Group items tagged

Created in January 2011, the authority started accepting complaints related to abuse or risk of harm a few months later. It has since investigated 150 homes. Valentine said the 50 in question have unresolved problems related to multiple complaints.

“When you are frail and have care needs, it’s very challenging to make an effective complaint,” Wahl said. “But just because a home hasn’t had complaints doesn’t mean it’s a good place.”

Homes range from expensive buildings that resemble luxury hotels, charging more than $6,000 a month, to low-cost houses that charge $1,200 a month.

At least 40,000 Ontario seniors live in retirement homes

Valentine said the focus is on homes with the worst complaints. But seniors’ advocate Judith Wahl argues that many troubled homes fly under the radar because residents do not speak up.

Regulations that will allow the authority to hold homes accountable for a full range of complaints won’t begin until 2014.

The licence application forms ask for detailed information, including the owners’ personal and financial history, presence of automatic water sprinklers in suites, staff training programs, and patient-care demands such as dementia, pressure ulcers or problems with bathing, eating or diapering.

Ontario Retirement Communities Association (ORCA)

80 per cent of Ontario’s retirement homes are members of ORCA and must pass an accreditation test before joining

Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, said the government promised that each home would be given an in-depth inspection each year. But now, Meadus said, the ministry says the new nursing home act only requires that a home has “an inspection” of any kind (mostly generated by an individual complaint) as long as it is done annually. “That means we are leaving it up to the homes to regulate themselves,” Meadus said. “If there are bad apples out there, they will be allowed to continue unchecked.”

They were angry that victims like them had not been personally informed about the hearings (good point). They were upset that previous patient complaints of sexual assault about Doodnaught had not been investigated years before they were assaulted (also, good point). And they were furious that doctors who sexually assault their patients are treated differently than bakers who sexually assault their customers, or city staff who sexually assault their colleagues, or anyone else for that matter (I hear you sisters!). "Take it out of the hands of a group of doctors and contact the police like you would do for any other profession in the real world. Medical staff are not gods. They are being treated like gods," said Eli Brooks, who was assaulted by Doodnaught while undergoing liposuction in 2009. "What has happened over and over will continue to happen until they are made criminally responsible." Brooks had the publication ban on her lifted, so I can tell you her name. She believes naming herself as a sexual assault victim will help weaken the crime's stigma. I applaud her for that.

I can't tell you the second victim's name. During the preliminary hearings of Doodnaught's trial, she was known simply as D.S. Her case was not, in the end, included among the 21 charges, so has not been proven in court. She tells the story that was the trial's refrain: Doodnaught was the anesthesiologist during her surgery at North York General Hospital in 2009. A screen was raised at her midsection, preventing her from seeing the doctors and nurses working below, but also preventing them from seeing Doodnaught at her head. She was barely conscious when she protested him touching her breasts, she said. She awoke to the sight of his penis, she said.

During the trial, it emerged that no fewer than four of Doonaught's colleagues at North York General Hospital had received complaints from patients who said Doodnaught had sexually assaulted them while they were in semi-conscious states. The complaints started in 2006 - four years before Doodnaught was charged. The four were surgeons and anesthesiologists. Not one had reported the complaints to anybody - the head of the hospital, the police, the college. North York General's then-chief of anesthesiology, Dr. Stephen Brown, testified that when police came calling about Doodnaught in 2008, he didn't tell them about two previous complaints by patients. Once police finally laid charges, he sent out an email to staff, entered as evidence, that stated: "We have to support George in any way we can during the investigation." (He said in court he had not meant for them to interfere with the police probe.)

"He didn't protect us," D.S. said. "Had he come forward, we might have saved many of us." She called on the task force to implement penalties for bystanders - doctors who hear about the sexual assault of patients by other doctors, but do nothing. Brooks went further: "Anyone who covers it up should be legally charged with aiding and abetting a crime." Later, the task force's ever-patient chair, Marilou McPhedran, informed the still-barren room that such a provision already exists. Under the Regulated Health Professions Act of Ontario, health professionals with "reasonable grounds ... to believe that another member of the same or a different college has sexually abused a patient" must file a complaint to their college registrar within 30 days - unless they think the accused will continue sexually abusing patients. Then there is "urgent need for intervention."

The penalty for failing to do this is "not more than" $25,000 the first time. The second, it goes up to "not more than $50,000." So, were those four doctors fined by the College of Physicians and Surgeons of Ontario, you might be wondering - particularly since they testified in criminal court about their failure to alert their college to patients' complaints about Doodnaught sexually assaulting them? No.

"The College has not commenced prosecutions ... in relation to a physician failing to make a mandatory report in this matter," CPSO spokesperson Prithi Yelaja wrote me in an email. In fact, in the history of the college, it has never prosecuted any physician for failing to make a mandatory report, she confirmed. Not once. See what I mean? The rules don't need to be changed, they simply have to be enforced by people who can be better trusted: the police. The task force hearings continue on May 8. Catherine Porter can be reached at cporter@thestar.ca.

"It's now up to the government to act and decide whether it will cover the cost of certain services and the use of medical equipment in private practice, or if it wants to revise the agreement on the accessory fees with the medical federations." Under the Quebec Health and Social Services Act, doctors who work in hospitals cannot bill patients for medically necessary services. These same physicians must abide by certain conditions in their private practice, since they have not opted out of medicare. They can only charge for "medications and anesthesia agents" in private, and they are not allowed to bill patients for the use of medical equipment. However, there is one exception to the rule: private radiology clinics in Quebec can bill patients for MRI scans - a sore point with Health Canada, which has argued that the exception violates the accessibility provisions of the Canada Health Act. In addition, Quebec did negotiate with the medical federations a list of fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10). Over the years, many physicians in private practice have started billing for many more items and services, sometimes prompting investigations by the Régie de l'assurance maladie du Québec (RAMQ).

Jane Meadus, a lawyer with the Advocacy Centre for the Elderly. “We are worse off now than we were before because now we no longer have annual inspections.”

the ministry stopped using the term “annual” for these inspections after the Ontario Long Term Care Act became law on July 1, 2010

“The backlog is so huge, more than a year for some

if a ministry inspector walks through the doors of a nursing home once a year, that is good enough, even if the complaint is about soggy green beans at lunch or a broken television in the lounge.

“The inspectors are so busy they are being told not to look at anything else when they go into a home to investigate a complaint,” said Janson, of the Ontario Public Service Employees Union.

Now, a ministry visit for any type of complaint is considered an “annual” inspection.

the worst homes often have fewest complaints because residents there usually have no family

those homes now have the least oversight

Margaret Melanson, Horizon's vice-president of quality and patient-centred care, said in a statement on Tuesday most of the people the health network employs for the incognito work are university students who are paid $16 to $18 an hour. Melanson said the first few language audits were conducted at such facilities as the Saint John Regional Hospital, The Moncton Hospital, the Miramichi Hospital and the Dr. Everett Chalmers Regional Hospital in Fredericton. She said the undercover auditors included some Horizon employees as well as students and members of the public.

The practice first came to light at a Horizon board meeting earlier this year in Fredericton. The Vitalité Health Network said Tuesday it has done similar audits using students in the past, "in line with our responsibilities under the Official Languages Act." People's Alliance Leader Kris Austin said Tuesday he is calling for an end to the "secret patient" exercise, which he said is intimidating unilingual Horizon employees. "We get calls from people who work in Horizon Health, unilingual employees, who are scared to death," Austin said in an interview. "They're saying things like, 'Are we going to be the next Wayne Grant if we don't provide bilingual service.' They are nervous. They don't know if they will be somehow punished. We're becoming too much like Quebec in terms of how we enforce our language policies. We have gotten so far from the original intent of bilingualism."

New Brunswick's commissioner of official languages Katherine d'Entremont launched an investigation last May after she wasn't served in French by unilingual commissionaire Wayne Grant, during a visit to the main government office building in Fredericton. The 10-month investigation caused a storm of controversy because after she raised the complaint, Grant lost his favourable front-desk position and was reassigned to an outdoor parking lot and the backroom of a government office building. D'Entremont declined to comment on the Horizon issue.

"As the Office of the Commissioner of Official Languages for New Brunswick will be addressing matters pertaining to official languages within the health networks in the 2015-16 annual report, comments on these issues will be made at the time of release of the annual report," said a statement from d'Entremont's office. In its last report, the Office of the Commissioner of Official Languages for New Brunswick reported three complaints about the Horizon Health Network's inability to provide care in the language of a patient's choosing. Austin said that number is tiny considering the roughly 1 million hospital visits Horizon handles annually. "It is perplexing that the health network would spend any resources on a problem that appears to be virtually non-existent," he said. But senior executives within the regional health authority said that despite the small number of complaints, the health network has a legal mandate to ensure access to service in French or English.

Horizon CEO John McGarry said at the January board meeting where the language audits were discussed, Horizon is legally obligated to provide care in both official languages. "Most people don't complain. They will convert (to another language) and not complain. But the fact is the law in New Brunswick is the law," he said at the board meeting.

We strive to live within the law of New Brunswick. Frankly, we can't answer for that. We can't decide we're not going to charge HST on our parking. It's the law. We must do it. We can't make a decision not to." McGarry said he knows many New Brunswickers find language policies frustrating. "I would say, 'Talk to your lawmakers. I would say, 'We have so much to do. We can't be involved with trying to argue our way out of the law of New Brunswick.' Argue with lawmakers," he said. McGarry said Horizon has done well at providing care in the language of a patient's choosing. Where it has struggled in the past, he said, was in making the offer of service.

"Frankly, we can do a lot better job," he said. "So what we're trying to do is to say to people, 'You've got to provide the active offer.'" Norma Robinson, president of the CUPE health-care unions, said she was unaware of the language audits and has not received any complaints from union members.

"I haven't heard one thing from any place in Horizon that would indicate there is an issue with this," she said in an interview. However, Robinson said she feels the tactic may be "sneaky." "I'm a bit disturbed as to why they would go to that length and not just survey the patients and the public to see if they are being given the active offer in French and English," she said. - With files from Adam Bowie

"We are committed to the health and well-being of Ontarians living in long-term care homes and firmly believe in public accountability and transparency," said ministry spokesman David Jensen. Today, the Star profiles the story of former nursing home residents Fatemeh Hajimoradi, who has a serious pressure ulcer on her buttock, and Dorothy Benson, who died from problems related to gaping bedsores on her leg and foot.

Hajimoradi is now in Credit Valley Hospital, thanks to her family's advocacy. But the complaint filed by her granddaughter, Trinos, with the ministry got no results. Trinos emailed those photographs, with a complaint, to the ministry last spring. The ministry inspector didn't visit the home until Aug. 25 - two months after Hajimoradi was permanently moved to the hospital. Without interviewing the family, the investigator discounted the complaint and told Trinos the photos were not accepted because they could be edited or photo-shopped.

"I feel like I'm helpless now," Trinos said, after ending her call with the ministry. "They aren't going to send anyone else in there. They just go in, close the book and that's it." Jensen, the ministry spokesman, said inspectors do accept photos and must interview families in their investigation. Asked why that didn't happen in this case, he said the inspector used notes and photos from Trinos' original complaint with an intake worker. Now Trinos and her mother, Mehdizadeh, want their story made public as a warning to other families: watch closely, speak up and remember that a bedsore isn't a benign skin condition - it's a toxic threat that requires the most vigilant care.

In January 2013, Mehdizadeh entrusted her mother, Hajimoradi, to the Erin Mills Lodge. Hajimoradi has Parkinson's disease and dementia. She isn't able to move on her own and - like a growing number of long-term care residents - requires help with regular repositioning so that pressure from sitting or lying in the same spot does not create bedsores. Mehdizadeh said she understood skin breakdown was a risk but expected the staff to provide intensive care - including proper nutrition and hydration - so as to prevent the agony of serious infections and open wounds.

"My mother is suffering, suffering. We are all suffering," Mehdizadeh said. "I'm speaking out about this for all people in the older generation. Nursing homes are supposed to give them a safe journey home. But where are their rights to proper care?" Two years later, in May 2015, Trinos' notes said a worker at Erin Mills Lodge privately told the family about a serious and smelly bedsore on Hajimoradi's bottom.

Trinos and her mother said they didn't recognize the significance of the sore, nor did they see it, because the dressings that covered it were changed before their visits. "Come at a different time than you usually do, come and surprise (staff)," they recalled the worker telling them. The next day, Trinos' mother, Mehdizadeh, visited in the morning instead of the late afternoon. She told the nurse to open the dressing on her mother's bottom. The pressure ulcer was partially black and smelled like rotting flesh. Horrified, she took the first of many pictures. Several days later, her mother wasn't eating and was shaking with fever and nausea. Mehdizadeh demanded that the home call 911 and took her mother to hospital.

Mehdizadeh said her mother was admitted to hospital with two infections: sepsis, from the bedsore, and a urinary tract infection. In the hospital, Mehdizadeh and Trinos watched as nurses treated the pressure wound with sanitary cleaning kits. They were impressed. When Hajimoradi returned to the nursing home 10 days later, Trinos took photos and notes to document the difference in wound care. She said staff didn't follow the specific instructions sent by the hospital and didn't have the same cleaning kits. She said staff didn't offer pain medication before using undiluted iodine on the open wound "while my grandma was crying and screaming." Unlike the careful cleaning process used in the hospital, where nurses changed their gloves twice, Trinos photographed a worker cleaning the infected sore with one gloved and one bare hand.

On June 21, Trinos and her mother noticed that the dressing for a pressure wound on her hand was missing and the air mattress to help with the bedsore on her grandmother's buttocks was deflated. Eventually, Trinos called 911 and Hajimoradi was returned to Credit Valley Hospital, where she remains. This time, she was admitted with a dark red early-stage ulcer on her tailbone and a deeper ulcer on her buttock.

Erin Mills Lodge was sold by Sifton Properties to Schlegel Villages on July 10 - after Hajimoradi left. Schlegel spokeswoman Rose Lamb said the former operators tried to work with Hajimoradi's family but said the family insisted on taking her to the hospital. Lamb also said a subsequent meeting between Erin Mills workers and hospital staff concluded there had been no neglect. Lamb said the home's current internal monthly data shows that four out of 86 residents have "worsening" pressure ulcers.

She also cited the most recent report from the Canadian Institute for Health Information, which shows the incidence of worsening pressure ulcers at the home declined in 2013-14. That year, Erin Mills' incidence rates dropped to 1.1 per cent from 3.9 per cent the prior year. The Ontario average for 2013-14 was 3.9 per cent. Hajimoradi developed problems with ulcers in the spring of 2015, a period that is not included in the report.

This is Lysyk's second review of home care this fall. Her first, released in September, revealed that nearly 40 per cent of the money the province spends on CCACs does not go to "face-to-face" treatment of patients. Her latest report shows that spending on home care has grown sharply in recent years, as have demands. Between 2008-09 and 2014-15, the Health Ministry increased home-care spending by 42 per cent, to $2.52 billion from $1.76 billion. Clients served increased 22 per cent, to 713,500 from 586,400.

In the meantime, 70 per cent of CCAC long-stay patients have complex care needs today, compared to fewer than 40 per cent five years ago. There are still no provincial standards for specifying the level of services clients with similar needs should get, a problem Lysyk highlighted in her 2010 report. Because of that, individuals with the same level of need may get five hours of personal support worker care weekly in one part of the province, eight hours in another and 10 hours in a third region. Even within the same region, service levels vary according to time of year. There were nine times more people on a wait list for home care at the end of the fiscal year 2014/15 compared with the beginning of the year in one CCAC, the report noted.

Health Minister Eric Hoskins has said that a major restructuring of the province's health system is on its way and has hinted that Ontario's 14 local health integration networks (LHINs) may take on some of the work now done by CCACs. But Lysyk's report also identifies problems with LHINs, which share the same geographic boundaries as CCACs, and are charged with planning and integrating health services and a local level and delivering provincial funding to them. It says LHINs' marching orders are not clear enough and that performance gaps are widening. For example, patients who no longer needed acute hospital care stayed in hospital more days in 2015 than 2007.

The government is committed to improving home-care wait times and to that end is increasing funding by $250 million this year and in each of the next two years, Hoskins said. Meantime, the report also found that a backlog of inspections of nursing homes, following complaints and critical incidents, is rapidly growing and placing residents at increasing risk.

We found the ministry often did not take timely action to ensure residents were safe and their rights protected," the 773-page report says in reference to those living in Ontario's 630 long-term care homes. It noted that the backlog of complaints and critical incidents had more than doubled - to about 2,800 in March 2015 from 1,300 in Dec. 2013. Critical incidents include neglect, abuse, unexpected or sudden death and misuse of residents' money. The auditor general found 40 per cent of complaints deemed high risk, which should prompt immediate inspections, took longer than three days to be inspected.

he auditor general notes the backlog of complaints and critical incidents regarding long-term care homes has more than doubled in recent years.

Gilles Lanteigne, the CEO of the Champlain CCAC where Cranney is receiving care, says his experience is unusual. “We have a very structured process to ensure that any patient or family can make a complaint [or escalate it] … the process works very well for most people,” he says, adding that they track and publicly report on complaints. He says a 60-hour-a-month cap isn’t unusual for a regular case – someone that isn’t receiving palliative care, for example. PSWs may provide homemaking services if there is time, and the CCAC can link clients with homemaking providers, but there is a co-payment for those.

The Quebec government has negotiated with the medical federations a list of fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10). Over the years, many physicians in private practice have started billing for many more items and services, occasionally prompting investigations by the Régie de l'assurance maladie du Québec (RAMQ).

In a statement made public Tuesday, College president Charles Bernard countered that the researchers based their conclusions on "impressions and partial data ... without taking the time to analyze in depth an issue so complex." Bernard noted that the College produced a report on accessory fees in 2011, and in January, it modified its code of ethics warning doctors that they cannot bill patients "disproportionately high" fees and that they must produce detailed invoices.

In April, the College called on the provincial government to modernize its system of accessory fees. In November, the National Assembly adopted Law 20, which gave the health minister the power to expand the range of fees now charged in private practice and to limit certain amounts. "We need to calibrate the expectations of pressure groups that would wish that the College - through its code of ethics - defend the public coverage of fees for medical services," Bernard added.

The number of Quebecers filing complaints about excessive fees soared by 374 per cent during the past five years, according to a report by the College in April. The complaints jumped from 31 in 2010-11 to 147 in 2014-15. To date, two cases over abusive fees have gone before the College's disciplinary board. In one of those cases, a Westmount physician was fined $10,000 in 2013 for charging patients "excessive and unjustified fees."

An Oct. 1 report by Quebec's Ombudsman found that some private clinics have billed patients $300 for eye drops; $100 to freeze offa wart; $40 to apply a four-centimetre bandage; and $200 to insert an intrauterine device. aderfel@montrealgazette.com Twitter.com/Aaron_Derfel

Dr. Charles Bernard, left, president of the Quebec College of Physicians, seen at a February news conference with college secretary Dr. Yves Robert, says researchers based their conclusions about accessory fees on "impressions and partial data."

This has gone too far. BGH has built and is still adding to its "Taj Mahal" at the expense of Trenton and Prince Edward County hospitals

The theory offered to offset the loss of beds in Trenton and the county is that there will be home-care and doctors' home visits; that's pie in the sky.

availability of such services is not there

There are still shortages of spaces in nursing homes for people who need 24/7 care.

They could lower their expenses greatly from needing to fight in-house bugs by employing full-time cleaning staff who have personnel available to ensure maximum cleanliness everywhere in the hospital at all times.

This includes the prompt cleanup and sanitizing of any area where a mishap may occur; such things are frequent in any nursing facility. Such staff should not be on a contract basis but full-time employees with benefits

Reinstate in-hospital food preparation and hopefully a full cafeteria offering healthy locally grown food to patients, staff, day patients and visitors.

cost-neutral

in Quebec — resources were simply reallocated from the health ministry

the powers of the provincial auditor general were recently expanded to cover hospitals. This is often cited as adequate oversight. But we all know the impact of hospitals on people’s lives goes far beyond financial matters.

a sharp rise in complaints to 142 in the first nine months of 2011-2012 from 89 in 2009-2010.

CSSSs - Centres de santé et de services sociaux - and the CLSCs under their wings, do not have enough money to provide the necessary care

Staff hired to take care of people in their homes are let go to balance CLSC budgets.

Bolduc will present an action plan in June.