Skip to main content

Home/ CUPE Health Care/ Group items tagged staffing

Rss Feed Group items tagged

Filter: All | Bookmarks | Topics Simple Middle
Govind Rao

Long-term care homes not up to minimum standards: report; Staffing levels an issue at 2... - 0 views

www.fpinfomart.ca/...244046042

from heather bc ltc cupe hospital inspections quality

shared by Govind Rao on 05 Apr 16 - No Cached
  • Vancouver Sun Tue Apr 5 2016
  • The vast majority of governmentfunded long-term care homes for seniors in B.C. do not meet Ministry of Health staffing guidelines. The Residential Care Facilities Quick Facts Directory, a report released by the Office of the Seniors Advocate, compiles staffing, serious incident reports and other qualityof-life measures for all publicly funded seniors homes in B.C. in 2014-15. Of the 292 governmentfunded facilities, 232 did not meet the ministry's staffing guideline, a recommendation of 3.36 hours of care per senior every day. This includes help with tasks such as toileting, feeding and bathing. Just 17 facilities
  • Of the 232 government-funded seniors homes below the staffing guidelines, 74 per cent were owned and operated by private businesses instead of health authorities or by a non-profit group, such as a church. All but two of the 25 care facilities providing the lowest number of staffing hours were in the Vancouver Coastal Health Authority. Isobel Mackenzie, the B.C. Seniors Advocate, and Jennifer Whiteside of the Hospital Employees Union, which represents care aides in long-term facilities, are calling on government to legislate minimum staffing levels instead of leaving it up to facility operators. "We regulate the staffing ratios in child care, why don't we regulate it in senior care?" said Mackenzie. She said she was surprised to learn how many seniors homes fall below provincial guidelines.
  • ...9 more annotations...
  • were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.
  • A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.
  • "Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.
  • Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.
  • A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.
  • We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."
  • THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.
  • 136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.
  • 9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.
Govind Rao

Fewer hospital staff on weekends put patients at risk Healthy Debate August 1 2013 - 0 views

healthydebate.ca/...nds-puts-some-patients-at-risk

from heather hospital staffing safety

shared by Govind Rao on 01 Aug 13 - No Cached
  • Govind Rao on 01 Aug 13
     
    by Jeremy Petch, Christopher Doig & Irfan Dhalla AUGUST 1, 2013 In the modern economy, many industries, such as aviation, retail and manufacturing, no longer slow down over weekends. Yet hospitals have mostly resisted this trend, even though demand for many forms of health care is no less on weekends than on weekdays. While most hospitals are open every day of the week, many operate with substantially reduced staffing levels on holidays and weekends. A typical internal medicine ward at a teaching hospital in Ontario, for example, might function with only one-third of the doctors on the weekend that it would have on a weekday. And the most senior of these doctors will have left the hospital by early afternoon. Allied health professionals (such as physiotherapists and dieticians) are often also absent on weekends, with only nurses staffed in numbers that are comparable to weekday staffing levels. It is understandable that health care professionals do not wish work over the weekend, but evidence points to a concerning "weekend effect" at hospitals: a small but meaningful increased risk of death associated with a hospital stay on a weekend versus a weekday. Is it time for hospitals to start staffing at the same level all week?
Cheryl Stadnichuk

Legislate B.C. care home staffing, advocates demand - 0 views

www.vancouversun.com/...story.html

ltc staffing BC

shared by Cheryl Stadnichuk on 09 Feb 16 - No Cached
  • Cheryl Stadnichuk on 09 Feb 16
     
    When Pamela Hollington placed her 80-year-mother into a nursing home she was shocked to learn there would be as few as two care aides at times overseeing 50 residents on a specialized ward for people suffering from dementia. To ensure her mother's needs are met, Hollington now pays for a companion to visit her mother daily to "augment staffing levels." Daycare has mandated staffing levels for children in care but that isn't the case for seniors in nursing homes. Instead, administrators of B.C.'s 331 long-term care facilities can decide their own staffing needs and can choose or not choose to follow Ministry of Health guidelines. Vancouver Coastal Health, for instance, follows the industry standard of one care aide at night for every 25 residents. The Hospital Employees Union, which represents 15,000 care aides in British Columbia, said the standard being used in the industry is not enough, and chronic understaffing has reached dangerous proportions. "We hear from our members routinely that they are not backfilled when they are on vacation or sick. Our members are literally rushed off their feet to the point where safety is compromised - both their safety and the safety of residents," said the HEU's Jennifer Whiteside. The union is among many advocates for seniors in B.C. who are calling for staffing levels to be put into law for long term care facilities, and at a higher staff ratio than the current guidelines. She said this would also ensure consistency in staffing levels for nursing homes across the province. A HEU study of care aides in late 2014 found more than 70 per cent of its members felt they did not have enough time to comfort, reassure or calm residents they were caring for when residents were feeling confused, agitated or fearful. And nearly 75 per cent said they felt they had to rush through basic care for the elderly. Another 83.1 per cent reported they have been "struck, scratched, spit on or subjected to
Heather Farrow

Legislate B.C. care home staffing, advocates demand - 0 views

www.vancouversun.com/...story.html

ltc cupe bc hospital staffing legislation violence

shared by Heather Farrow on 27 Jun 16 - No Cached
  • WEST VANCOUVER -- When Pamela Hollington placed her 80-year-mother into a nursing home she was shocked to learn there would be as few as two care aides at times overseeing 50 residents on a specialized ward for people suffering from dementia.
  • Hollington now pays for a companion to visit her mother daily to “augment staffing levels.”
  • “You see a lot of private, paid companions. This is not an indictment of the staff. I don’t know how they do it. To go to work every day knowing there are just two of them,” she said.
  • ...10 more annotations...
  • possibly violent.
  • Daycare has mandated staffing levels for children in care but that isn’t the case for seniors in nursing homes.
  • Instead, administrators of B.C.’s 331 long-term care facilities can decide their own staffing needs and can choose or not choose to follow Ministry of Health guidelines.
  • Vancouver Coastal Health, for instance, follows the industry standard of one care aide at night for every 25 residents.
  • Nick Whittle, administrator of Inglewood Care Centre, said the facility is not in contravention of the industry standard. He said that besides the two care aides for the 50 residents on the dementia ward at night, there are other staff nearby should they be needed, including a registered nurse and a licensed practical nurse.
  • The Hospital Employees Union, which represents 15,000 care aides in British Columbia, said the standard being used in the industry is not enough, and chronic understaffing has reached dangerous proportions.
  • “We hear from our members routinely that they are not backfilled when they are on vacation or sick. Our members are literally rushed off their feet to the point where safety is compromised — both their safety and the safety of residents,” said the HEU’s Jennifer Whiteside.
  • Whiteside said seniors who have dementia, which sometimes includes aggressive tendencies, often strike out violently when they don’t have the support they need.
  • At the end of the day, if employers think we can address violence rates without addressing staffing, it’s not realistic. There’s a correlation between the two,” she said.
  • A HEU study of care aides in late 2014 found more than 70 per cent of its members felt they did not have enough time to comfort, reassure or calm residents they were caring for when residents were feeling confused, agitated or fearful.
Irene Jansen

Residential care quality: A review of the literature on nurse and personal care staffin... - 0 views

www.health.gov.bc.ca/...affing-and-quality-of-care.pdf

unregulated workers nursing staffing care aide bc ltc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Nursing Directorate BC Ministry of Health by Janice M. Murphy Increases knowledge of nurse to resident ratios as it relates to nurse and resident outcomes in residential settings. Relationship between overall staffing levels and quality of care. LPNs and CA also contribute to quality care. Job satisfaction, staffing turnover and retention related to quality of care.
Irene Jansen

Minimum safe staffing levels may be set for emergency departments and elderly care ward... - 0 views

www.bmj.com/...bmj.d8353

staffing hospitals safety england

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The public inquiry into the high number of deaths at Mid Staffordshire NHS Foundation Trust is expected to recommend that minimum staffing ratios be set for total numbers and the skills mix of doctors and nurses in accident and emergency and elderly care wards in England to ensure the safety of care.
  • counsel to the inquiry, Tom Kark QC, said “that consideration should be given to the production of model staffing guidelines for certain types of wards and departments against which the Care Quality Commission should assess the acceptability of staffing.”
  • Mr Kark pointed out that the real danger in accident and emergency services at Mid Staffordshire was understaffing, inadequate training, and poor governance.
  • ...5 more annotations...
  • Brian Jarman, director of the Dr Foster Unit at Imperial College London, told the inquiry that hospitals with poor staff ratios had higher hospital standardised mortality ratios.
  • more doctors per bed
  • the Care Quality Commission made it clear that it does not want to see minimum staffing ratios
  • Mr Kark said that although he recognised that the number of patients on some wards often changed, making the setting of minimum staffing ratios a complex business, certain wards were less susceptible to such change and would benefit from some guidance, particularly elderly care wards and accident and emergency departments.
  • guidelines are merely that and one-off failure to comply would be unlikely to attract disproportionate attention from the regulator
Doug Allan

Improving quality in Canada's nursing homes requires "more staff, more training" - Heal... - 3 views

healthydebate.ca/...uires-more-staff-more-training

LTC staffing

shared by Doug Allan on 20 Jun 13 - No Cached
  • According to data from Statistics Canada, staffing levels in Ontario’s nursing homes have historically been below the national average (behind only British Columbia for the lowest staffing levels in the country).
  • While Ontario legislation requires there to be a nurse on duty at all times in nursing homes, Ontario has not legislated a minimum staffing ratio – the ratio between the number of nursing home staff (nurses and non-nurses) compared to the number of patients they care for.
  • Statistics Canada data shows the average staffing ratio in Ontario nursing homes was 4 hours per resident day in 2010 (the last year for which data is available). This was 25% less than in Alberta, where nursing homes averaged 5.3 hours per resident day. (This is only a measure of the hours paid to all staff in nursing homes, not of the actual time care staff spend providing care ‘at the bedside.’)
  • ...9 more annotations...
  • Staffing levels in nursing homes are a concern not only because they are low, but they may not be increasing fast enough to meet the rising medical complexity of patients in nursing homes.
  • Data from the Canadian Institute for Health Information shows that between 2008 and 2012, the proportion of residents in Canadian nursing homes with disease diagnoses increased for every category of disease.
  • Dementia is also increasingly common among Canadian nursing home residents, with over three quarters of residents having some level of cognitive impairment. More than one in four residents suffers from severe dementia.
  • As a result, the care needs of nursing home residents have grown. In Ontario, care needs are assessed using the Method for Assigning Priority Levels (MAPLe) scoring system. The system ranges from a score of 1 (low needs) to 5 (very high needs). In 2012, 85% of new admissions from the community and 78% of admissions from hospital were in the High or Very High (MAPLe 4 and 5) clinical needs categories. Less than 1% of admissions were in the low and mild (MAPLe 1 and 2) clinical needs categories. Projections from the Ontario Long Term Care Association suggest that soon virtually all patients admitted to nursing homes will be from the two highest need categories.
  • The increasing needs of nursing home residents in Ontario has been driven in large part by the shift from letting individual nursing homes choose their residents, to having Community Care Access Centres determine who is in greatest need of long term care, says Dr Samir Sinha, lead for Ontario’s Senior Strategy
  • Ontario has begun to increase both the number and skill sets of nursing home staff, while also trying to find efficiencies to free up more staff time for direct patient care.
  • “One of the most promising initiatives to date has been Behavioral Supports Ontario (BSO),” says Sinha. The BSO initiative is province-wide, and has funded the hiring of 604 new staff (194 nurses, 272 PSWs, and 138 other health care professionals, such as social workers) with specialized skills in caring for and supporting residents with complex and challenging behaviors, such as violence.
  • Researchers and policy strategists in Alberta believe another key to improving quality in nursing homes is to engage Health Care Aides (HCA in Alberta is the rough equivalent of a PSW) as full members of the care team.
  • Carole Estabrooks, a Professor of Nursing at the University of Alberta has been researching the engagement of HCAs in quality improvement for the last several years. She believes that too often, HCAs are not treated as members of the care team. “Care Aides typically have the least amount of formal training, and as a result doctors, nurses and others too often assume they have nothing to offer,” she says. Frequently, this means they have little input into the care plans they are expected to carry out.
Govind Rao

Safe staffing key to quality health care International Council of Nurses July 15 2013 - 4 views

www.nursesunions.ca/...2013_pr_13_safe_staffing.pdf

from heather international nursing staffing safety

shared by Govind Rao on 15 Aug 13 - No Cached
  • Govind Rao on 15 Aug 13
     
    highlights the need to ensure an appropriate number of nurses and other staff is available at all times across the continuum of care, with a suitable mix of education, skills and experience to ensure that patient care needs are met and that hazard-free working conditions are maintained. "It is well known that nurse staffing affects the patient's length of stay in hospital, morbidity and mortality and their reintegration into the community," said Judith Shamian, President of the International Council of Nurses. "In addition, safe staffing levels are associated with improved retention, recruitment and workforce sustainability as well as better cost efficiency for the health care system - in short this is essential to the functioning of all health services."
Govind Rao

We Need More Nurses - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246198|nytm|20150528|221425925

from heather nursing US staffing cuts

shared by Govind Rao on 29 May 15 - No Cached
  • The New York Times Thu May 28 2015
  • SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients -- and their nursing licenses -- were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent. The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly -- whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her -- was assigned 20 patients with non-life-threatening conditions.
  • "The nurse-patient ratio is insane, the hallways are full of patients, most patients aren't seen by the attending until they're ready to leave, and the policies are really unsafe," Molly told the group. That's just how the hospital does things, one nurse said, resigned.
  • ...9 more annotations...
  • Unfortunately, that's how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios. Dozens of studies have found that the more patients assigned to a nurse, the higher the patients' risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital -- and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.
  • In pediatrics, adding even one extra surgical patient to a nurse's ratio increases a child's likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses' working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.
  • Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)
  • And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)
  • It's not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. "It happens all the time, and nurses are harassed into taking what they know are not safe assignments," she said. "The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up."
  • The landscape hasn't always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. "The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety," said David Schildmeier, a spokesman for the Massachusetts Nurses Association. "Absolutely every decision is made on the basis of cost savings."
  • Experts said that many hospital administrators assume the studies don't apply to them and fault individuals, not the system, for negative outcomes. "They mistakenly believe their staffing is adequate," said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. "It's a vicious cycle. When they're understaffed, nurses are required to cut corners to get the work done the best they can. Then when there's a bad outcome, hospitals fire the nurse for cutting corners."
  • Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans' Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union's reading of the mandate).
  • Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right. ☐
Govind Rao

Staffing low in Sask. long-term care: report | Video - 0 views

www.leaderpost.com/...story.html

from heather Saskatchewan ltc staffing

shared by Govind Rao on 28 May 15 - No Cached
  • REGINA — Care is good but there isn’t enough staff. Those are two common themes in Saskatchewan’s long-term care facilities, according to the 2014 CEO tour reports released Wednesday.In the Regina Qu’Appelle Health Region (RQHR), that paradox is apparent.
  • Without a more significant investment in staffing, it’s difficult for us to do anything across the board,” said Redenbach. “We think the care needs of long-term care residents is growing over time and that our staffing levels, although they’ve increased over time, have not increased at the same pace.”Staffing is also a highlighted issue in the Saskatoon Health Region report.
Irene Jansen

CUPE calls for 'adequate' staffing in seniors' care facilities | CTV News - 1 views

www.ctvnews.ca/...iors-care-facilities-1.1198307

Ontario ltc violence staffing cupe

shared by Irene Jansen on 18 Mar 13 - No Cached
  • A homicide in a Toronto seniors’ home is raising questions about long-term care home capacity in Ontario
  • A recent report from the province’s auditor general on wait times for beds in such facilities revealed a growing demand that is already taxing the system: the average wait is 98 days – a number that has almost tripled since 2005. The report also found that 15 per cent of people on long-term care wait lists die before ever receiving accommodation.
  • Tamara Daly, a Canadian Institutes of Health Research chair and an associate professor of Health at York University, said government should be addressing staffing levels at long-term care facilities, where workers are few and still overburdened by paperwork and government red tape.
  • ...4 more annotations...
  • there are fewer staff today in long-term care facilities than there were 10 to 15 years ago
  • “You have fewer staff, you have higher care needs and you have more paperwork,” Daly said. “So you kind of have a perfect storm.”
  • In a statement on the death of a senior attacked by another resident at Wexford Retirement Home in Scarborough, Ont., on Thursday, the Canadian Union of Public Employees (CUPE) renewed its appeal to Ontario’s health minister for increased care and staffing levels.
  • CUPE members who work in the sector say that often there is only one personal support worker overnight and 24 to 30 patients per floor, and one registered nurse for every three floors.
Irene Jansen

HCA, Giant Hospital Chain, Creates a Windfall for Private Equity - NYTimes.com - 0 views

www.nytimes.com/...ndfall-for-private-equity.html

us hospital hca fraud staffing quality corporation

shared by Irene Jansen on 22 Aug 12 - No Cached
  • profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared
  • The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
  • only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion
  • ...24 more annotations...
  • 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms
  • Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff
  • HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.
  • In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
  • inadequate staffing in important areas like critical care
  • Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
  • One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
  • Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.
  • “If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.
  • some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.
  • HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.
  • Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.
  • Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.
  • HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.
  • Nearly overnight, HCA’s patients appeared to be much, much sicker.
  • No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.
  • The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.
  • Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.
  • When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”
  • Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.
  • “Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.
  • HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.
  • an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities
  • The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.
Govind Rao

Nurses concerned about numbers; Worries centre on short-staffing and staff mix - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|relp|20150624|223423218

from heather Saskatchewan nursing union cupe lpn

shared by Govind Rao on 24 Jun 15 - No Cached
  • The Leader-Post (Regina) Wed Jun 24 2015
  • Nurses are raising concerns about staffing in Saskatchewan health-care facilities, in spite of an increased number of nurses working in the province. "We're really concerned around short-staffing," said Saskatchewan Union of Nurses (SUN) president Tracy Zambory. "There isn't enough registered nurses on the floor to provide safe care."
  • Further, she said the right staff mix is an issue. A Canadian Institute for Health Information (CIHI) report released Tuesday says there were 10,341 registered nurses (RNs) working in Saskatchewan last year. The number has increased every year since 2006, when 8,480 RNs were working in the province.
  • ...11 more annotations...
  • The number of licensed practical nurses (LPNs) has also jumped every year since 2005; last year saw the biggest increase, with 3,134 LPNs working, up from 2,842 the year before. There are more nurses, but you have to consider whether they're working full time, said Shirley Mc-Kay with the Saskatchewan Registered Nurses Association (SRNA), the regulatory body for the province's RNs.
  • In 2014, 59 per cent of RNs were full time, 26 per cent were part time and 15 per cent were casual. As for LPNs, 52 per cent were employed full time, 30 per cent part time and 18 per cent casual. Gordon Campbell, president of the CUPE Health Care Council, which represents LPNs, said the numbers have grown, but so has Saskatchewan's population.
  • "There's more people accessing long-term care, there's more people accessing acute care, hospitals, health centres," said Campbell. Zambory said RNs are regularly seeing an "inappropriate staff mix." "We have to look at having ... the right provider with the right knowledge and skill for the right patient at the right time," McKay agreed. "In certain situations, you may need the registered nurse. ... In other situations it may be different."
  • RNs provide guidance and help co-ordinate with other professions, including physicians, pharmacists and nutritionists, said McKay. In 2014, SUN members had 768 concerns relating to staffing levels.
  • In the General Hospital emergency department, Zambory said one RN sometimes looks after 14 patients due to short-staffing. Six patients per nurse is the norm.
  • At Wascana Rehab, one RN h
  • been responsible for 105 patients on two separate floors, said Zambory. Typically, at night, one RN and one LPN share the care of 60 to 80 people.
  • Santa Maria was the "worst-case scenario," she said, with one RN managing 147 patients on three floors.
  • At Pioneer Village, Zambory said, often on nights and weekends there is no RN on duty. Common practice calls for three RNs or LPNs to each care for upwards of 96 residents. "(RNs) have the critical thinking skills, we do the split-second decision making. ... We're not interchangeable (with other staff)," said Zambory.
  • "If you have an elderly person with complex (needs), chronic diseases," said McKay, "their health condition can change fairly quickly, so you need the ongoing oversight of the registered nurse to be there assessing the patient, anticipating some of the subtle changes."
  • Campbell said LPNs work within their scope of practice, can work without direction from a RN and can be in charge in some cases, like in long-term care. "Where there is the proper number of staff, regardless of who they are, it doesn't become an issue," said Campbell.
Govind Rao

Drugs are no solution to nursing home underfunding | Toronto Star - 1 views

www.thestar.com/...nursing_home_underfunding.html

from heather seniors ltc staffing funding drugs

shared by Govind Rao on 23 May 14 - No Cached
Tracey Pinder liked it
  • So it is paradoxical — some would say tragic — that nursing home residents are too often put on drugs they don’t need, which can be dangerous and may even kill them.
  • There is accumulating evidence that antipsychotic medication is used excessively in some nursing homes.
  • It also revealed that 33 per cent of Ontario’s nursing home residents are on an antipsychotic drug.
  • ...8 more annotations...
  • A recent report by the Canadian Institute for Health Information found that the odds that a senior person living in a Canadian nursing home will be given antipsychotics are nine times higher than for the elderly living in the community.
  • Ensuring seniors remain calm and easy to manage is not what residents suffering from dementia personally need the most from nursing homes, but this may be what nursing homes need from them. The evidence suggests that in several cases these facilities are using prescription drugs as a cost-effective way to deal with their residents’ unwanted behaviours.
  • Provinces typically express concern when such issues are raised. Policy-makers establish new guidelines, promise to better educate doctors and stakeholders and may even make data about drug use in nursing homes publicly accessible. Sadly, this has not been enough, as evidenced by the large numbers of seniors in these institutions who continue to take unnecessary medications. More — and different — action is needed to ensure an efficient response.
  • The evidence suggests that behavioural interventions and improved management of dementia can significantly reduce the need for antipsychotic medication. Such solutions require better designed, better equipped and better staffed nursing homes. How well prepared are we to provide these conditions?
  • The core problem lies in the largely insufficient funding levels for nursing homes at the same time that this sector is facing a rapidly growing demand for services. Significant investments will be needed for nursing homes even if the goal is limited to maintaining the status quo. Strong determination is needed from politicians and policy-makers if they seek to improve the current conditions.
  • There’s one thing we know for certain: using prescription drugs as a response to nursing home struggles with staffing shortages and insufficient resources is not a solution.
  • Better designed, better equipped and better staffed nursing homes are what the elderly need.
  • By: Nicole F. Bernier Published on Wed May 21 2014
  • Doug Allan on 23 May 14
     
    What a great column from the Toronto Star.  Drugs are not the answer -- better staffing is needed in LTC.
Govind Rao

Union, Horizon spar about potential job losses in centralized scheduling - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|frdg|20151017|231581910

from heather NB hospital cupe cuts admin

shared by Govind Rao on 19 Oct 15 - No Cached
  • The Daily Gleaner (Fredericton) Sat Oct 17 2015
  • The union that represents thousands of New Brunswick's front-line health-care professionals says a plan to centralize employee scheduling within the Horizon Health Network will cut jobs and reduce spending in some rural communities. However, officials with the province's largest regional health authority say job losses should be minimal and employees affected by the change may be able to move to keep their positions. Earlier this year, the Horizon Health Network announced that it would create a new dedicated scheduling team in Saint John that would help work units across New Brunswick schedule employee shifts, make arrangements for vacation time, and sort out which employees would be called in to work if a colleague called in sick.
  • The goal, say officials with the Horizon Health Network, is to remove unnecessary paperwork from the duties of managers in the field, standardize scheduling protocols at sites across the province, reduce payroll errors, and avoid potential union grievances by ensuring the proper distribution of overtime and call-in shifts. Robin Doull, Horizon's regional director of workforce optimization, said roughly 80 per cent of the health authority's staff will eventually be scheduled in this way by March 2017.
  • ...7 more annotations...
  • Doull said the project will begin rolling out in January, when certain staff members at the Miramichi Regional Hospital will start using the software developed for this initiative and working in collaboration with the scheduling team in Saint John. Ralph McBride, co-ordinator for CUPE Local 1252, said it's a shame the professionals who are currently scheduling staff at various sites across the province aren't able to keep those responsibilities. "We see this as taking away important jobs in rural New Brunswick and moving them to urban centres," he said. He said that based on what he's heard from the Horizon Health Network, between 17-20 health-care professionals working in Miramichi could be affected by this organizational decision.
  • "To lose 17-20 positions, to lose any positions out of the Miramichi, out of any rural setting and off to a place like Saint John, creates a hardship in that economy, in that area," he said. "I guess what the government failed to consider is that most of the people that are in these central scheduling systems are long-term employees. They've got stakes in their hometowns. That's where many have grown up. That's where they live. Some of them are 20-year employees, 25-year employees, 30-year employees. To ask somebody that's in their mid-50's to uproot and move is, I think, shameful and disrespectful."
  • Doull said that, to be clear, this decision to centralize staffing was made by the Horizon Health Network - not the Department of Health, as suggested by the union. "A couple of years ago we started on this in a preliminary way and it's now becoming operational for us," he said. Doull also denied that many positions will be in jeopardy.
  • "There are three staffing support clerks in Miramichi that are affected," he said, explaining that employees impacted by the move to centralized scheduling will have the option to move to Saint John and continue working there. "All employees who work in the staffing support clerk classification have the option to take a position in the staffing centre in Saint John. If they do not take the offered position, they may choose to 'bump' into another CUPE position, if they have the basic qualifications for the position and the person in that position has less seniority. Their right to 'bump' includes any position (as described) at any site in Horizon." McBride said he thinks the provincial government would have to be on board with a plan of this scope. "I believe the government is not wanting to be the forerunners of this so they're using the health authority to deliver a message," he said, explaining that there are already rumours more services - such as accounts payable - could be following suit in the months ahead. "Things don't happen in health care in New Brunswick without the Department of Health knowing. Somebody has to give the blessing on this."
  • The union representative said the changes will cause turmoil for work units across the province as, per the terms of the existing collective bargaining agreements, senior employees affected by the scheduling changes choose to bump junior colleagues out of other positions. "(The affected employees) will exercise their right to bump under the collective bargaining agreement. But somewhere down the line it's going to take away from the economy," he said.
  • McBride said that he hopes the new centralized scheduling program works effectively when employees begin using it in January, explaining that it was initially slated to kick off earlier. "There's going to be some stuff they'll have to work out," he said.
  • "This move was supposed to happen the first of November. But we got word (this week) that it had been delayed because there had been glitches in the system. It's like any software program, it's not been tested to its full extent. So there's going to be issues with it." It's too bad, he said, that the employees who were already working on scheduling staff at various sites across New Brunswick couldn't join the centralized scheduling team, yet remain at their initial site. "With today's technology, they should be able to do scheduling from any office, any facility in the province. They don't need to centralize them all into one location," he said.
Heather Farrow

Government orders review of seniors' care staffing | Hospital Employees' Union - 0 views

www.heu.org/...s-review-seniors-care-staffing

cupe bc hospital seniors ltc government

shared by Heather Farrow on 27 May 16 - No Cached
  • May 24, 2016 Guardian, spring 2016
  • The growing crisis in seniors’ care isn’t new. But after a week of sustained pressure in the media and the legislature in mid-April, B.C. Health Minister Terry Lake has ordered a review of staffing guidelines in the province’s residential care homes. HEU’s secretary-business manager Jennifer Whiteside is welcoming the review, and says the union will continue to call on government to legislate staffing levels that would ensure seniors get the quality and continuity of care they need.
Heather Farrow

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

shared by Heather Farrow on 03 Aug 16 - No Cached
  • The Hospital Employees’ Union (HEU) says improved staffing levels are key to addressing resident-to-resident aggression in long-term care facilities. The 46,000-member union is responding to a report on the topic released today by B.C.’s Seniors Advocate. In her report, Isobel Mackenzie recommends a review of staffing levels for residents with more complex care needs.
Irene Jansen

Canada News: Fire chiefs want sprinkler systems for seniors' homes, not body bags - the... - 1 views

www.thestar.com/...or-seniors-homes-not-body-bags

ltc assisted_living ontario standards staffing revera

shared by Irene Jansen on 12 Apr 12 - No Cached
  • Residents of many seniors homes in Ontario would die if a fire broke out because their buildings are short-staffed and lack sprinkler systems, according to a preliminary study by top provincial fire chiefs.
  • Roughly 24 retirement and nursing homes in 10 cities — including London, Kitchener, Niagara Falls and Huntsville — have been tested in mock evacuations and most failed
  • Ontario fire chiefs are frustrated with the province’s refusal to force homes to install sprinklers that would protect the elderly. The fire chiefs say their study is the latest effort in a long campaign to convince Queen’s Park.
  • ...18 more annotations...
  • Ontario seniors homes have the worst fire fatality record in North America with 45 deaths since 1980.
  • Four private members’ bills and three inquests have all recommended sprinklers.
  • Residences built after 1998 must have sprinklers but the devices are still not required in 4,000 older “care occupancies,” which house more than 200,000 seniors and other vulnerable people across Ontario including the intellectually challenged. The frail, elderly are more likely to die in fires than any other age group, experts say.
  • Madeleine Meilleur, Minister of Community Safety and Correctional Services
  • “Sprinklers are not the only answer. They are important, but nothing will replace the staffing levels and how they are trained in case of fire,”
  • There are never fire deaths in homes with sprinklers except in the rare case where a person who caused the fire is overcome by injuries, said Sean Tracey, of the U.S.-based National Fire Protection Association.
  • Toronto Fire Services is first conducting a survey of each care home in the city to learn the cognitive abilities of residents before conducting the mock tests.
  • Here is how the chiefs did the study: Firefighters visited a retirement or nursing home — sometimes without advance notice — and performed a mock evacuation based on the number of overnight staff when few employees are on shift. Firefighters ordered staff to conduct a fire drill. Using a stopwatch, they tested staff’s ability to move residents out of the building or behind a firewall
  • Oak Terrace long-term care home, a government-licensed nursing home operated by the Revera chain, failed a test in October 2010.
  • After fire officials sent a letter to each member of Revera’s board of directors, the home decided to install sprinklers
  • Revera has installed sprinklers in 85 per cent of its 200 retirement and nursing homes across Canada
  • Homes that fail mock evacuation tests are hit with legal orders under the Fire Prevention and Protection Act, telling them to hire enough staff to be able to safely evacuate 24 hours a day — or install sprinklers.
  • Sprinkler installation costs roughly $3 a square foot. That translates to $40,000 for a 30-person home or about $110,000 for a 155-person home.
  • Fragile residents, combined with inadequate staffing and the fiery nature of materials in modern furniture, like the foam padding in couches, are a recipe for disaster.
  • In 2010, a year after the Orillia fire killed four residents (and left two brain dead), the government began a consultation on fire safety. Meilleur said she expects the report will be released in June.
  • an early draft said most respondents (more than 230 comments came from firefighters, retirement homes, municipalities and advocates) agreed that sprinklers should be mandatory in all care homes.
  • “If 45 children had died in fires would we still be waiting for the government to take action?”
  • residents, some drugged for a night’s sleep
Irene Jansen

Hospital staffing, organization and quality of care Conference paper - 0 views

intqhc.oxfordjournals.org/...5.full.pdf

hospitals staffing fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Staffing affects quality of care. International Journal for Quality in Health Care. 2002.
Irene Jansen

October 2010. HEU. Higher staffing levels, continuity of care critical to attending to ... - 0 views

www.heu.org/...cal-attending-seniors-dementia

violence dementia bc ltc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The union says that a WorkSafe BC guide on preventing dementia-related violence being previewed in Vancouver today offers solid information for caregivers on interventions that can prevent or minimize the risk of on-the-job injury. But it’s only part of the solution.
  • The research is unequivocal, resident aggression and violence against workers is reduced when adequate staffing levels are in place and continuity of care is maintained
  • A 2009 Stats Canada study of long-term and acute care facilities across the country found a clear link between abuse from patients/residents and the workplace environment. And a 2008 York University study on violence in 71 unionized, public, long-term care facilities in Ontario, Manitoba and Nova Scotia found that short-staffing, workload, lack of supervisor support, and inadequate trainingto deal with mental health issues like dementia were contributing factors to violence at work.
1 - 20 of 265 Next › Last »
Showing 20▼ items per page