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Sources say the provincial Liberals are pulling the plug on yearly inspections at more than 500 homes, just three years after they were found violating their own inspection law

Posted: June 28, 2016

(June 28, 2016)

Author: Jonathan Sher, The London Free Press

Three years after it vowed to do more to protect nursing home residents, Ontario’s Liberal government is quietly pulling the plug on yearly inspections at more than 500 homes, Postmedia has learned.

Starting next week, 84% of Ontario’s 630 long-term care homes will get a full inspection just once every three years, say sources that include the Ontario Long Term Care Association, which met last Thursday with bureaucrats in Ontario’s Health Ministry.

“We’re very pleased the Ministry of Health listened to our sector,” Association chief executive Candace Chartier said.

In the two-thirds of years that they don’t get full inspections, home will face inspectors with half the manpower, half the time and new limits on what they can do, sources say.

Inspectors who interview 40 residents at full inspections will only be able to question 20 and will no longer be permitted to interview members of family councils at the homes.

Many of the key activities inspectors formally observe in full inspections will be out-of-bounds, including security, emergency plans, quality improvement, staffing levels, personal support services, dining and home responses to aggressive residents, hospitalization and changes in health conditions.

The changes pleased Chartier, who said the annual inspections drained too much time and resources from nursing homes and the ministry alike — the time saved can be used in other ways to improve care, she said.

But an advocate for the elderly says the Liberal government has taken a step backwards from its 2013 pledge to protect residents of nursing homes.

“I’m very concerned about the changes,” said Jane Meadus of the Toronto-based Advocacy Centre for the Elderly. “There will be more issues at homes because there will be less eyes on those homes.”

The changes landed in the lap of Health Minister Eric Hoskins two weeks ago, when Premier Kathleen Wynne shuffled her cabinet and assigned him responsibility for nursing homes that had been looked after by an associate minister, Dipika Damerla.

Asked by Postmedia if fewer full inspections would harm residents of nursing homes, Hoskins issued a statement, writing changes were needed but nothing had been finalized — the latter claim at odds with what the Long Term Care Association says it was told by ministry officials at last week’s meeting in Mississauga.

“Our government is committed to ensuring that Ontario long-term care homes are both safe and accountable, (which) is why we mandated annual resident quality inspections in every home and in the past year added 100 new inspectors,” Hoskins wrote.

“Moving forward, all long-term care homes will continue being subject to an annual (inspection). We are currently working with our inspection team and consulting with external partners on ways that we can strengthen this program.”

But Meadus suspects the scaling back of inspections is about cutting costs, not protecting patients — the ministry doesn’t have enough inspectors and doesn’t want to spend more to hire more.

“It’s because they are not able to (do full, annual inspections) with the staffing they have,” Meadus said.

It’s not the first time a Liberal health minister has been singed defending how nursing homes are inspected.

Hoskins’ predecessor, London North MPP Deb Matthews, claimed for nearly a year that no full inspections were required even though her government in 2010 passed a law that required just that.

Matthews reversed course in 2013 after Postmedia showed her claim was at odds with her government’s law — she announced the ministry would spend $12 million to more than double the number of inspectors.

“We’re renewing our commitment to annual, proactive inspections, and adding enough new inspectors to get the job done,” Matthews said in 2013.

But her additions weren’t enough. While each home received a full inspection last year, that stretched inspectors so thinly they delayed by months investigations into critical incidents and complaints by some of the homes’ nearly 78,000 residents.

“Backlog of inspections triggered by complaints and critical incidents doubled between December 2013 and March 2015, from 1,300 to 2,800,” Ontario Auditor General Bonnie Lysyk wrote last year.

Lysyk also noted the ministry had inspected many homes with better track records before it inspected those with worse track records, suggested the priority should be switched and recommended analyzing how frequently full inspections should be done.

But rather than inspect higher-risk homes more often, the ministry has opted to inspect so-called lower-risk homes less often — a perilous decision, Meadus says, because it’s difficult to determine which homes are the riskiest.

Some homes trigger fewer complaints because vulnerable residents can’t speak up for themselves. “It’s very difficult to tell, based on statistics where the problems lie,” she said.

— — —

‘Lite’ inspection

Starting next week, Ontario’s health ministry will scale back inspections of 84% of the province’s 640 long-term care homes. Instead of a full inspection every year, they’ll get one every three years. The other two years, inspectors will do a “lite” inspection:

— Two inspectors visit the home rather than three or four.

— Five-day inspections rather than two weeks.

— 20 interviews of residents rather than 40.

— Many areas formally probed with full inspections won’t with lite inspections, including security, emergency plans, quality improvement, staffing levels, personal support services, dining and home responses to aggressive residents, hospitalization and changes in health conditions.

— — —

A brief history

2010: Ontario’s Liberal government enacts law to protect residents of nursing homes whose cornerstone would be annual, comprehensive inspections.

2010-2013: 80% of nursing homes don’t get a full inspection; then-health minister Deb Matthews defends the inaction, claiming her government never promised full, annual inspections

June 3, 2013: Under pressure from The Free Press, Matthews admits her ministry has fallen short of expectations. A week later, she says her ministry will spend $12 million to more than double the number of inspectors and do full inspections every year.

2015: Inspectors are so busy doing full, annual inspections, they fall months behind responding to critical incidents and complaints.

July 4, 2016: Health Ministry will exempt 84% of homes from full, annual inspections; they’ll get a full inspection once every three years and a “lite” inspection the other years.

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