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

It is here, in a tightly packed maze of buildings in Seattle's First Hill area, that 880 Saskatchewan health care leaders flock to learn. With Virginia Mason as their model, the treks are part of a sweeping overhaul of how the provincial health system is managed. ....... Based on lean management principles, the goal is to constantly improve what they do with seemingly small steps that sound like no-brainers, but weren't happening before. ......... When Saskatchewan's health ministry decided lean management was the way to improve an ailing provincial health system, it did not dip a toe in the pool. It capsized a cruise liner into the ocean. One University of Saskatchewan researcher tasked with evaluating the initiative calls it "the biggest experiment worldwide in terms of implementing a quality improvement philosophy or approach like lean." The ministry is now two years into an up to four-year contract with Seattle-based consultants John Black and Associates. Black is their sensei, and if the ministry renews all four years of the contract, the province will spend nearly $39 million.

Dr. Mark Lemstra outlines the high price tag for Lean in Saskatchewan health care. "If you're not dead, you're going to end up in one of your health-care systems here in bed, with a tube up your ass and one down your throat. You're going to be saying to yourself: 'My God, I wish I could have asked John Black to come in and help improve my care.'" The words belong to consultant John Black of Seattle, who received $39 million over four years to reform Saskatchewan's health-care system using lean management practices. However, a private, for-profit American hospital that was close to financial ruin was hardly in the same situation as a publicly financed, not-for-profit Saskatchewan health-care system with a seemingly endless supply of taxpayers' money. even the Canadian Medical Association now concludes that at least 50 per cent of all health outcomes are due to social factors. Others suggest the number is as high as 75 per cent. Lean management obviously will not have any impact on social factors that cause disease.