An investigation by Manitoba's auditor general found more than half of the province's 126 nursing homes failed to meet four of the five core standards of care set out by the government.

The homes failed by the end of last year to meet basic standards on the use of restraints, care plans for residents, medication reviews, security and staff education, Carol Bellringer said Wednesday.

While most homes met provincial safety standards, they didn't do as well in other areas, Bellringer said. She conceded the province's standards are tough.

"For example, use of pencil or whiteout on an integrated care plan would cause the integrated care plan standard to be assessed as not met," she wrote in her report released Wednesday.

"Similarly, a single staff member without fire safety training would cause the staff education standard to be not met."

Better inspection methods needed

Bellringer's audit also concluded the province needs to do a better job of inspecting nursing homes and enforcing its own standards.

Facilities are inspected once every two years, she said, but the province doesn't base the inspections on whether a home has had trouble meeting standards in the past. That means there's no consideration of whether some nursing homes "might be in need of more frequent visits than others."

Inspections are also scheduled in advance and conducted on weekdays. Bellringer recommended the visits be unannounced and conducted on evenings and weekends.

"Visiting some personal care homes without prior notice and at a variety of different times would allow the standards … team to observe different activities and staffing levels than they are able to observe by scheduling the visits only in advance and on weekdays," she wrote.

"These visits would provide an additional level of assurance on compliance with the standards."

Followup visits to ensure homes are doing a better job of meeting basic standards are also lacking, she said. Although the province promised unannounced followup inspections at 30 per cent of its nursing homes, Bellringer found only seven per cent of those visits had occurred by the end of last year.

Standards introduced 4 years ago

Health Minister Theresa Oswald said the province introduced a core set of standards four years ago and never expected all nursing homes to be able to comply right away.

"They were set very high — which is a good thing — and there were no expectations on anyone's part that every single one of those standards would be met 100 per cent immediately," she said. "They were a goal that we needed to work towards."

The province is taking Bellringer's recommendations seriously, Oswald added. It is increasing the number of unannounced visits to one-third of the homes in every region and beefing up followups.

"There is always room for improvement," she said.

'I would like to say nothing falls by the wayside because we are talking about caring for human beings, but care is compromised at times.' — Nicole Campbell, CUPE health care co-ordinator

The union representing nursing home workers said more frequent inspections aren't necessarily the answer. Nicole Campbell, the health-care co-ordinator with CUPE Manitoba, said homes are chronically short-staffed.

She said turnover is high and, when employees are ill, they aren't always replaced.

"I would like to say nothing falls by the wayside because we are talking about caring for human beings, but care is compromised at times," Campbell said. "Are they … [taken to the bathroom] as often as perhaps they should be? Maybe not."

But Real Cloutier, vice-president of long-term care for the Winnipeg Regional Health Authority, said staffing isn't the primary issue. He said homes are still adjusting to the new standards set out by the province.

When they were first introduced, Cloutier said most facilities weren't meeting the requirements when it came to use of restraints.

Now, he said homes are doing a better job of consulting families and residents before using restraints, including bed rails.

"Over the next three to four years, we should be able to get good compliance on these things," said Cloutier, who oversees 39 nursing homes. "The standards do have to be at a high level. If they're not, then you are not striving for excellence."

The problem of meeting standards for basic care isn't unique to Manitoba. Ontario's ombudsman is investigating how the province oversees its nursing homes.

An investigation last year by The Canadian Press found almost three-quarters of Ontario's 616 nursing homes that posted inspection results online violated some of the 400 general standards set out by the province — a proportion that hadn't changed significantly since 2004.