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Reports of assaults on nurses on the rise; Union demands measures to counter violence '... - 0 views

shared by Govind Rao on 06 Jul 15 - No Cached

Toronto Star Thu Jul 2 2015
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A nurse is punched in the face by a patient. Another is kicked in the breast. One patient calls a nurse a "Nazi b---h." Another throws urine.
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One man fondles his genitals in front of a hospital staffer. Another spits in a nurse's face. These are all incidents of assault that hospital staff reported in 2014 at University Health Network (UHN), according to information obtained by the Star through an Access to Information request. Over the past three years, reports of violence on hospital staff by patients and families of patients have been on the rise - in some cases doubling, according to information provided to the Star. In an email to the Star, a UHN spokesperson said the increases are probably the result of changing violent-incident reporting requirements. There are similar increases in violent incidents reported at other Toronto-area hospitals, statistics show.
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The numbers underscore the need for improvements to hospital staff safety measures, something the Ontario Nurses' Association (ONA) has long been calling for to better protect health-care providers. "Violence isn't part of this job. It shouldn't be part of this job," said Andy Summers, vice-president of health and safety with ONA. "Eventually, somebody will get killed."
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Summers called the current situation of violence against nurses in Ontario "completely unacceptable." At UHN, which includes Toronto General Hospital and Toronto Western Hospital, there has been a consistent increase in reports of assault in the past three years. The number of reported violent incidents doubled in two years, jumping from 166 incidents in 2012 to 331 in 2014, according to data provided to the Star. In 2014, 11 workers who were injured were unable to return to work for their shift following the assault. Spokeswoman Gillian Howard said changes in reporting standards probably account for the rise. The changes include a Behaviour Safety Alert, implemented at UHN in 2014, which requires staff to put an alert on patient records if the patient has aggressive or violent behaviour. Howard also said increased reporting could be attributed to the fact that unions are encouraging staff to report every incident: "a very good thing," she said.
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"We do not want any staff member at risk from a patient, but given the care we provide, the medications used, the fact that some patients have cognitive impairment as a result of injury or aging, the impairment of some patients when they arrive, and the risks associated with some of the treatments, it is not likely that we will see a year with no incidents," said Howard, adding that UHN employs approximately 13,000 staff and has over one million patient visits per year. But ONA lashed out at this explanation, saying employers are trying to downplay the issue.
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Erna Bujna, occupational health and safety specialist with ONA, said some employers "absolutely" still discourage staff from reporting incidents, by telling workers that violence is just part of the job. ONA wants to see a violence strategy implemented at hospitals across the province. The strategy would include mandatory reporting of every violent incident reported to the Ministry of Labour - currently, employers are only required to report fatalities and critical incidents to the ministry - mandatory risk assessment of every patient, increased security and more health-care providers hired. They also want the Ministry to charge individual hospital CEOs when workers are not adequately protected from violence.
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He added that legislation requires employers to assess the risks of workplace violence, create workplace violence and harassment policies, develop programs to implement those policies, and take every precaution reasonable to protect workers from workplace violence. ONA's call for an updated safety strategy comes on the heels of a decision by the Ministry of Labour to lay charges against Toronto's Centre for Addiction and Mental Health (CAMH) in December 2014. The charges - made under the Occupational Health and Safety Act and relating to failure to protect workers from workplace violence - stem from a violent incident in January 2014 in which a nurse was dragged, kicked and beaten beyond recognition, according to ONA.
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Toronto police later charged the patient, who was found guilty of assault causing bodily harm, according to court documents. "We don't want staff ever to feel that aggression is the norm," said Rani Srivastava, chief of nursing and professional practice at CAMH, in response to the comments. "We are committed to a culture of safety and recovery and that means safety for staff and patients." Jean Dobson, a nurse at University Hospital in London, Ont., said she's been strangled with a stethoscope, stabbed with a metal fork and spat at by patients over the course of her 42-year career. "People think that they can hurt a nurse and that's OK," she said. "We have to smile and take it."
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In one incident, Dobson had her nose broken when she was kicked in the face by a patient. She was forced off work for weeks and suffered from PTSD, she said. Dobson said she's seen the frequency of patient-on-nurse assaults and the severity of violence increase during her career. At Sunnybrook Hospital, reports of abuse against staff by patients and visitors jumped from 140 in 2012 to 320 in 2013. The hospital attributes the increase mainly to their move to electronic reporting, which makes it easier to record violent incidents, a spokesperson told the Star. According to a 2005 national study from Statistics Canada, 34 per cent of nurses surveyed reported being physically assaulted by a patient in the previous year, and 47 per cent reported experiencing emotional abuse. For those working in psychiatric and mental-health settings, 70 per cent of nurses reported experiencing emotional abuse.
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Senate Social Affairs Committee review of the health accord- Evidence - March 10, 2011 - 0 views

www.parl.gc.ca/...22evb-e.htm accord senate

shared by Irene Jansen on 23 Jan 12 - No Cached

Dr. Jack Kitts, Chair, Health Council of Canada
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In 2008, we released a progress report on all the commitments in the 2003 Accord on Health Care Renewal, and the 10-year plan to strengthen health care. We found much to celebrate and much that fell short of what could and should have been achieved. This spring, three years later, we will be releasing a follow-up report on five of the health accord commitments.
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We have made progress on wait times because governments set targets and provided the funding to tackle them. Buoyed by success in the initial five priority areas, governments have moved to address other wait times now. For example, in response to the Patients First review, the Saskatchewan government has promised that by 2014, no patient will wait longer than three months for any surgery. Wait times are a good example that progress can be made and sustained when health care leaders develop an action plan and stick with it.
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Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.
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only 32 per cent of Canadians had access to more than one primary health care provider
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In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.
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We believe that jurisdictions are now turning the corner on primary health care
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Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.
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The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.
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Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.
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there have also been improvements on our capacity to collect, interpret and use health information
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Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.
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John Wright, President and CEO, Canadian Institute for Health Information
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While much of the progress since the 10-year plan has been generated by individual jurisdictions, real progress lies in having all governments work together in the interest of all Canadians.
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the Canada Health Act
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Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.
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We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.
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John Abbott, Chief Executive Officer, Health Council of Canada
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I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.
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Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.
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The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.
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We have a very good working relationship with the jurisdictions, and that has improved over time.
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One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.
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As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.
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each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.
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there has been progress. In some cases, there has been much more than in others.
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How many government programs have been created as a result of the accord?
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The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.
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I am a director of the foundation of St. Michael's Hospital in Toronto
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Not everyone needs to have a family doctor; they need access to a family health team.
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With all the family doctors we have now after a 47-per-cent-increase in medical school enrolment, we just need to change the way we do it.
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The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.
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The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.
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At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.
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The family health care team should have strong family physicians who are focused on diagnosing, treating and controlling chronic disease. They should not have to deal with promotion, prevention and diet. Other health providers should provide all of that care and family doctors should get back to focus.
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I have to be able to reach my doctor by phone.
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They are busy doing all of the other things that, in my mind, can be done well by a team.
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That is right.
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if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."
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We want to share best practices.
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it is not likely to happen without strong direction from above
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Excellent Care for All Act
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quality plans
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with actual strategies, investments, tactics, targets and outcomes around a number of things
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Canadian Hospital Reporting Project
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by March of next year we hope to make it public
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performance, outcomes, quality and financials
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With respect to physicians, it is a different story
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We do not collect data on outcomes associated with treatments.
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which may not always be the most cost effective and have the better outcome.
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We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.
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Substantive change in how we deliver health care will only be realized to its full extent when we are able to measure the cost and outcome at the individual patient and the individual physician levels.
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In the absence of that, medicine remains very much an art.
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Senator Eaton
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There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.
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The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.
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universal screening
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A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.
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For the vast majority of quality benchmarks, we do not have the evidence.
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A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.
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We have to be careful when we start implementing best practices because if they are not based on evidence and outcomes, we might do more harm than good.
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The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is
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If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?
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Senator Cordy: Private diagnostic imaging clinics are springing up across all provinces; and public reaction is favourable. The public in Nova Scotia have accepted that if you want an MRI the next day, they will have to pay $500 at a private clinic. It was part of the accord, but it seems to be the area where we are veering into two-tiered health care.
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colorectal screening
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the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider
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adverse drug effects
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over-prescribing
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There are no drugs without a risk, but the benefits far outweigh the risks in most cases.
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catastrophic drug coverage
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a patchwork across the country
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with respect to wait times
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Having coordinated care for those people, those with chronic conditions and co-morbidity, is essential.
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The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.
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In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.
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We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.
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Have we made progress?
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I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.
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The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?
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In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.
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There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.
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The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.
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send him or her to the States
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Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?
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When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.
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Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?
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Dr. Kitts: We are without a leader.
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Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.
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You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.
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The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.
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There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.
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there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.
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The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.
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The question then came up about whether 50 per cent of the population is the appropriate target
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If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.
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The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.
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the national pharmaceutical strategy
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in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.
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The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.
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The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.
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Irene Jansen on 23 Jan 12

CIHI Health Canada Statistics Canada

<div class="cArrow"> </div><div class="cContentInner">CIHI Health Canada Statistics Canada</div>

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Health-care system in need of more transparency, report says | Toronto Star - 0 views

www.thestar.com/...d-in-health-system-report.html from heather quality privatization

shared by Govind Rao on 16 Nov 15 - No Cached

C.D. Howe Institute says there should be more public reporting on patient experience within Canada’s health-care system.
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Seniors health was a hot issue during the recent federal election. A recent C.D. Howe Institute report argues Canada's whole health care system needs greater transparency.
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By: Theresa Boyle Health, Published on Thu Nov 12 2015
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Canada’s health system is not transparent enough, says a new report that calls for more public reporting on patient experience, such as in instances when they are harmed. Consideration should be given to publicly reporting physician-level outcomes, such as death rates for patients of individual cardiac surgeons, states the report published Thursday by the C.D. Howe Institute. More collection and public disclosure are critical to creating better value for the health system, it says, urging the federal and provincial governments to pave the way. “From a democratic perspective, publicizing outcome measures can empower patients, families and communities to engage in the policy debate about which outcomes matter most and at what cost — and in the ways health care should be delivered,” says the report, titled “Canadian Health Care Needs a Checkup, Here’s How.”
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Health-care outcomes that could be measured and publicly reported include data about death, disease, disability, discomfort and dissatisfaction, it states. As well, there could be more transparency surrounding patient satisfaction and health-system responsiveness.
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“Public reporting of any individual physician or health-care provider has not shown to improve patient outcomes or satisfaction levels,” a statement from the OMA said. “Our health-care system is made better through the collection and reporting of accurate and meaningful data that physicians use to innovate how they deliver care.”
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Portrait of caregivers, 2012 - 1 views

www.statcan.gc.ca/...89-652-x2013001-eng.htm homecare

shared by Doug Allan on 28 Sep 13 - No Cached

Over one-quarter (28%), or an estimated 8.1 million Canadians aged 15 years and older provided care to a chronically ill, disabled, or aging family member or friend in the 12 months preceding the survey.
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While the majority of caregivers (57%) reported providing care to one person during the past 12 months, assisting more than one care receiver was not uncommon. In particular, 27% of caregivers reported caring for two and 15% for three or more family members or friends with a long-term illness, disability or aging needs.
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Providing care most often involved helping parents. In particular, about half (48%) of caregivers reported caring for their own parents or parents in-law over the past year (Table 1)
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In 2012, age-related needs were identified as the single most common problem requiring help from caregivers (28%) (Chart 1). This was followed by cancer (11%), cardio-vascular disease (9%), mental illness (7%), and Alzheimer’s disease and dementia (6%).
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The majority of caregivers reported providing transportation to their primary care receiver, making it the most frequent type of care provided in the last 12 months (73%)
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Most often, caregivers spent under 10 hours a week on caregiving duties. In particular, one-quarter of caregivers (26%) reported spending one hour or less per week caring for a family member or friend. Another 32% reported spending an average of 2 to 4 hours per week and 16% spent 5 to 9 hours per week on caregiving activities.  
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The most common types of care were not always the ones most likely to be performed on a regular basis (i.e., at least once a week). For instance, despite the fact that personal care and providing medical assistance were the least common forms of care, when they were performed, these tasks were most likely to be done more regularly.
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Emotional support often accompanied other help to the care receiver. Nearly nine in ten caregivers (88%) reported spending time with the person, talking with and listening to them, cheering them up or providing some other form of emotional support. Virtually all caregivers (96%) ensured that the ill or disabled family member or friend was okay, either by visiting or calling.
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Overall, caregivers spent a median of 3 hours a week caring for an ill or disabled family member or friend. This climbed to a median of 10 hours per week for caregivers assisting a child and 14 hours for those providing care to an ill spouse (Chart 3).
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In addition, about half of caregivers (51%) reported that they performed tasks inside the care recipients’ home in the last 12 months, such as preparing meals, cleaning, and laundry. Another 45% reported providing assistance with house maintenance or outdoor work.
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For some, caregiving was a large part of their life - equivalent to a full time job. Approximately one in ten caregivers were spending 30 or more hours a week providing some form of assistance to their ill family member or friend.  These caregivers were most likely caring for an ill spouse (31%) or child (29%).5
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The actual time spent performing tasks is often combined with time needed to travel to provide care. Approximately three-quarters (73%) of caregivers indicated that they did not live in the same household or building as their care receiver, meaning they often had to travel to reach the care recipients’ home. Just over half (52%), however, reported having to travel less than 30 minutes by car.  Roughly 12% of caregivers provided help to a family member who lived at least one hour away by car.
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Certain health conditions required more hours of care. This was the case for developmental disabilities or disorders, where 51% of these caregivers were spending at least 10 hours a week providing help
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Caregivers have multiple responsibilities beyond caring for their chronically ill, disabled or aging family member or friend. In 2012, 28% of caregivers could be considered “sandwiched” between caregiving and childrearing, having at least one child under 18 years living at home
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Four provinces had rates above the national average of 28%, including Ontario (29%), Nova Scotia (31%), Manitoba (33%) and Saskatchewan (34%) (Textbox Chart 1). The higher levels of caregiving in Ontario, Nova Scotia and Manitoba were largely related to caring for a loved one suffering from a chronic health condition or disability, whereas in Saskatchewan, the higher level of caregiving was attributed to aging needs. 
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Historically, caregivers have been disproportionally women (Cranswick and Dosman 2008). This was also true in 2012, when an estimated 54% of caregivers were women.
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Although the median number of caregiving hours was similar between men and women (3 and 4 hours per week, respectively), women were more likely than their male counterparts to spend 20 or more hours per week on caregiving tasks (17% versus 11%). Meanwhile, men were more likely than women to spend less than one hour per week providing care (29% versus 23%) (Chart 5).
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For instance, they were twice as likely as their male counterparts to provide personal care to the primary care receiver, including bathing and dressing (29% versus 13%).
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Caring for an ill or disabled family member or friend can span months or years. For the vast majority of caregivers (89%), their caregiving activities had been going on at least one year or longer, with half reporting they had been caring for a loved one for four years or more.
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The aging of the population, higher life expectancies and the shift in emphasis from institutionalized care to home care may suggest that more chronically ill, disabled and frail people are relying on help from family and friends than in the past. Using the GSS, it is possible to examine the changes in the number of caregivers aged 45 years and older, recognizing that methodological differences between survey cycles warrant caution when interpreting any results.
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Bearing in mind these caveats, results from the GSS show that between 2007 and 2012, the number of caregivers aged 45 and over increased by 760,000 to 4.5 million caregivers, representing a 20% increase in the number of caregivers over the five years.
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Having less time with children was an often cited outcome of providing care to a chronically ill, disabled, or aging family member or friend. About half (49%) of caregivers with children under 18 indicated that their caregiving responsibilities caused them to reduce the amount of time spent with their children.6
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Overall, the vast majority of caregivers (95%) indicated that they were effectively coping with their caregiving responsibilities, with only 5% reporting that they were not coping well.7 However, the feeling of being unable to cope grew with a greater number of hours of care. By the time caregivers were spending 20 or more hours per week on caregiving tasks, one in ten (10%) were not coping well.  
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In addition, while most were able to effectively manage their caregiving responsibilities, 28% found providing care somewhat or very stressful and 19% of caregivers indicated that their physical and emotional health suffered in the last 12 months as a result of their caregiving responsibilities.
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The health consequences of caregiving were even more pronounced when caregivers were asked specific questions on their health symptoms. Over half (55%) of caregivers felt worried or anxious as a result of their caregiving responsibilities, while about half (51%) felt tired during the past 12 months (Chart 8). Other common symptoms associated with providing care included feeling short-tempered or irritable (36%), feeling overwhelmed (35%) and having a disturbed sleep (34%).8
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The financial impacts related to caring for a loved one can be significant. Lost days at work may reduce household income, while out-of-pocket expenses, such as purchasing specialized aids or devices, transportation costs, and hiring professional help to assist with care, can be borne from caring for a loved one. In many cases, financial support, from either informal or formal sources, can ease the financial burden associated with caregiving responsibilities. Overall, about one in five caregivers (19%) were receiving some form of financial support. 
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Doug Allan on 28 Sep 13

Survey of care givers

<div class="cArrow"> </div><div class="cContentInner">Survey of care givers</div>

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Urgent need for home-care task force - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150927|230149517 from heather home care Ontario privatization

shared by Govind Rao on 28 Sep 15 - No Cached

Toronto Star Sun Sep 27 2015
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The audit was requested by the Ontario legislature's standing committee on public accounts in March 2014 after a series of news stories and columns in the Toronto Star in 2013 and early 2014 detailed the beleaguered state of the home-care system, particularly when it comes to the CCACs. The Star described how CCAC executives were getting massive pay raises despite the system being starved for money with patients suffering as their services and many front-line workers were overworked and without a wage increase in years. The auditor general's report comes six months after a report by the Liberal government's own expert panel, chaired by Gail Donner, a former dean of nursing at the University of Toronto that called for "urgent action" to fix the chaos in the system.
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Basically, her report described a troubling situation where Queen's Park champions the huge CCAC bureaucracy that costs too much money and does nothing very well. Among her findings was the stunning revelation that more than $900 million of the $2.4 billion that CCACs receive annually to deliver for home- and community-care services actually go for administration and overhead - not direct patient care.
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In fact, barely 62 cents of every $1 goes to actual direct patient care. For years, CCAC bosses have being boasting - falsely it turns out - that 92 cents of every dollar went to direct patient care. Lysyk's audit also found that barely half of the complex-needs patients discharged from hospitals receive the care they are supposed to get within 24 hours, often because CCAC nurses don't work on weekends or rarely after 5 p.m.
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In the wake of the latest major report that blasts the way Ontario looks after home care in this the province, it is time for Ontario Health Minister Eric Hoskins to take immediate action to fix a system that is clearly broken. The latest horror-filled report, released last week by auditor general Bonnie Lysyk, outlined a system that is utterly confusing, often mismanaged, lacking in oversight and filled with inconsistencies in how patients are treated. Lysyk took particular aim at the 14 Community Care Access Centres (CCACs), the publicly funded organizations that co-ordinate nursing, therapy and personal support services for patients outside of hospitals.
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Despite these two major reports and similar reports in years gone by, the Liberal government has done nothing to address the troubles within the CCACs. Now it's up to Hoskins to act boldly and quickly to fix the system.
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As a first step, Hoskins should immediately create a powerful task force that can review the CCACs and look for a better way of co-ordinating home-care in Ontario. Ultimately, that could mean scrapping the CCAC system, which as Lysyk's report finds, is simply not working. The task force should be composed of experts from all sectors of the health area, including representatives of hospitals, patient advocacy groups, nurses, therapists such as speech language pathologists, personal support workers, CCACs and the 14 Local Health Integration Networks (LHINs) that oversee and fund CCACs, hospitals and other community health services. Also, Hoskins should give the task force a short deadline to report its recommendations, ideally within six months. That's a tight schedule, but it should be possible given that so much investigation has been done over the last five years into the flaws in the system. One specific mandate that Hoskins should give the task force is to determine if all planning and monitoring roles for home care now performed by CCACs can be transferred to beefed-up LHINs.
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Also, the task force should study whether care co-ordination now handled by CCACs can be transferred to the primary-care sector. Hoskins, who has talked of wanting "bold and transformative change," has hinted broadly that he is willing to look in this direction. He has taken great efforts to point out the auditor's recommendation that the government revisit the current model of delivering home and community care. "We endorse this recommendation and see it as a catalyst not only to continue but to deepen our reform process," he said. The auditor general will release two more reports on home care in 2015, both to be included in her annual report to be filed likely in early December. One is on the CCAC's home-care program focusing on personal support services and the other on the performance of the 14 LHINs. But Hoskins doesn't need to wait for these reports before acting.
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The evidence that the home-care system is a mess and that the CCACs are a big reason for that sorry state is overwhelming. It's time for Hoskins to appoint a task force with a mandate to propose real reforms that will improve the lives of all Ontario patients who need treatment at home. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca
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In the News: Health Care Wait Times - What is the Real Story? - Ontario Health Coalition - 0 views

www.ontariohealthcoalition.ca/...t-times-what-is-the-real-story from heather coalition Ontario waits

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December 8, 2015
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By: Natalie Mehra, Executive Director, Ontario Health Coalition Today, a high-profile report tracking health care wait times was released from the Wait Times Alliance. Eliminating Code Gridlock in Canada’s Health Care System, is a credible summary and a useful addition to public policy decisions about health care planning. It is written by an alliance of physician specialists’ organizations to track progress in wait times and public reporting.
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Fraser Institute
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Fraser Institute
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Both reports are about wait times in health care.
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response rate is only 21%.
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Though the report does not say this, many of these waits are due to a severe shortage of hospital beds. (Ontario has cut more beds than anywhere in Canada.)
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public hospital system including better wait list management and pooled referrals, additional operating room nurses and health professionals have improved wait times in Saskatchewan.
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Ontario has one of the most robust reporting systems in the country,
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On the negative side, most provinces do not report their wait times on most procedures, so the report is based on limited information and only from those provinces that do report.
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Long waits in hospital emergency departments were cited in Ontario. Waits are up to 26 hours for Ontario patients with complex conditions that require additional diagnostic tests or admission into a hospital bed.
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So, focusing on the report that is worth looking at – The Wait Times Alliance report is a thought-provoking addition to the body of research on access to care and timeliness of care.
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These are good recommendations that we should support.
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There is only really one item with which we would take issue in the report: there is considerable confusion about Alternate Level of Care (ALC) patients.T
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one type of hospital bed waiting for another type of hospital bed (not waiting for discharge to long-term care or home care).
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Unfortunately, this misinformation is driving dangerous levels of hospital cuts.
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There is also a gratuitous positive mention of the LEAN methods in the report, without any real analysis. We receive endless complaints about this Toyota management system that is now being used in public hospitals.
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askatchewan Premier Brad Wahl,
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Instead the evidence is that patients in those provinces are being charged fees ranging from hundreds to tens of thousands of dollars for medically-needed care.
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On top of these user fees, private clinics are billing the public system — for the same procedures. I
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NDP appeals to province for action on nurse assaults; Critics want Queen's Park to do m... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150703|224088626 from heather Ontario nursing nurses violence health and safety

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Toronto Star Fri Jul 3 2015
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Ontario's NDP health and labour critics are calling on the government to take action following a Star report detailing the rising number of nurses reporting assaults by patients. In an open letter, labour critic Cindy Forster and health critic France Gélinas urged Health Minister Eric Hoskins and Labour Minister Kevin Flynn to improve the safety of patients and staff in Ontario's health-care system. "It is deeply disturbing that nurses and health-care professionals are facing increasing levels of workplace violence in our province," wrote Gélinas and Forster.
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In an emailed statement to the Star, a spokesperson for the health minister wrote that Hoskins and Flynn are committed to ensuring Ontario's nurses have safe workplaces, but acknowledged there is room for improvement. "We recognize that there is more work to be done, which is why Minister of Labour Kevin Flynn met with the (Ontario Nurses' Association) earlier this year to discuss these very issues, and meets regularly to keep an open dialogue so we can continue working together to protect health-care workers," read the statement. On Thursday, the Star reported on the dramatic increases of reports of assaults on nurses at several Toronto-area hospitals over the past three years.
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At the University Health Network, the number of reported violent incidents against staff by patients doubled in two years. Reported assaults included incidents of verbal abuse, as well as patients kicking, punching and throwing urine at staff, according to reports obtained by the Star through an access to information request. UHN said the increase is likely due to a change in the method of reporting incidents and to a push from unions encouraging staff to increase reporting.
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"Sadly, I'm not surprised (by the increase in assault reports)," said Doris Grinspun, CEO of the Registered Nurses' Association of Ontario, who called on the government to hire more nurses. "When you do not address staffing, the temperature only raises more and more." ONA president Linda Haslam-Stroud told the Star Thursday that she is in discussions with Hoskins and Flynn about addressing workplace violence for nurses but is waiting for confirmation of how they plan to tackle the issue. She added that talking is not enough. The ONA wants to see increased hospital staffing levels, better trained security guards and more accountability from CEOs.
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Why a health-care report was dead on arrival - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150722|225356574 from heather federal accord innovation government

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The Globe and Mail Wed Jul 22 2015
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When the Harper government has something to brag about, we hear about it, endlessly. When the government has something to hide, the information comes out without ministerial comment on a Friday afternoon. So it was last week that the Prime Minister's Office buried a long, detailed report about federal innovation in health care that the government itself had commissioned.
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The Advisory Panel on Healthcare Innovation, chaired by former University of Toronto president and dean of medicine David Naylor, was to have been released at a news conference in Toronto on July 14. The day before the news conference, however, the PMO cancelled it and decided to release the report without notice on the Health Canada website on July 17. Just as the PMO hoped, the report received little attention. Health Minister Rona Ambrose, who was to have spoken about the report, was gagged. The posting on her department's website was timed so that it appeared only after the provincial premiers had finished their final news conference in St. John's, in case the report gave any or all of them ammunition to embarrass the federal government. Such is the way this government works.
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It's not hard to figure out why the Naylor report displeased the government. The panel was given a difficult, bordering on impossible, job: recommend innovations without Ottawa spending any more money. The panel's mandate read that recommendations "must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in health care."
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The Naylor panel ignored the mandate, explaining in its report that "although it was not an easy decision, we did not follow this guidance." Later, it warned that "absent federal action and investment, and absent political resolve on the part of provinces and territories, Canada's healthcare systems are headed for continued slow decline in performance relative to peers." To that end, the panel recommends creating a health innovation fund with a $1-billion yearly budget to invest in changes to the health-care system in conjunction with willing provinces and health-care institutions.
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Such a fund would be just about the last thing the Harper government desires. This government is running on balancing the budget. Adding $1-billion a year in spending would not be what the government wants. Such an investment fund would have little political profile - nothing as sexy as, say, national pharmacare (which the panel cursorily debunked). It would also run the risk of provoking premiers who screamed in St. John's for more cash transferred from Ottawa to them, without strings attached.
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For 2017-18, the federal government has announced it will reduce the increase in Ottawa's annual health-care transfer to the provinces from 6 per cent to something in the range of 3 per cent to 3.5 per cent, depending on economic growth. The provinces would likely not appreciate losing money from Ottawa with one hand, and then getting some, but only some, of it back through the innovation fund. The Harper government was hoping for change-on-the-cheap from the panel: innovation that would cost nothing but improve the system. It certainly has no interest in an expanded, direct federal role in health care, having made it abundantly clear that health care is for the provinces, except for Ottawa's responsibility for aboriginal and veterans' health, public health and drug approvals.
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Moreover, provincial health budgets are rising on average now by only 2 per cent a year, compared with 7 per cent a decade ago, far below the 6-per-cent increases in transfers still coming from Ottawa. The premiers would love the transfer to return to 6 per cent, as would the federal New Democrats. That would be the single dumbest move any federal government could make, given the lamentable experience of the 2004-11 period, when money gushed out of Ottawa but bought little improvement in the healthcare system. The Naylor panel noted, as have many observers, that the money improved things for providers, but not for many patients.
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The Naylor report covers all the ground about the manifold weaknesses and sturdy strengths of the Canadian system compared with other countries. It hails, quite rightly, some aspects of the U.S. system, especially the coordinated care of the best health organizations such as Kaiser Permanente.
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Its broad recommendations, however, are dead on arrival in Mr. Harper's Ottawa, which is why the report slid into the public domain with such little notice.
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Hospital pest woes blamed on renovations; Official says rodents do not pose imminent he... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|cahr|20150119|212716167 from heather bc privatization food health and safety safety hospital

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Calgary Herald Mon Jan 19 2015
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Rats scurrying down hospital hallways, chewing through wires and nibbling on food scraps near the cafeteria. These are a few of the recent rodent sightings reported by public health inspectors, nurses and staff members at B.C. Women's and Children's Hospital in Vancouver.
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Inspectors issued verbal and written directives after the Dec. 22 visit, according to the environmental health inspection report, which notes: "Minimal pest proofing has been completed to date which is contributing to the difficulty in controlling and abating the rodent activity with the food services." The report also mentions: "A number of food products have been chewed through resulting in products being discarded," and "wiring of equipment chewed on in the retail side which also raises a safety concern." The most recent inspection report lists a "Target Completion Date" for rodent control recommendations as Jan. 27. Taki said the hospital has an action plan in place with the help of the pest control company. "We've asked them to almost quadruple-up on the service until everything gets under control," said Taki.
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A surging rat population in the hospital's cafeteria and food preparation area has prompted management to step up rodent control efforts in recent weeks. Inspectors believe that despite the increase, the rodents do not pose an imminent health risk to the hospital's patients, visitors or staff, said Richard Taki, regional director of health protection for Vancouver Coastal Health. But the results of last month's inspection highlight the hospital's ongoing challenges dealing with vermin, a situation hospital management and health inspectors say has been exacerbated by demolition and construction work in recent months. Inspection reports from 2013 show Vancouver Coastal Health had previously identified issues with rats and mice in the hospital cafeteria and more recently, last month's inspection found signs the problem had worsened.
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"I don't think it's any different from any restaurant that has a rodent problem. They have rodents, they're under control, they've got a company looking after it. They're working toward resolving a problem, but you know, we live in a city that has rats everywhere." Nurses have seen the pest problem worsen, along with general cleanliness, said Claudette Jut, regional chair of the B.C. Nurses Union council. The Hospital Employees Union has identified the issue of short staffed cleaning and food service in the hospital and raised it "on several occasions" with the private contractor who employs the workers, said HEU spokesman Mike Old. "It's hard for us to tell what exactly has contributed to the rat infestation," said Old. "But it's a problem, I think, that the delivery of services is so badly fragmented because of privatization."
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Frank Levenheck, director of facilities management for B.C. Women's and Children's Hospital, said demolition and construction on the hospital campus has contributed to the cafeteria's rodent issue. Over the past three weeks, hospital management has increased its efforts, Levenheck said, which includes working to seal holes in the building that act as entry points for vermin, more frequent cleaning and more frequent visits from the pest control company. Demolition for the hospital redevelopment began last May. Excavation began in August and is scheduled to be complete in February. Eight months before demolition began, hospital management had been directed to improve rodent control, records show. A VCH inspection on Sept. 3, 2013 found issues with "Inadequate Insect/Rodent Control," noting: "Areas have not been cleaned and Manager not aware if Pest Control has been in to specifically address these new sightings. Communication between services found to be poor and lacking in followup."
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A week later, a followup reinspection report dated Sept. 10, 2013, noted: "Rat droppings still to be THOROUGHLY cleaned from underneath the heater vents in the production area. Noted mouse droppings in warehouse areas have not been cleaned up." The next Inspection Report, from July 2014, does not specify whether the rodent situation had improved or worsened since the problems noted in the report from the September before. The July 2014 report was the most recent posted to the Vancouver Coastal Health website until Postmedia News contacted the health authority this month to ask about inspections. Taki acknowledged the Dec. 22 inspection and provided Postmedia with a copy of the report, which was subsequently uploaded to the health authority's website.
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Kristy Anderson, a spokeswoman from the provincial Ministry of Health, said if an inspector finds a food service establishment is not responsive to food safety notices or orders, the establishment "could be fined or ultimately be required to shut down until the situation is remedied. To our knowledge this has never occurred in a hospital or health authority-run facility."
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Eight months before demolition, management at B.C. Women's and Children's Hospital had been directed to improve rodent control, records show.
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Report claims Alberta facing crisis with seniors' care; Aging population, lack of beds ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|town|20161101|259616880 ltc alberta privatization

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Town & Country
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Tue Nov 1 2016
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The availability of long-term care beds has plummeted over the last 15 years and the number of privately-operated long-term care beds has increased while government-operated beds has decreased, according to a report published by an independent Alberta-based research network.
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Last week, the Parkland Institute - which is based out of the University of Alberta - released its report Losing Ground: Alberta's Elder Care Crisis. It was an update of another Parkland report from 2013. The report states that as of March 31, 2016, there were 14,768 longterm (LTC) beds in Alberta and 9,936 designated supportive living (DSL) beds, as well as 243 palliative care or hospice beds.
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The number of LTC beds in Alberta has been relatively stagnant - Alberta only has 377 more LTC beds than it did in 2010, an increase of only 2.6 per cent. The number of DLS beds, on the other hand, has increased by 4,770 or 92.3 per cent. As well, the number of continuing care beds classified as DLC as opposed to long-term care beds grew from 26 per cent in 2010 to 40 per cent in 2016.
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That means nearly half of the continuing care beds available in the province for elderly Albertans do not have a registered nurse on-site and are not subject to minimum staffing requirements. "Losing Ground" also examines who is operating the LTC beds in the province. About 21 per cent are operated by Alberta Health Services (AHS) or a regional health authority. Another 10,808 were run by for-profit corporations and 8,881 were run by non-profits. In the last seven years, Alberta has lost 333 beds in public facilities while private, for-profit facilities have added 3,255 beds.
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The issue is that publicly-run LTC facilities generally provide more health care to residents than privately-run or non-profit facilities. On average between 2011 and 2013, registered nurses, licensed practical nurses and health care aids in public facilities provided four hours of direct health care to residents compared to three and 3.1 hours per day in non-profit and private facilities respectively. The report stresses that all facilities are required to provide 4.1 hours of care per day to residents, which means they are all falling short due to a lack of staff.
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The report also notes that the NDP government has fallen far short of its election commitment to open 2,000 new long-term care beds by the end of 2019, including 500 new beds in 2015. The growth in the older population, coupled with a stagnant number of new LTC beds and move towards private care, means the availability of beds for Albertans over the age of 85 has nearly been halved since 2001. "This drop has greatly reduced the province's ability to meet the care needs of its most frail seniors," said report author David Campanella, in a release.
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Minister's response In an e-mail, Minister of Sarah Hoffman said they know there is a huge demand for longterm care and dementia beds that stems from "years of neglect" on the need for affordable spaces for seniors under the previous government. "As a result, we are building spaces and putting in the beds Albertans need as we committed to do in the election and we are doing it collaboratively with communities and community partners." Hoffman said that last year, the province did a thorough review of all proposed Affordable Supportive Living Initiative (ASLI) projects, and implemented important changes to proposed projects to address the needs of Albertans.
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Every new approved ASLI project has since opened with higher numbers of dementia and long-term care beds than originally planned, she said. "With ASLI now ended, we are developing a new capital program for long-term care with criteria to ensure the right level of care and the right methods of delivery are expanded," said Hoffman. She noted they have $365 million earmarked for senior care in the current budget and that will improve access for families across Alberta. Following the report's release, the Canadian Union of Public Employees (CUPE) issued a statement that it is disappointed by the lack of progress being made reforming the province's system of senior care.
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CUPE Alberta president Marle Roberts said the union, which represents 2,600 long-term care workers throughout the province, has repeatedly asked the current and previous Alberta governments to shift its focus to publicly-delivered services. "This study confirms what others have indicated before - caregivers in public facilities have more times for patients and deliver better outcomes," said Roberts.
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We are disappointed that the number of private beds continue to increase, while the number of public beds has dropped ... We are letting patients down by not offering them the care they need," she added.
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A report from the Parkland institute claims there has been a trend away from publicly- run long-term care beds, such as those at the Westlock Continuing Care Centre (seen above). The number of long-term care beds offered by private organizations or non-profit organizations, on the other hand, is on the rise.
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Quebec auditor general's report: User fees in clinics uncontrolled | Montreal Gazette - 0 views

montrealgazette.com/...s-uncontrolled-auditor-general user fees private clinics Quebec

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May 10, 2016
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QUEBEC — Extra fees charged in private clinics for procedures covered by medicare are not being controlled and may be abusive, the province’s auditor general said in a report Tuesday. Extra billing has been in dispute ever since the government of Quebec adopted Bill 20 in November. The bill aimed, among other things, to regulate add-on fees by creating a standardized price list. The situation remains ambiguous, confusing and misunderstood, auditor general Guylaine Leclerc wrote in her report.
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Doctors have argued in the past that they need the extra money to pay their operating costs, but the report recommended the health department take time to really “assess the operating costs of clinics, determine the funding to be granted and consider the funding already paid.”
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QUEBEC — Extra fees charged in private clinics for procedures covered by medicare are not being controlled and may be abusive, the province’s auditor general said in a report Tuesday. Extra billing has been in dispute ever since the government of Quebec adopted Bill 20 in November. The bill aimed, among other things, to regulate add-on fees by creating a standardized price list. The situation remains ambiguous, confusing and misunderstood, auditor general Guylaine Leclerc wrote in her report. Neither the health department nor Quebec’s health insurance board (RAMQ) has a firm grip on these add-on fees, which are estimated at $50 million a year, she noted. For example, the report said, Quebecers are charged between $300 and $400 for a colonoscopy, $125 to $225 for a vasectomy, $51 to $100 for a biopsy and $5 to $50 for an excision, depending on the clinic. 
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Lawyer Jean-Pierre Ménard insisted last week Quebec is the worst offender when it comes to over-billing patients, and that the fees are creating a two-tier health-care system that may violate the Canada Health Act. With Ménard’s help, various patients’-rights groups have come together to launch legal action against the federal government to make sure the Canada Health Act is applied in Quebec and other provinces. Reacting to the report Tuesday, Health Minister Gaétan Barrette reiterated his recent promise to abolish add-on fees by possibly rolling them into doctors’ salaries. “For care that is medically required, there won’t be any fees,” he told reporters.
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Parti Québécois MNA Diane Lamarre said Barrette’s “about-face” is the result of relentless criticisms by her and the PQ. “When we started studying Bill 20, we were fighting the fact that the minister introduced an amendment that authorized accessory fees,” Lamarre said. “It was a new opportunity to charge, legally, new medical fees. … We asked the minister many times to (scrap) his amendment and he refused. “(It) was a way to introduce accessory fees and make some patients with no money unable to have access to medical services, which is completely against the law. Now we’re proud that he changed his mind,” she said. Both Lamarre and Coalition Avenir Québec MNA François Paradis said they are concerned Barrette will not be able to convince doctors’ associations to include the fees in their remuneration. If doctors’ salaries are boosted by an additional $50 million in the next contract agreement, for example, it will mean that collectively we will all be paying the fees indirectly, Paradis said.
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Report details improvements ; HEALTH CARE - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|kiws|20150626|223591339 from heather Ontario cupe hospital cuts

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The Kingston Whig-Standard Fri Jun 26 2015
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Significant improvements have been made at Kingston General Hospital over the past five years, according to an internal report released by the hospital on Wednesday. "I am thrilled with the very real progress that the teams at KGH have made toward our theme of "outstanding care always" in the past five years," said Leslee Thompson, president and CEO of KGH. The report focuses on some of the quantitative evidence of change over the past five years. For example, the report states that KGH went from a provincial low of 34% hand hygiene compliance to being one of the best, with performance hovering around 90%.
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The hospital has also cleared a $26 million operating deficit, which created difficult times for the hospital back in 2010, just as Thompson was introduced as the hospital's new CEO. Thompson said the organization has had to make drastic changes to how the hospital operates, but she's proud with the level of quality that has been achieved, even with provincial health budgets frozen for the past four years. Even under the strict financial budget, KGH has been able to increase investments into technology and equipment that provide better quality care. Over the past five years, the hospital has gone from investing $3 million a year to $20 million a year into its facilities. Thompson said a great deal of savings have come from each department's assessments of efficiency and the ability of staff to change and adapt to taking on new responsibilities.
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"We have gone in every corner of organization to try and find ways to lower our costs, though at the same time deliver outstanding care always," she said. The hospital also installed new energy efficient equipment, which saves $800,000 per year that has been redirected to patient care. The report also states patient satisfaction has increased as well as the condition of patient rooms and the number of patients treated per year. Thompson said the positive change is directly related to a new approach of patient-and family-centred care. "The approach to everything we did before was really under the philosophy of doing for patients and doing things to patients," she said. "Now we approach everything as doing with patients."
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KGH has eliminated restricted visiting hours and now allows for 24-7 patient visits. Thompson said the new approach values patient input even more, and patients have been included on organization committees. However, not everyone is as thrilled with the report as Thompson. Mike Rodrigues, acting president of CUPE Local 1974 for KGH, said there are some discrepancies in the report's findings. "There's been at least 20 jobs eliminated over the last two years through attrition that have not been replaced. Workloads are increasing and the number of staff is decreasing, so absolutely they're eliminating their deficit, but it's through attrition, and the staff are wearing it," Rodrigues said.
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Rodrigues also cited a 2014 quarterly report that states patient satisfaction with food was at 52%, based on National Research Corporation Canada (NRCC) data. The hospital report states an increased satisfaction to 90%, based on another survey. Rodrigues said that as far as he understands from the feedback he receives from members of the union, there is still a lot of work that needs to be done in the hospital, especially focused staff needs. The report can be viewed online at www.kghconnect.ca/kgh-journey/#journey.
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C. difficile infection rates drop sharply; The Ottawa Hospital reports just 74 infectio... - 0 views

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C. difficile infection rates drop sharply; The Ottawa Hospital reports just 74 infections, down from 112 in 2013
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Ottawa Citizen Fri Feb 6 2015
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The Ottawa Hospital appears to be winning its struggle against persistently high rates of Clostridium difficile. In 2014, the hospital's General campus reported 74 new C. difficile infections, a sharp reduction from the 112 it reported in 2013 and 134 in 2012. The Civic campus had just 45 new cases last year, barely half as many as in 2013. In 2012 and 2013, the General campus reported more new C. difficile infections than any hospital in Ontario. But last year, it ceded that dubious distinction to London's Victoria Hospital, which reported 112 cases.
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The General now sits in the middle of the pack among large teaching hospitals, with infection numbers similar to several comparable hospitals in Toronto, Hamilton and London. The Civic is at the low end among comparable hospitals, with C. difficile infection numbers almost identical to those of three Toronto hospitals: St. Michael's, Princess Margaret and Toronto Western. Moreover, the General campus beat the hospital's target of 0.45 infections per 1,000 patient days seven out of 12 months last year.
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In 2013, it did that only twice. The Civic was below target 10 out of 12 months in 2014 after doing so only four times the previous year. "We're very pleased to see the rates come down," said Dr. Kathy Suh, the hospital's medical director of infection prevention and control. "It's been a long time coming for us.
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"We've had our challenges, which have been quite prolonged, with C. difficile, so we're pleased to see the rates drop like this." C. difficile, which is found in stool, is typically spread in hospitals after patients or stafftouch soiled surfaces such as toilets, handles and bedpans. Patients taking antibiotics are especially vulnerable because the medication kills good bacteria as well as bad, allowing C. difficile bacteria to multiply more easily.
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Suh attributed the reduction to several initiatives, including an emphasis on hand hygiene, the use of bleach to clean patients' rooms and a program to improve the use of antibiotics, a key driver for C. difficile. A team of physicians and pharmacists reviews individual cases to ensure that antibiotics are only used when necessary, that they're stopped when no longer needed and that the most appropriate antibiotics are prescribed, Suh said. The hospital also continues to use anti-infection "SWAT teams," first introduced two years ago, whenever cases of C. difficile are diagnosed. The multi-disciplinary teams review processes in the affected unit and ensure that patients are promptly isolated and tested.
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It all seems to be working. The General reported just three new C. difficile cases in December, a month when infections often spike. In December 2013, for example, it reported 11 new cases. In December 2012, there were 15. At the Civic, there were seven new C. difficile infections in December, the most since February 2014. But most months, the numbers have been low. In three separate months - June, August and November - the Civic reported just a single new infection.
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The hospital's objective is to keep infection rates below the 0.45 threshold, Suh said.
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BY THE NUMBERS C. difficile infections in Ottawa hospitals in 2014 (2013 numbers in brackets) 74 (112) Ottawa Hospital, General campus 45 (81) Ottawa Hospital, Civic campus 25 (28) Queensway-Carleton Hospital 18 (23) University of Ottawa Heart Institute 19 (34) Montfort Hospital 14 (12) Children's Hospital of Eastern Ontario
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AG warns of home-care waits; Unequal access was flagged five years ago, but problem has... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20151203|235016163 from heather home care Ontario ag

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Toronto Star Thu Dec 3 2015
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The province's home-care system is still beset with problems such as long waits and unequal access, even though they were flagged by the auditor general five years ago and the government has identified the sector as a priority. Provincial auditor general Bonnie Lysyk's annual report, released Wednesday, said the health ministry has yet to correct problems identified in her 2010 annual report.
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"Although the ministry has recognized the importance of strengthening the home and community care sector, clients still face long wait times for personal support services, and they still receive different levels of home-care service depending on where in Ontario they live," she said. Her findings spell more bad news for the province's 14 beleaguered community-care access centres (CCACs), which co-ordinate home care in distinct geographic regions of the province. Sources say the province is on the brink of scrapping them.
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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.
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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.
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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.
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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.
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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.
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he auditor general notes the backlog of complaints and critical incidents regarding long-term care homes has more than doubled in recent years.
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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

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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
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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

<div class="cArrow"> </div><div class="cContentInner">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</div>

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Privatization accelerated under Sask Party: report - Infomart - 1 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|sasp|20151009|231005549 from heather Saskatchewan privatization research

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The StarPhoenix (Saskatoon) Fri Oct 9 2015
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A policy think tank is bringing attention to what it sees as an "acceleration" of privatization under the Saskatchewan Party, something the deputy premier dismisses as "fearmongering." A new report by the Saskatchewan office of the Canadian Centre for Policy Alternatives documents what it considers to be more than 50 instances of privatization, or at least announced plans for it, in the past decade, from the sale of Crown subsidiaries to public-private partnerships to the contracting out of public services. The office's director and report author, Simon Enoch, called the reco d "quite substantial - a lot more than I think the average citizen would suspect."
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Enoch said that despite studies showing strong public support for Crown corporations, the "subterranean privatization agenda going on really hasn't seemed to activate the public." He suspects that's because much of the privatization that's occurred has been below-the-radar, such as that of the Information Services Corporation or hospital laundry services. He said the issue is likely to pick up steam as the government wades into more well-known areas like liquor stores and MRIs. "I would fully expect to see them attempt a major privatization should they win a new mandate in the next election," Enoch said. The trend hasn't gone unnoticed by the Saskatchewan Federation of Labour. Its president, Larry Hubich, said the report "reaffirms what we've known. We've been saying for quite a while that there's a creeping privatization agenda that's almost being carried out in stealth." He added that privatization is "risky and costs taxpayers more in the long run."
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In that vein, Enoch said in the report that accountability and transparency have been the first victims of privatization in Saskatchewan. "What it also means is that hard-working Saskatchewan people are losing good jobs," Hubich said. The report argues that in many instances, privatization has not delivered on the promises of "lower-cost, yet also higher-quality and more responsive services than the public sector." NDP MLA Trent Wotherspoon agreed the government seems to "use privatization at every turn," which he called short-term thinking that is not in the best interest of the province, driving up the cost of living and giving away quality jobs. "There's a large and growing concern across Saskatchewan about what's next," he said.
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Deputy premier Don Mc-Morris dismissed the report as "fearmongering." "The basis of their argument is all around fear, trying to scare people to think that nobody else can deliver these services except government employees," he said. "That just isn't the record here in Saskatchewan or really anywhere else in North America." McMorris touted the growth Saskatchewan has seen under his party. "We'd never want to go back to the type of thinking that this organization is trying to profess," he said, referring to the idea that "privatization is an absolutely terrible word." He emphasized as one example how surgical wait lists have decreased with privatization. "They would have rather had people languish on long wait-lists than actually do something about it by using the private sector," McMorris said of the centre.
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Privatization hasn't "necessarily" accelerated under the Saskatchewan Party, and future moves will be dictated by a common-sense approach, he said. While the report noted that several jurisdictions in Canada and around the world are bringing privatized sectors back into the public realm, McMorris pointed to the growing popularity of public-private partnerships in North America. "I wouldn't say jurisdictions are backing away," he said. McMorris was hesitant to say whether privatization would figure large in the 2016 provincial election, but Hubich and Wotherspoon said they think it will be a lightening rod. "I actually think it will define the next election," Enoch said. nlypny@leaderpost.com twitter.com/wordpuddle
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Seniors Advocate's report on resident-to-resident aggression underlines need for improv... - 0 views

www.heu.org/...ggression-underlines-need-impr cupe bc hospital ltc staffing

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NDP Supplementary Report to the Standing Committee on Health's Review of Progress on th... - 0 views

www.parl.gc.ca/...Publication.aspx accord health committee ndp

shared by Irene Jansen on 23 Jan 12 - No Cached

the unilateral Liberal cutbacks of 1995 – the greatest single cut ever to our public health care budget – had played out in service cuts and personnel shortages leading to longer waits for medical procedures
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The 10-year Plan was a call for renewal.  It recommitted governments at all levels to the principles of the Canada Health Act and to making strategic improvements in 10 key areas to strengthen health care. 
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The Health Council told the Committee “These accords have laudable, much needed and ambitious goals.  But have they had the broad national impact that government leaders intended?  In short, the answer is no.”
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the Health Council told us, there remain “clear disparities in the availability of publicly-funded homecare across the country”
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The Health Minister, ignoring the 80% of Canadians who want more home and community care added to the health system, has stated flatly that he is “not going to get involved” in home care because he sees it as a provincial matter.  As if to underscore his point, the government has dismantled the Secretariat set up in 2001 to coordinate the development of a national strategy on end-of-life care.
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the government has been sitting on the report of the Wait Times Advisor for two full years.  Positive recommendations, including a more multidisciplinary approach and gender analysis, have been side-tracked. 
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the federal government’s silence while for-profit forces have exploited public concern over wait times to resurrect their false promise of salvation through parallel for-profit care
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after developing the Framework for Collaborative Pan-Canadian Health Human Resources Planning, the action plan so urgently needed has hit the doldrums
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The Health Council has said planning remains “fragmented”
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urgent need to address the health deficit faced by aboriginal Canadians with improvements to both health services and the determinants of health for aboriginal communities
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Although the 10-year Plan includes health care in Northern communities and has incorporated the 2004 Blueprint for Aboriginal Health, the Health Council reports that “preventable health problems… continue to be of concern across the country”, and that “relatively little funding seems to have flowed”.
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the federal government’s decentralized approach to national health care priorities has resulted in the loss of a national vision for health care and a directionless, leaderless renewal process at the national level
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We recommend, therefore, that the federal government commit itself to a national, pan-Canadian, system-wide approach to public health care renewal anchored in Canada Health Act principles and enforcement, and with the jurisdictional flexibility and asymmetrical federalism found in the 10-Year Plan to Strengthen Health Care.
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We recommend, therefore, that the government take urgent actions to get the Plan back on track in each of its areas of focus as quickly as possible, including: acting on the recommendations of the 2006 Interim Report of the National Pharmaceutical Strategy and the Report of the Wait Time Advisor; advancing the action plan under the Framework for Collaborative Pan-Canadian Health Human Resources Planning; energetically pursuing the objectives of the 2004 Blueprint for Aboriginal Health (most particularly where it relates to measures under direct federal jurisdiction); working with the provinces and territories to re-establish the Advisory Committee on Governance and Accountability as a functioning part of the renewal process; and convening a meeting of ministers of health to identify roadblocks that are impeding progress and to develop strategies to overcome these obstacles. 
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the Canada Health Act, our main tool in protecting public health care, to which the 10-Year Plan to Strengthen Health Care is committed, is being undermined through inadequate monitoring and enforcement
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The for-profit health industry continues to grow unabated
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The Canada Health Act annual reports to Parliament do not reflect this due to their limited scope and the government’s failure to make improvements identified by the Auditor General back in 2002.
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We recommend, therefore, that the Health Minister fully enforce the Canada Health Act by: setting data collection standards for reporting and enforcement that capture all for-profit activities that may impact on public health delivery; working collaboratively with the provinces and territories to fill gaps in reporting; stipulating that federal transfers should only be used for non-profit health care delivery; and removing any requirements that health infrastructure endeavours consider for-profit options such as public-private partnerships.
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Nursing home neglect - thestar.com - 0 views

www.thestar.com/...1088858--nursing-home-neglect ltc ontario

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A private nursing home chain enforced such strict rations on diapers that staff wrapped residents in towels and plastic garbage bags to keep their beds dry.
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A resident at a Bradford home who was prone to falls was left alone on a toilet. The resident fell and sustained a head injury.
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Residents in a Hamilton home had untreated bedsores and were famished from lack of food.
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...15 more annotations...
An elderly woman with a broken thighbone in a Pickering nursing home suffered for days without treatment.
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A Brantford home was so short staffed that residents frequently missed their weekly baths.
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Eight years after an Ontario government promise to revolutionize nursing home care, the elderly are still suffering neglect and abuse.
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The Star’s investigation draws from material uncovered by a new inspection system created by the Ministry of Health and Long-Term Care in July 2010. It has since investigated 2,993 complaints and critical incidents, like broken bones or assaults. We analyzed more than 1,500 of those inspection reports and found at least 350 cases of neglect where residents were left in soaking diapers, suffered untreated injuries, bedsores, dehydration, weight loss or were put at risk from outdated care plans that ignored changing medical needs. Other reports, scrutinized for Thursday’s story, focused on abuse. Today the Star probes the issue of neglectful treatment of home residents. The reports reveal that many families have no idea what their loved ones are subjected to. Inspectors found that some homes do not disclose problems to the ministry or police.
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Diaper shortages can be found in many of Ontario’s 627 homes, said Sharleen Stewart president of the union representing front-line nursing home staff. “Our members tell us the shortages leave residents with rashes and sores,” said Stewart, of the Service Employees International Union, which represents 50,000 Ontario health care workers, including 22,000 nursing home employees.
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Last November a ministry inspector wrote, “Five different nursing staff members working the day shift from all home areas… indicated they are only provided with one (diaper) per (eight hour) shift for the resident and frequently have to go to another home area to try and borrow products.”
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The report also described a resident with an open sore whose diaper was soaked in the morning. Since staff could not find a replacement, the resident was only given a paper insert to keep urine from the senior’s wound.
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Two months later, in January 2011, the ministry was back at the same home, this time investigating a complaint from a family who said their loved one was wearing the same diaper from the previous day and it was “heavily soiled.”
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Ko dismissed allegations that a Revera home in north Etobicoke rations diapers. But one current and one former resident of Westside Long Term Care on Albion Rd. told the Star residents are only given one diaper per eight-hour shift.
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She praised the staff, saying they scramble to find an extra diaper if one’s needed. “They’re embarrassed that I’m embarrassed.”
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Two employees at Westside said the home locks up diapers and staff have to sign them out. The workers at Westside spoke on the condition of anonymity, saying they are afraid of being fired. One worker said she is so worried about leaving residents in wet diapers that she places towels and plastic garbage bags under them to prevent urine from soaking their bed sheets.
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Revera was “shocked” to hear allegations that makeshift diapers were being used and she has both launched an investigation and is conducting educational sessions for staff
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Westside workers say their bosses warn staff they will be fired if they tell residents’ families the home is rationing diapers. Whistleblower protection in Ontario homes only helps staff who divulge problems to their nursing home supervisors or the health ministry. It does not protect the jobs of workers who warn residents’ families that their relatives are being neglected, complain to their union or speak to the media.
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The new inspection report system often hides bad care from public scrutiny. The public report is often stripped of details. A private version for the home’s management, on the other hand, gives precise information about each violation. It took Lorraine Henderson 11 months to obtain copies of these private reports through access to information legislation.
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The Star’s analysis of inspection reports found more than 50 cases in which elderly residents fell and got injured, many times when they were left unassisted by caregivers or dropped from mechanical lifts.
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Ontario task force to tackle abuse in nursing homes - thestar.com - 0 views

www.thestar.com/...-tackle-abuse-in-nursing-homes abuse investigation ltc ontario

shared by Irene Jansen on 23 Jan 12 - No Cached

Ontario nursing homes and seniors advocates have created a task force to stop abuse in their facilites after a Star investigation found vulnerable residents are beaten, neglected and even raped by staff.
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They came up with the plan after being summoned to an emergency meeting on Friday with Health minister Deb Matthews who demanded changes to nursing home practices
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Matthews said the task force will bring together residents, families, staff, owners and advocates to create a “real culture change.”
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Attending the meeting were representatives of two nursing home associations, representing private and not-for-profit homes, a seniors advocacy group and organizations for resident and family councils.
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the task force will come up with strong recommendations for change within a few months
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The Star stories examined the Health Ministry’s inspection reports and found that residents are routinely abused and neglected in many of the 627 Ontario-licensed nursing homes. The stories analyzed more than 1,500 inspection reports filed since the province rolled out a new system in July 2010, which itself was the result of a 2003 Star investigation into nursing home neglect. Serious problems were found in 900 cases. Of those, roughly 125 were abuse-related, 350 revealed neglect of a senior and the remainder found other types of poor care.
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The Star also found that residents are limited to one diaper per eight-hour shift in some homes. That is “not acceptable care,” Matthews said.
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After an hour inside a Ministry of Health boardroom, about 10 nursing home leaders left with a commitment to improve conditions inside the homes.
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The fastest way to create change, Matthews said, is for families and staff to report every example of abuse or neglect to the ministry’s complaint line. The Star’s stories found many homes tried to cover up their problems by delaying or not reporting incidents to the ministry.
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the association that represents Ontario’s 33,000 nurses sent a letter to its members on Friday saying they must report abuse
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Grinspun said. “We are telling out members to report, report, report. We will stand by them in every instance where their voice is pushed to silence.”
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