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For health authorities to avoid a financial penalty, 90 per cent of their hip patients must be treated within 26 weeks, 90 per cent of knee patients within 26 weeks, and 90 per cent of cataract patients within 16 weeks.

there is a drawback to the way the penalties are applied, Dr. Vertesi said

They are all or nothing, he said, meaning a health authority that falls only a few patients short of the targets is liable to be subject to the full holdback.

“It’s not that there shouldn’t be any consequences, but they are a very blunt tool. If you’re not careful and use them in the wrong way, you may get results you don’t want.” Published on Monday, Feb. 06, 2012 10:46PM EST

The greatest cutback in cleaners was 67 workers at Royal North Shore hospital, which joined Mt Druitt, Campbelltown, Nepean, Liverpool, Westmead, ­Fairfield and Blacktown hospitals in failing the ­hygiene test of toilet doors.

“Improving hand hygiene among doctors, in particular, and other health care workers is currently the single most effective intervention to reduce the risk of hospital-acquired infections in NSW hospitals, ” she said.

But Ms Skinner accused the HSU of “reckless scaremongering” over their claims the cutbacks could cause an infection outbreak.

Another 45 cleaners were cut from Westmead and ­Nepean hospitals where all surfaces tested failed, ­including seats in the ­emergency waiting area.

Campbelltown Hospital, where 15 cleaning positions have been cut, failed both hygiene tests and recorded an elevated level of staph on a toilet door.

Guelph University microbiologist Keith Warriner conducted the tests for Marketplace and found alarming results. “I wasn’t expecting [bacteria] to be so prolific,”

Over 70 per cent of remote controls tested were rated a caution or fail.

faucets in hotel rooms were quite dirty themselves, with 16 fails out of 54

Comforters were the most consistently contaminated spot, rating a "fail" in 23 out of 51 tests

Other major hot spots included bed throws, bathroom sinks, toilet bases and telephones.

a pillow with so much bacteria it has “its own life story.”

Overburdened hotel staff is the main reason that many rooms are so filthy

Canada’s hotel union tries to enforce a cap 15 to 16 rooms cleaned per shift, giving staff approximately 30 minutes per room. Ruiz says that isn’t enough.

many housekeepers work unpaid overtime to reach their daily targets, but many still use time-saving “shortcuts” like not dusting or vacuuming.

"The plaintiffs state that the negligence of the defendants was the sole cause of Mrs. Scott's death and the losses the plaintiffs suffered as a result of Mrs. Scott's death," the claim states. In the negligence claim, her sons - Bruce Findlay Scott, Glenn Carne Scott, and Thomas Andrew Scott - allege that the retirement home hired incompetent staff, failed to screen staff and failed to properly instruct and supervise its staff. The claim says the retirement home also failed to ensure that staff had the right equipment and did not have a proper program of inspection for the maintenance and use of mechanical lifts. The claim also states that the retirement home "knew that its staff ... were using toileting slings to transfer residents, and that this practice posed a serious threat to the health and safety of its residents, but did not take adequate steps, or any steps at all, to stop this practice." The Scott sons also claim that the retirement home failed to warn their late mother about its "dangerous conditions."

The Ottawa Jewish Home for the Aged has not yet filed a statement of defence but is expected to do so. The Scott brothers' claim, which has not been proven in court, is seeking $225,000 in damages for loss of care, guidance and companionship as a result of their mother's death, plus funeral expenses. The Scott brothers have also named the retirement home's staffing agency in the lawsuit.

Ontario seniors homes have the worst fire fatality record in North America with 45 deaths since 1980.

Four private members’ bills and three inquests have all recommended sprinklers.

Residences built after 1998 must have sprinklers but the devices are still not required in 4,000 older “care occupancies,” which house more than 200,000 seniors and other vulnerable people across Ontario including the intellectually challenged. The frail, elderly are more likely to die in fires than any other age group, experts say.

Madeleine Meilleur, Minister of Community Safety and Correctional Services

“Sprinklers are not the only answer. They are important, but nothing will replace the staffing levels and how they are trained in case of fire,”

There are never fire deaths in homes with sprinklers except in the rare case where a person who caused the fire is overcome by injuries, said Sean Tracey, of the U.S.-based National Fire Protection Association.

Toronto Fire Services is first conducting a survey of each care home in the city to learn the cognitive abilities of residents before conducting the mock tests.

Here is how the chiefs did the study: Firefighters visited a retirement or nursing home — sometimes without advance notice — and performed a mock evacuation based on the number of overnight staff when few employees are on shift. Firefighters ordered staff to conduct a fire drill. Using a stopwatch, they tested staff’s ability to move residents out of the building or behind a firewall

Oak Terrace long-term care home, a government-licensed nursing home operated by the Revera chain, failed a test in October 2010.

After fire officials sent a letter to each member of Revera’s board of directors, the home decided to install sprinklers

Revera has installed sprinklers in 85 per cent of its 200 retirement and nursing homes across Canada

Homes that fail mock evacuation tests are hit with legal orders under the Fire Prevention and Protection Act, telling them to hire enough staff to be able to safely evacuate 24 hours a day — or install sprinklers.

Sprinkler installation costs roughly $3 a square foot. That translates to $40,000 for a 30-person home or about $110,000 for a 155-person home.

Fragile residents, combined with inadequate staffing and the fiery nature of materials in modern furniture, like the foam padding in couches, are a recipe for disaster.

In 2010, a year after the Orillia fire killed four residents (and left two brain dead), the government began a consultation on fire safety. Meilleur said she expects the report will be released in June.

an early draft said most respondents (more than 230 comments came from firefighters, retirement homes, municipalities and advocates) agreed that sprinklers should be mandatory in all care homes.

“If 45 children had died in fires would we still be waiting for the government to take action?”

residents, some drugged for a night’s sleep

the deal offered by Mr. Harper’s government is reasonable. It is fiscally responsible, tying spending increases to inflation

It is also politically astute, for a host of reasons:

* It avoids the sordid scene we saw in 2004 when provincial premiers ganged up on prime minister Paul Martin and extorted $41-billion in additional health dollars and a spendthrift 6-per-cent escalator clause on transfers.

* It is a 10-year deal, just as the provinces demanded, allowing some certainty in budgeting.

* It respects Mr. Harper’s election promise to maintain 6-per-cent increases beyond 2014 – at least nominally. (Those who wanted 6 per cent per annum were dreaming in Technicolor.)

* It puts the onus on the provinces to justify why health-care spending should exceed inflation, something they have never been able to do.

* It places no restrictions on how the provinces spend the $40-billion a year they receive in federal health transfers (along with another $20-billion in social transfers for education and welfare programs.)

It should be an instrument for improving health-care delivery, and in that regard, Mr. Flaherty’s offer fails miserably

What the public should expect from Ottawa is that federal funds be used to exercise leadership and foster innovation

The reason Ottawa transfers money to the provinces in the first place (because health is a provincial responsibility constitutionally) is to ensure some semblance of equity coast-to-coast-to-coast. But there are areas, such as catastrophic drug coverage and homecare, where there are gross regional disparities.

This accord will force the provinces to rein in health spending, which is not a bad thing in itself. But one of the consequences will likely be greater disparities in the quality of care and breadth of coverage between the have and have-not provinces.

The great failure here is not refusing to increase transfers by 6 per cent, it is failing to attach strings to the monies.

With this deal, Mr. Harper has shown himself to be politically astute and fiscally prudent, but he has failed to show a commitment to strengthening health care, and medicare more specifically.

He added, “The government is very helpfully moving away from what they have given all of us to work with, which were 28 standards, which we have translated into 16 outcomes.

Some of the suggested criteria, which are intended to capture the diversity of care and of service providers, include cleanliness; protection from abuse and discrimination; adequate pain relief; the provision of food and drink; whether complaints are listened to; and the effective organisation of ongoing care.

“These are really shocking indictments of the system when you realise just how many older people in particular simply don’t have those really fundamental needs met in a whole range of care settings.”

“They [the government] will consult next month on essentially a new set of standards [which] will be about the fundamentals of care—the really basic things. Are people hydrated? Are they fed? Are they supported to hydrate themselves? Are their basic care needs being addressed?

The new standards reflect the regulator’s beefed up approach to inspection, which it announced in April this year,1 in the wake of stinging criticism of its role in the well publicised care failings at Winterbourne View, Mid Staffordshire NHS Foundation Trust, and Cannock Chase Hospital.

One of those reports was released earlier this year by the federal Auditor-General. It found, among other things, that just one in 45 nurses working at a sample group of onreserve nursing stations had completed all of the government's mandatory training courses; that nurses are being asked to do jobs they are not authorized to do; that the stations had numerous health and safety deficiencies; and that Health Canada does not know whether individual reserve facilities are capable of providing essential services. Several of those issues seem to have been at play when Brody fell ill. His father Fraser Meekis and Ms. Keno have five surviving children - three boys in primary school and two girls still in diapers. Just as the reserve school began a break week in the spring of last year, all of the Meekis boys came home with fevers and sore throats. Mr. Meekis took his ailing children to the nursing station, but the nurse did not take throat swabs, he said. She instead advised him to give the boys Tylenol, to rub their chests with Vicks VapoRub and to come back for a second appointment the following week. Sandy Lake has just one medical vehicle to ferry people to and from the facility. It is a van that sometimes breaks down on the rough dirt roads of the reserve and is often diverted by emergencies. It didn't arrive on time to get the kids to the follow-up visit and the family doesn't own a car. So they missed the second appointment.

"It was a student nurse who was watching my son there," Mr. Meekis said. "I kept asking, 'How come he looks like that?' And the nurse was like, 'I don't know.' And the next thing you know, I saw foam coming out of his mouth and I said, 'He's not breathing!' The nurse panicked. I ran out of the room and said 'emergency, emergency.' "But it was too late: Although the nurses managed to revive Brody once, he died later that morning. The problems at the Sandy Lake nursing station are well known to the community. Council members say the facility was constructed for a reserve of 500 people that is now home to nearly 3,000. Local residents have been trained to perform duties that would normally be done by medical professionals. "So you could have your janitor taking X-rays - when he's available," said John McKay, a councillor who was once in charge of medical administration.

He was sent back home with a couple of Tylenol and Advil and he was told to rub Vicks VapoRub on his chest," Mr. Kakegamic said. Wesley Kakegamic died on March 10. He had been a drug user and his family believes that was a factor in the lack of treatment he received. They are angry at the nurses. But the leaders of the community stress they do not believe the nurses are to blame. "It is the health system that we know today that is failing the First Nations," said Bart Meekis, the Sandy Lake Chief. "We're not asking for more than what the normal Canadian gets for health care," he said. But "we're losing people needlessly." Brody Meekis, he said, was one of them. "I want you to know that this is not about pointing fault at one person to help ease the pain that I feel," Fraser Meekis said of his decision to go public with Brody's story, "but to let you know that the system failed my son."

"She was there for a month before she caught the flu and died. Staff never returned our many phone calls or responded to our e-mails. "This system has to change. It's a disgrace on all levels, both home care and facility care. "Julie Cameron, Vancouver "When the Ontario government cut acute-care beds in the 1990s, adequate home care was not put in place first, reflecting the headin-the-sand approach of successive governments to an aging society. "Home care has long been the Cinderella of the health-care system, underfunded and undervalued, yet it is of increasing importance. "Preventative support to keep seniors independent in the community has markedly decreased, because resources are concentrated on the acute needs of patients discharged from hospitals. This leads to unnecessary early institutionalization. "The burden is increasingly born by patients and their informal caregivers. These caregivers are often frail and vulnerable themselves or, if they are the patient's children, there is the economic impact of taking them away from their work. "Inevitably, there is a two-tier system, where the wealthy are able to obtain necessary support, while the rest are on waiting lists, receiving less than adequate care.

"With an aging society, the problem will become worse. "It is time to review the whole community care system and, learning from other jurisdictions, put in place a comprehensive, transparent and properly funded home-care system. "Rory Fisher, professor emeritus, medicine, University of Toronto

"My wife has advanced multiple sclerosis. Two years ago, she got a cut on her foot, which became infected. She was seen at a local hospital, where it was determined she would need intravenous antibiotic every eight hours. With the first treatment at 1 p.m., every third treatment was at 5 a.m. "After the fourth visit, a nurse at the hospital asked why we were not getting these treatments through home care. We did not know it was an option. "She picked up the phone and by the time we returned home, we had a message from the Champlain CCAC to schedule a nursing visit for the treatment.

"Within 48 hours, my wife was assessed and services assigned that exceeded our expectations in quality and oversight of her condition. Over a two-year period, she has received regular reassessment, with treatment plans adjusted according to her needs. "There is no doubt in my mind that home care is not only more cost-effective, but allows treatment to be delivered in a more comfortable setting without travel and waiting room purgatory. "There is also no doubt that the government planning process has failed this system miserably. "We are an hour from Ottawa, which may have something to do with it, but I cannot believe we are the only people in Ontario who have been this fortunate. "Ken Duff, Vankleek Hill, Ont.

"I used to "warn" my patients' families that the first thing CCAC tries to do is to get the family to take over care, even though they "promise" home care while in hospital (to get them out of the hospital). Then, CCAC cuts back on the hours until they "decide" that they must not need home care, because they are only getting four or five hours per week (instead of the 15 or 20 they were originally promised!). It is not the doctors and nurses trying to "get rid of patients," it is administration because of bed times (days in hospital). "Linda Steele, Grand Bend, Ont. "Government needs to put this on speed dial. "April Nairne, Vancouver

"Let's not paint the home-care system with one brush. My husband had excellent, timely and compassionate care through the last weeks of his life which allowed him to die at home, as was our wish. Nurses, personal support workers and supervisors were kind and empathetic. We could never thank them enough. "Ann A. Estill, Guelph, Ont. "Caregivers are frustrated and burning out. One in five Ontarians is a caregiver and they are not receiving the support they need to keep their loved ones at home - be it aging and/or ill parents, spouses or children. "Ontario has acknowledged the need for caregiver supports and more home care. That is great - but where is the change, instead of just lip service?

"In the meantime, families increasingly abandon their loved ones at hospital emergency departments, more caregivers fall into depression, and care recipients end up in hospital or longterm care when they could have stayed home. "We are ready for improvements to home care - any time now. "Lisa Levin, chair, Ontario Caregiver Coalition "Anyone wondering why we baby boomers are demanding the right to assisted suicide should read Kelly Grant and Elizabeth Church's excellent coverage of the Ontario home-care situation to learn the reasons. "Brian Caines, Ottawa " "Associated Graphic "'Care recipients end up in hospital or long-term care when they could have stayed home.'

"ADAM BERRY/GETTY IMAGES

We know that income provides the prerequisites for health including housing, food, clothing, education and safety. Low income limits an individual's opportunity to achieve their full health potential (physical, psychological and social) because it limits choices. This includes the ability to access safe housing, choose healthy food options, find inexpensive child care, access social support networks, learn beneficial coping mechanisms and build strong relationships. Here's what everyone needs to know:

1. In Canada, there is no official measure of poverty. The way in which we measure and define poverty has implications for policies developed to reduce poverty and its effect on health. Statistics Canada does not define poverty nor does it estimate the number of families in poverty in Canada. Instead, it publishes statistics on the number of Canadians living in low-income, using a variety of measurements. Following the federal government's cancellation of the mandatory long-form census, long-term comparisons of income trends over time have been made difficult because the voluntary survey is now likely to under-represent those living in low income. 2. There is a direct link between socioeconomic status and health status. Robust evidence shows that people in the lowest socioeconomic group carry the greatest burden of illness. This social gradient in health runs from top to bottom of the socioeconomic spectrum. If you were to look at, for example, cardiovascular disease mortality according to income group in Canada, mortality is highest among those in the poorest income group and, as income increases, mortality rate decreases. The same can be found for conditions such as cancer, diabetes and mental illness.

3. Poverty in childhood is associated with a number of health conditions in adulthood. More than one in seven Canadian children live in poverty. This places Canada 15th out of 17 similar developed countries, and being at the bottom of this list is not where we want to be. Children who live in poverty are more likely to have low birth weights, asthma, Type 2 diabetes, poorer oral health and suffer from malnutrition. But also children who grow up in poverty are, as adults, more likely to experience addictions, mental health difficulties, physical disabilities and premature death. Children who experience poverty are also less likely to graduate from high school and more likely to live in poverty as adults. 4. People living in poverty face more barriers to access and care. It has been found that Canadians with a lower income are more likely to report that they have not received needed health care in the past 12 months. Also, Canadians in the lowest income groups are 50 per cent less likely than those in the highest income group to see a specialist, and 40 per cent more likely to wait more than five days for a doctor's appointment. They are also twice as likely as higher-income Canadians to visit the emergency department for treatment. Researchers have reported that Canadians in the lowest income groups are three times less likely to fill prescriptions and 60 per cent less able to get needed tests because of costs.

5. There is a profound two-way relationship between poverty and health. People with limited access to income are often more socially isolated, experience more stress, have poorer mental and physical health and fewer opportunities for early childhood development and post-secondary education. In the reverse, it has been found that chronic conditions, especially those that limit a person's ability to maintain viable stable employment, can contribute to a downwards spiral into poverty. Studies show the former people living in poverty experiencing poor health occurs more frequently than poor health causing poverty.

As we approach the October election, Canadians ought to remember that poverty, health and the economy are inextricably linked issues. We ignore those links at our peril. Carolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation in Winnipeg.

The expert panel steered clear of making recommendations on structural problems, but acknowledged that the current structure is not working. That was a reference to the province's 14 CCACs and 15 local health integration networks (LHINs). CCACs co-ordinate home and community care for 700,000 clients, and LHINs plan and integrate health and community services. CCACs have been criticized for cutting client care when they are running deficits and for providing varying levels of service across the province. NDP health critic France Gelinas said the report validates concerns she has long been raising in question period. Conservative deputy health critic Bill Walker said he hopes the government adopts the recommendations as soon as possible. Health Minister Eric Hoskins said the recommendations will serve as an important guide, "as we improve and transform the home and community care sector."

Natalie Mehra, executive director of the Ontario Health Coalition, said she is concerned that a recommendation calling for LHINs to select a lead agency to design and co-ordinate delivery of services could lead to more privatization of health care. Earlier this week, the coalition released a scathing report on the state of home care in the province. Toronto resident Tracey MacMaster said changes are desperately needed. She believes that insufficient home care was one of the reasons her elderly mother suffered a stroke last August. Her mother lived alone in Burlington and was not eating properly and was not able to properly care for herself, said MacMaster, explaining that she had to make a big fuss with the CCAC and wait three months just to get her mother one hour of care a week.

Across Ontario, 44 clinics have fallen short of basic standards in just three years, according to CPSO inspections. Meanwhile, the number of private clinics has skyrocketed by 31 percent since 2010 under this Liberal government. At least 20 patients in Ontario have contracted serious infections at these private health clinics.

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.

the college will not name clinics that have failed in the past, no matter how serious the infraction