, care services must include a staffing requirement. Currently some retirement homes allow personal support workers to provide medication to residents and check resident sugar levels.
It is SEIU Local 1.on’s position that no unregulated health care provider should dispense medications.
Present regulations state a RN can delegate a controlled act to an unregulated person provided the RN is sure the individual has first hand knowledge of and competency in performing the act. However, this compromises both a RN’s position under the Regulated Health Professions Act and the PSW.
If a mistake is made in administering drug dosages in unregulated facilities such as retirement homes, who is ultimately responsible if a drug dispensing mistake is made? No unregulated health care provider should dispense medications.
Residents must have the assurance that care givers at each level have a documented skill set and qualifications to provide the care.
The basic hands on care giver in a retirement home must be a certified PSW.
A PSW register should be developed under the Ministry of Health and Long Term Care. The registry would include criminal background checks and educational qualifications.
PSW certification should be granted after an individual has successfully completed the community college program.
It is crucial employees are oriented to the condition of each new resident.
Residents must have a complaints procedure.
The new Residential Tenancies Act 2006 is silent as to advocacy or mediation, save for the eviction of a tenant where the dispute shall be sent to mediation before the Board makes an order (Sec. 148(3)). Many complaints about a home and conditions in that home will occur before an eviction process may occur.
The Landlord and Tenant Board may not be the appropriate vehicle wherein seniors can have their voices heard.
Self regulation by the industry, will give the residents no confidence their complaints are heard by a genuine independent complaints body.
There are over 700 retirement homes in Ontario. Fewer than 400 are members of ORCA.
Again SEIU objects to the fact that standards may be set using only ORCA accreditation guidelines.
Resident’s money and trust accounts must never be handled by the retirement home. Only residents themselves, a designated person by the resident, or a person with the power of attorney should handle a resident’s financial affairs.
Every home must have a resident’s council independent of the home’s administration. Only residents of the home should be members of the council.
A resident’s council should advice residents of their rights and obligations; attempt to resolve disputes between the residents and the administration of home; and review inspection reports including health and safety hazards and structural inspections.
A retirement home must adhere to all relevant provincial legislation and municipal bylaws.
Maintenance of health records must comply with all confidentiality and privacy information legislation.
Medications must be stored under lock and key and administered only by a qualified health professional.
Persons with cognitive impairments should not belong in a retirement home.
Abuse of any kind can not be tolerated. Provincial regulations must be set to ensure retirement homes have in place a zero abuse policy that conforms to provincial standards.
The Ontario Seniors Secretariat should develop a website that captures complaints against a home. (dietary, housekeeping, quality of care, type of accommodations the home provides, the age of the home, and rental rates so consumers can make better choices.
Use of restrains both physical or chemical must never be used under any circumstances.
Food services must comply with all health regulations. Administrators must ensure meal plans have been approved by dieticians and based on the Canada Food Guide.
Dietary regulations are essential.
A witness in a lawsuit brought by St. Elizabeth Villa in Hamilton against the region city and public officials testified that unfinished food from residents’ plates were put back onto serving trays.
To ensure the healthiest living conditions, retirement homes must comply with provincial standards regarding infection controls, particularly concerning the prevention and containment of airborne viruses.
Emergency call bells must be placed in each unit to ensure the safety of each resident.
Each residential unit must be constructed with a sprinkler system.
Retirement homes must ensure the security of tenants and immediate response to any health care need by employing one full time caregiver for every sixteen residents between the hours of 11:00 p.m. and 7:00 a.m.
Q. 8-13 Enforcement of Standards
A. The preamble to this section of questions suggests the government wants to move toward a third-party regulatory compliance agency.
We repeat such a model will not ensure the safety and welfare of retirement home residents.
The industry can not regulate itself. The industry must not police itself, handle consumer complaints or conduct its own inspections and investigations.
Retirement homes must be regulated by the Ontario government through legislation.
The provincial government must establish an inspection branch with investigative powers and the authority to impose violations charges and penalties. Inspectors will need training. A good model to emulate would be the Ministry of Labour’s Inspection Branch training.
Elder abuse must be stopped. A CTV investigative report in early 2004, at Charlotte Villa in Brantford showed abuse of a resident had clearly occurred. A senior citizen in a retirement home then and the proposed self regulatory model will not stop abuse. Abuse stops when strict standards are applied.
Self regulation cannot guarantee a fair resolution to disputes because the industry is already an interested party driven by financial considerations.
The Ontario government must also establish a mediation disputes mechanism that is independent of any legal issues that may fall under the Residential Tenancies Act 2006.