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Govind Rao

Does Ontario have too many under-regulated health workers? - Healthy Debate - 0 views

healthydebate.ca/...health-professional-regulation

from heather regulation Ontario psw care aide

shared by Govind Rao on 05 Apr 16 - No Cached
  • by Wendy Glauser, Mike Tierney & Michael Nolan (Show all posts by Wendy Glauser, Mike Tierney & Michael Nolan) March 31, 2016
  • In recent years, various health care professions have called for better regulation – including paramedics, personal support workers, physician assistants and others. Inadequate regulation has led to confusion that can put the public at risk, representatives of the professions say.
  • For many paramedics in Ontario, the Emergency Health Services Branch of the Ministry of Health sets the rules around how paramedics transport people and provide basic care like managing wounds, while base hospitals delegate more advanced care activities like administering medications and inserting breathing tubes.
  • ...10 more annotations...
  • Other non-RHPA occupations have less oversight. Personal support workers, who provide services including assisting with bathing, helping patients adhere to their medications and other tasks in the home, don’t have any provincial body to monitor their training or to ensure they’re practising appropriately, explains Miranda Ferrier, president of the Ontario Personal Support Worker Association (OPSWA).
  • these doctors tend to err on the side of under-delegation, knowing that if something goes wrong, they’ll be held accountable.
  • A personal support worker could be fired because of an accusation of abuse or neglect and they can literally get up and walk down the street and get hired by another agency and they wouldn’t know anything about it,” says Ferrier.
  • The OPSWA conducts a national criminal record and credential check for the 16,000 PSWs registered with them, but registration is voluntary. There are over 80,000 PSWs in the province who haven’t registered with OPSWA, Ferrier explains. “We would like to see one curriculum for all PSWs,” she says. “There should be expectations upon them for retraining and we should have the ability to blacklist ones that get charged with abuse.”
  • however. Chinese medicine practitioners were granted self regulating status in 2013 and naturopaths in 2015 – but not without controversy.
  • The problem is that not just in Ontario but broadly, in Canada, we’ve defined regulation in health care as self regulation and other countries don’t do that.”
  • UK and Australia
  • government oversight
  • New legislation should also allow smaller professions that can’t afford to maintain an RHPA-defined College to have title protection, says Grosso. And the voluntary oversight the professions currently do recognized legally, she adds. “When it comes to public protection, size should not matter,” says Grosso. 
  • Alberta’s government has overseen the development of a College of Paramedics,
Irene Jansen

PSW Final Report September 2006 Ontario - 0 views

www.ocsa.on.ca/...PSW-FinalReportSept27-06.pdf

regulation unregulated workers ontario fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Regulation 1. HPRAC recommends that Personal Support Workers not be regulated under the Regulated Health Professions Act, 1991 as they do not meet the requirements for regulation. 2. HPRAC recommends that a Registry for Personal Support Workers not be req
Irene Jansen

CBC.ca | White Coat, Black Art | Unfinished Business Show - 0 views

www.cbc.ca/...unfinished-business-show-1

care aide retirement homes regulation ltc ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • we have reaction from Ontario's Minister of Health and Long Term Care to our season debut episode on personal support workers and the work they do at retirement homes in the Province of Ontario
  • personal support workers or PSWs, the subject of our full edition season debut episode back in September
  • unlike nursing homes, retirement homes operate in a regulatory grey zone.  And it's at these retirement homes where we found PSWs who say they're expected to perform duties they aren't qualified to do, like injecting insulin or administering narcotics.
  • ...4 more annotations...
  • We played some of Jen's interview to Deb Mathews, Ontario Minister of Health and Long Term Care. 
  • "That is a very troubling clip you just played for me," Mathews told WCBA.  "No health care worker should ever be put into a position where they feel that they're compromising the health and safety of their patients or their own personal safety."
  • As for the operators of retirement homes that compel PSWs to perform nursing duties that they may not be qualified to perform? "Well, I would say that they're taking a very big risk," she added.  "They really should not be supporting a practice that isn't safe."
  • But if retirement homes are taking a big risk, as the Minister puts it, it's a risk that exists in part because retirement homes aren't regulated nearly as strictly as long term care facilities.  And that won't be changing any time soon.  In terms of regulations, a retirement home is little different from your own home.  
  • Irene Jansen on 23 Jan 12
     
    The story on PSWs and interview with Deb Mathews runs from minute 1:34 to minute 9:28. Mathews: I would say to the operators "they are taking a very big risk and they really should not be supporting a practice that isn't safe - they have to take that responsibility very seriously" I'm asking PSWs to "please stand up and report this". The scope of practice for PSWs is not as clear as it ought to be ... this is why we're establishing the PSW registry. It will allow us to see the training and experience of PSW - this information will be available to the public. My expertise is long-term care homes. Very high standards there. Retirement homes in Ontario are different - wide range of people. They do not fall under the Ministry of Health. Dr. Goldman: Why not regulate retirement homes? Mathews: Because they serve a very different function - e.g. for people who are very healthy but would like to have for example their meals prepared for them. They are not health care facilities the way long term care homes are. A retirement home is a home. We really do want to offer choice to people. The retirement homes determine when a person needs care they can't provide. Dr. Goldman: Regulation of PSWs?  Mathews: I don't see it any time soon. We are working with our training colleges and universities on a common curriculum. Until we have that standard training and established scope of practice, we can't take them the next step to make them a regulated health care professional.
Irene Jansen

CBC.ca | White Coat, Black Art | WCBA Season Debut: Personal Support Workers and Seniors - 0 views

www.cbc.ca/...al-support-workers-and-seniors

retirement homes care aide regulation ltc ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • today, more and more seniors are being cared for by largely unregulated health care workers.  The workers go by different names in different parts of the country.  BC, Saskatchewan, New Brunswick and Newfoundland call them Home Support Workers.  In Alberta and Quebec, they're known as Health Care Aides.  Canada's largest province calls them Personal Support Workers or PSWs
  • click below to listen right now or download the podcast: 
  • Some of these care providers work in hospitals, but the majority are employed by long-term care facilities and home care agencies. They also provide much of the care given to seniors at more than 650 privately-operated and largely unregulated retirement homes across Ontario.  These residences may also be known as assisted living as well as care homes. 
  • ...26 more annotations...
  • It is at places like these that PSWs say they're expected to perform duties that go beyond their training and their scope of practice. The PSWs we spoke to are concerned that performing those duties may put their professional well-being and the safety or residents at risk. 
  • There are no national standards for PSW training programs. 
  • Health Canada estimates that there are 100,000 PSWs working in Ontario alone.
  • In Ontario, community colleges, private career colleges, Boards of Education, and Not-for-Profit training organizations operate PSW schools.  The courses - which range between 600 and nearly 800 hours in length - include theory plus supervised practical work experience.
  • PSWs can assist clients to take their own medications.  That means they may help seniors open pill bottles and blister packs.  According to PSW training, what they shouldn't do is measure medications and administer them to seniors. 
  • Increasingly, they're being asked to that and more.
  • "We actually do wound care as well."
  • "When I started, it was another PSW that was on duty that was training me to do everything."
  • Natrice Rese is a retired PSW who speaks for the Ontario Personal Support Worker Association (OPSWA).
  • We're being pushed beyond what our training is, and we're being told if we don't like it, we can leave."
  • "It was written in the book.  If levels are between this and that, you dose that."
  • it's not illegal for PSWs to perform duties like injecting insulin or administering narcotics at retirement homes.  But the rules governing what PSWs like Jen and Brenda can do at retirement homes are unclear and open to disagreement.
  • "When a mistake happens, then it's the PSW's head that rolls,"
  • "Everybody that works there is burning out and it's getting pretty scary," says Jen.
  • In 2010, the Ontario Government passed the Retirement Homes Act.  It requires that the people licensed in the province to run retirement homes ensure all the staff employed there have the proper skills and qualifications to perform their duties and that they possess the prescribed qualifications.  However, the Act does not give specifics on what duties PSWs can and cannot perform.
  • the laws that regulate health professionals do permit PSWs to perform some of these nursing-type duties provided they are part of the resident's routine activities of living
  • For example, it's probably okay for a PSW to inject the same dose of insulin each day to a resident with well-controlled diabetes because that's part of the resident's daily routine.  But, it would not be permissible to inject insulin where the dose needs to be adjusted frequently.
  • permission for the PSW to perform a nursing duty under 'exception' provisions must be granted for each resident
  • Paul Williams, a health policy expert at the University of Toronto says little is known about what kind of medical care is delivered at retirement homes.
  • Williams was part of an expert panel set up by the Ontario Government to consider how to regulate retirement homes.  He says he sees little appetite for tight regulation of retirement homes.
  • "If we start to regulate, if we put in quality improvement stuff, if we start to accredit along recognized lines, you're going to push the cost up,"
  • As for regulating PSWs like the provinces do nurses and physicians, Williams says that's just as unlikely.
  • When you professionalize a group, you take responsibility for what they do.
  • "Maybe there's a disincentive to governments to regulate PSWs because quite frankly, it will probably cost you more money.  You can't pay twelve dollars an hour (a typical wage for PSWs) to someone who is professionally regulated."
  • Last year, BC became the first province to set up a registry of PSWs, known there as care aides and community health workers.  The registry sets province-wide training standards and ensures a fair process for investigating complaints against front line workers.  Earlier this year, Ontario announced plans to set up its own PSW registry.
  • The issue of who does what while caring for your loved ones will undoubtedly grow in the years ahead.  Given our aging population, would-be residents of retirement homes are increasingly likely to be frail seniors with dementia who require complex medical care.  They will need skilled, competent and well-educated professionals to meet their medical needs. 
Irene Jansen

HEU submission on LPN regulation Jan 8 2013 - 0 views

www.heu.org/...akes-submission-lpn-regulation

from heather bc cupe pn regulation scope

shared by Irene Jansen on 22 Jan 13 - No Cached
  • In response to proposed changes to the regulation that governs the LPN profession that were announced this fall, HEU made a submission on December 21 to the B.C. Ministry of Health. 
  • government’s proposed changes to the regulation currently governing LPN practice – while containing some advancements – also has the potential to set back LPN practice
  • the regulation moves away from LPNs being under the direct supervision of an RN, to a “restricted activities” model
  • ...1 more annotation...
  • the proposed new regulation does not reflect the full scope of current LPN practice and competencies, and could negatively impact LPN utilization
Cheryl Stadnichuk

Medical regulators in every province impose safeguards for assisted dying - The Globe a... - 0 views

www.theglobeandmail.com/...article30134608

physician-assisted-dying canada

shared by Cheryl Stadnichuk on 25 May 16 - No Cached
  • Medical regulators in every province have issued detailed guidelines doctors must follow to help suffering patients end their lives once Canada’s ban on medically assisted dying is formally lifted next month.And most of those guidelines impose safeguards similar to — or even more stringent than — those included in the federal government’s proposed new law on assisted death. The existence of guidelines in every province undercuts federal Justice Minister Jody Wilson-Raybould’s contention that there’ll be a dangerous legal void if the government’s controversial new law on assisted dying isn’t enacted by June 6.
  • Like the proposed federal law, most of the various guidelines produced by provincial colleges of physicians and surgeons require that at least two doctors must agree that a patient meets the eligibility criteria for an assisted death, that a patient must submit a written request signed by witnesses, that there be a waiting period between the request and the provision of an assisted death, that a patient must be competent to give free, informed consent throughout the process, up to the time of dying.Some impose more stringent safeguards, for instance putting the age of consent at 19 rather than the federally proposed 18, and requiring a psychiatric assessment in cases where depression or mental illness might impair a patient’s ability to give consent.The one big difference, said Paterson, is that the provincial guidelines rely on the relatively permissive eligibility criteria spelled out by the Supreme Court whereas the federal government is proposing more restrictive conditions.
  • Yet the federal government has all but ignored the wishes of medical regulators and the guidelines they’ve produced, citing instead approval of its proposed law by the Canadian Medical Association, which lobbies on behalf of doctors but does not regulate, license or discipline them.“I’m not sure that the federal government generally ... has a good understanding about the role of medical regulators and our powers and our authority and our ability to regulate our professions,” said Theman.“So it may be that they see a void (if the legislation isn’t enacted by June 6) because they’re not used to dealing with us and they’re less aware of what we’re capable of.”
Irene Jansen

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
Govind Rao

Ottawa trans man files Charter challenge - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150509|220128665

from heather equity gender court

shared by Govind Rao on 11 May 15 - No Cached
  • The Globe and Mail Sat May 9 2015
  • An Ottawa trans man who paid out of pocket for a double mastectomy has launched a Charter challenge against the Ontario government, arguing that a law that forces trans people to obtain approvals for sex-reassignment surgery from one overburdened Toronto clinic is a violation of his rights. A notice of application filed in the Ontario Superior Court on Friday asks the court to strike down a Health Insurance Act regulation that says trans people can obtain public funding for their sex reassignment surgeries only if they first get the goahead from the Adult Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH).
  • As of last month, there were 680 people waiting for appointments at the clinic, the vast majority of them seeking consent for publicly insured sex-change operations. Wait times are now approaching two years and the demand for the procedure is growing. "I think that by forcing people to travel halfway across the [province] to do an interview process to allow them access to health care that everyone should have automatically, it's an unfair process," said Chrystofer Maillet, the 35-year-old federal government employee who is hoping to strike down the regulation. "It just seems like we're making it a whole lot harder for anyone to just be themselves."
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  • Mr. Maillet's lawyer, Tim Gleason, plans to argue that the regulation violates his client's right to life, liberty and security of the person, and his equality rights, both of which are guarded by the Canadian Charter of Rights and Freedoms. "This regulation, in my view, is a relic," Mr. Gleason said. "It's a relic of a past that's rooted in ignorance and bigotry. This regulation treats transgender people differently than other people, exclusively on the basis of their gender or their sex ... it can't be justified." The Globe and Mail reported last month on the case of Mr. Maillet, who decided to extend his line of credit to cover the $7,401.50 cost of a double mastectomy he underwent on March 3, 2013.
  • The alternative - waiting months or possibly years just to be seen at CAMH - was not something he felt he could endure. "The applicant's wait for [sexreassignment surgery] during his transition caused serious suffering and hardship," the court application reads. "During this period, the applicant was isolated and suffered extreme depression." Nine months after his surgery, Mr. Maillet secured an appointment at CAMH and a retroactive approval from the clinic. But the Ontario Health Insurance Plan, and a quasi-judicial panel that reviews OHIP rejections, refused Mr. Maillet's claim because the regulation clearly states patients must obtain approval before, not after, their procedures. Ontario Health Minister Eric Hoskins said last month that his ministry is already looking into the possibility of expanding the number of sites that can approve sex-reassignment surgeries. He said he hoped to be able to move on the issue in the "near future." In the meantime, Mr. Maillet is hoping that his court case will eventually make accessing health services easier for other trans people in the future.
Doug Allan

New calls for regulation of patient transfer companies; Ontarians need reassurance that... - 1 views

www.fpinfomart.ca/...165583828

EMS

shared by Doug Allan on 09 Apr 13 - No Cached
  • "We have to regulate this business and the sooner the better," Ontario NDP health critic France Gélinas said Monday. "What we have now is more than a disaster waiting to happen.
  • Calls for regulation of the patient transfer business have been issued regularly since the industry appeared in the mid-1990s. Among the changes introduced then by the Mike Harris government was to ban the use of ambulances for routine transfers, giving rise to a new industry of private operators who claimed they could do the work at far lower costs.
  • Doug Allan on 09 Apr 13
     
    Patient transfer regulation coming, says Minister Matthews
Govind Rao

Physician Assistant regulation: can nurses' unions have it both ways? - Healthy Debate - 0 views

healthydebate.ca/...urses-unions-have-it-both-ways

from heather doctors staffing regulation

shared by Govind Rao on 06 Feb 14 - No Cached
  • by Maureen Taylor (Show all posts by Maureen Taylor) January 27, 2014
  • Physician Assistants are “handmaids” to doctors. PAs were “created by physicians” who were frustrated that nurses no longer tolerate being ordered around by MDs. And that’s just a taste of the negative reaction from some nurses to a recent Healthy Debate article on integration of physician assistants in Canada. I found it disheartening, but not entirely surprising that nurses left these comments. Doris Grinspun, the executive director of the Registered Nurses Association of Ontario, once told CBC News, “I would say to my family, friends, colleagues, to the public: don’t let (PAs) touch you. Make sure to ask who is taking care of you.”
  • Since their introduction in Ontario in 2006, nursing and midwife unions have argued that PAs are unsafe because they are an unregulated profession,
  • ...5 more annotations...
  • This put nursing groups in an awkward position. After saying publicly for years that PAs are a danger to patients because they are unregulated, now they would have to make the opposite case: that regulating PAs is unnecessary because there is no evidence they have harmed the public.
  • HPRAC, and the Minister of Health agreed with the RNAO. PAs, said HPRAC’s report, do not pose sufficient harm to patients to require regulation, although as their numbers grow, that may change.
  • What’s really broken is the relationship between physicians and nurses, at least at the organizational level. PAs, whose practice of medicine depends entirely on collaborating and consulting with physicians, are just collateral damage in a century-old war.
  • There are signs that in the US, where PAs are one of the fastest-growing professions and in high demand, some PAs want to break out of their “assistant” shackles to practice more autonomously, which many of them already do in underserviced areas where physicians choose not to practice.
  • Maureen Taylor is a Physician Assistan
Govind Rao

Health Canada should regulate hospital pharmacies CBC - 0 views

www.cbc.ca/...ugs-expert-review-results.html

from heather hospital drugs

shared by Govind Rao on 07 Aug 13 - No Cached
  • Govind Rao on 07 Aug 13
     
    Health Canada should regulate hospital pharmacies, study finds Ontario wants College of Pharmacists to inspect, license hospital pharmacies The Canadian Press Posted: Aug 7, 2013 6:57 AM ET Last Updated: Aug 7, 2013 3:20 PM ET Health Canada should regulate all entities that mix drugs outside a licensed pharmacy, an expert that looked into the chemotherapy drug scare that rocked two provinces recommended Wednesday. It also urged Ontario to bring in stronger rules for licensed pharmacies, by inspecting and licensing those in the province's clinics and hospitals as well as pharmacies that prepare large volumes of drug mixtures. The recommendations come four months after it was discovered that 1,202 patients in Ontario and New Brunswick - including 40 children - received diluted chemo drugs, some for as long as a year.
Govind Rao

Health Professions Regulatory Advisory Council (HPRAC) - Diagnostic Sonographers - 0 views

www.hprac.org/...Diagnostic_Sonographers.asp

from heather regulation Ontario

shared by Govind Rao on 19 Nov 13 - No Cached
  • Regulation of Diagnostic Sonography under the Regulated Health Professions Act, 1991  The Minister's Question On March 26, 2010, the Minister of Health and Long-Term Care, the Hon. Deb Matthews directed HPRAC to reference a previous HPRAC report and "make recommendations on the currency of, and any additions to, advice provided in relation to the regulation of Diagnostic Sonographers". On May 7, 2013, the Minister noted that there may be additional considerations related to the regulation of the profession; and further directed HPRAC to "conduct a broad public consultation with key groups and stakeholders within the diagnostic sonographer community who may not have been included in the original review." The minister extended the timeline for this referral and requested that HPRAC submit its advice by June 30, 2014.
Doug Allan

Hospitals and care homes that fail to provide basic care will face prosecution, says UK... - 0 views

www.bmj.com/bmj.f5850

hospital quality

shared by Doug Allan on 28 Sep 13 - No Cached
  • The performance of hospitals and care homes is to be subject to a new tier of inspection criteria that will include basic standards of care, such as whether an individual has been given adequate food and drink, a senior adviser at the Care Quality Commission has said.
  • Alan Rosenbach, special policy adviser at the CQC, said that providers that fail to deliver the basics will be fast tracked to prosecution under new powers awarded to the regulator. The new powers will include the ability to place providers into a “quality failure regime.”
  • the government wanted the regulator to include basic elements of care in its inspection regime.
  • ...5 more annotations...
  • 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.
  • Doug Allan on 28 Sep 13
     
    British hospital regulator -- the Care Quality Commission --  to expand inspection criteria.  Will include basic standards of care -- food, cleaning, hydration. "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."
Irene Jansen

PSW Registry Consultation - July 2011 | Canadian Auto Workers | CAW - 0 views

www.caw.ca/10455.htm

care aide union ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    It is troubling that the purpose of establishing a registry is apparently not yet defined given the clear central recommendation of the HPRAC in 2006 to theMinister that Personal SupportWorker should not be regulated as a profession under the RHPA. The HPRAC report also concluded that the closest alternate form of regulation - a PSW Registry - should not be implemented. We have reproduced these recommendations below:
Irene Jansen

CCPNR-The Canadian Council for Practical Nurse Regulators - 0 views

www.ccpnr.ca

regulation canada pn

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The Canadian Council for Practical Nurse Regulators (CCPNR) / Conseil canadien de réglementation des soins infirmiers auxiliaires (CCRSIA) is a federation of provincial and territorial members identified in legislation responsible for the safety of the public through the regulation of Licensed/Registered Practical Nurses.
Irene Jansen

Gone Without a Case: Suspicious Elder Deaths Rarely Investigated - ProPublica - 0 views

www.propublica.org/...der-deaths-rarely-investigated

abuse ltc us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dec. 21, 2011
  • When investigators reviewed Shepter's medical records, they determined that he had actually died of a combination of ailments often related to poor care, including an infected ulcer, pneumonia, dehydration and sepsis.
  • Prosecutors in 2009 charged Pormir and two former colleagues with killing Shepter and two other elderly residents. They've pleaded not guilty. The criminal case is ongoing. Health-care regulators have already taken action, severely restricting the doctor's medical license. The federal government has fined the home nearly $150,000.
  • ...31 more annotations...
  • Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities.
  • For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices [1], which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.
  • If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate.
  • "a hidden national scandal."
  • Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities.
  • In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.
  • Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis [2] found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.
  • "father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      Staff were more likely caring for dozens of other patients, run off their feet. See pp. 38-40 of CUPE's Our Vision for Better Seniors Care http://cupe.ca/privatization-watch-february-2010/our-vision-research-paper
  • "We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."
  • A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.
  • Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.
  • State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so
  • there has to be a professional, independent review process
  • a public, 74-bed facility
  • As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses.
  • Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.
  • Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.
  • Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.
  • Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.
  • Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.
  • "Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."
  • "Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."
  • a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.
  • "It was a horrible place,"
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      This facility was for-profit, owned by Riley's Corporation. See CUPE Our Vision pp. 52-55 for evidence on the link between for-profit ownership and lower quality of care.
  • investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores
  • prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.
  • Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases
  • They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.
  • A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."
  • staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!!  Better staffing, better care, everyone wins.
  • Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money.
Govind Rao

August 14, 2013Health Canada should license companies that mix drugs, says report CMAJ - 0 views

www.cmaj.ca/...at_mix_drugs_says_report.xhtml

from heather drugs

shared by Govind Rao on 14 Aug 13 - No Cached
  • Govind Rao on 14 Aug 13
     
    Health Canada should regulate businesses that mix drugs outside of licensed pharmacies, recommends an expert who investigated why 1202 patients, including 40 children, in Ontario and New Brunswick received diluted chemotherapy drugs between February 2012 and March of this year. In the Ontario government-commissioned report, "A Review of the Oncology Under-Dosing Incident," Jake Thiessen, founding director of the School of Pharmacy at the University of Waterloo, Ont., makes 12 recommendations to clarify who regulates what and to improve the supply chain that hospitals use to procure drugs."The entire incident was preventable," he writes in the report.
Govind Rao

Regulated health professionals in hospitals OHA - 0 views

www.oha.com/...EventDetail.aspx

from heather Ontario conference hospital nursing regulation

shared by Govind Rao on 29 Nov 13 - No Cached
  • Regulated health professions are required by law to deliver competent, ethical and professional services, and are accountable to the public through their respective colleges for their professional behaviour and activities.
  • Fee: $515 + HST
  • Event Date: 2014/01/27
  • ...2 more annotations...
  • Location: Radisson Admiral Hotel Toronto-Harbourfront 249 Queen’s Quay West Toronto, Ontario
  • Legal Issues for Regulated Health Care Professionals Working in Hospitals
Govind Rao

Regulating Care Studies in Political Economy Vol 95 (2015) - 0 views

spe.library.utoronto.ca/...showToc

from heather ltc regulation quality equity privatization

shared by Govind Rao on 22 Jun 15 - No Cached
  • Vol 95 (2015)Regulating Care
  • Forum: Regulating Care
  • Govind Rao on 22 Jun 15
     
    thanks to Doug Allan
Govind Rao

Supply of nurses in Canada declines for first time in 2 decades | CIHI - 0 views

www.cihi.ca/...ada-declines-for-first-time-in

from heather nursing nurses research staffing

shared by Govind Rao on 01 Sep 15 - No Cached
  • June 23, 2015 — For the first time in 2 decades, more regulated nurses left their profession than entered it, according to a recent report from the Canadian Institute for Health Information (CIHI). Fewer of these professionals — which include registered nurses (RNs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs) — applied for registration, while more chose not to renew their registration due to factors such as retirement, a new career path or a move outside Canada. Regulated Nurses, 2014 reveals that while growth in the regulated nursing workforce (those working in the profession) has remained stable over the last 10 years, the supply of regulated nurses (the broader group of nurses who are eligible to work) dropped 0.3% in 2014 from the previous year. Specifically, the supply of RNs declined 1.0%, mitigating reduced growth among LPNs and RPNs.
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