By the year 2029, nearly one in three Canadians will be over the age of 65. A recent British report paints a grim picture of the way seniors are cared for in British hospitals. The report has some serious implications for hospitals here in Canada.
In December 2010, the British Secretary of State for Health asked Care Quality Commission to look at the standards of dignity and nutrition at hospitals run by the National Health Service. Care Quality Commission is a government-funded arms length agency that is the independent regulator of all health and social care services in England. Its job is to make sure that care provided by hospitals, dentists, ambulances, care homes and services in people's own homes and elsewhere meets government standards of quality and safety.
Between March and June 2011, the Commission conducted one hundred unannounced inspections of hospitals. Overall, it found that forty-nine of the one hundred hospitals failed to provide good nutrition to elderly patients while forty hospitals did not offer dignified care.
At the latter hospitals, several deficiencies were uncovered. Patient privacy was often not respected. For example, curtains weren't properly closed when personal care was given to patients. Call bells were put out of the reach of patients or were not responded to in a reasonable period of time. Inspectors observed staff speaking to patients in a condescending or dismissive way. Both staff and patients told inspectors that there were not always enough staff with the right training on duty to spend adequate time giving care.
Regarding nutrition, the report did not look at the quality of the food served. Rather, it looked at the way the hospital assessed and monitored the nutritional needs of patients. Among the problems uncovered, seniors were not given the help they needed to eat, meaning they struggled to eat and in some cases were physically unable to eat. If they were unable to feed themselves, there was no guarantee they would be fed. This is especially relevant in seniors, given the high prevalence of strokes, arthritis and dementia, all of which can affect the senior's ability to feed themselves.
A nurse at one hospital said "Sometimes I am the only staff member to feed on the ward. How can I feed all these people?"
As well, patients were frequently interrupted during meals and had to leave their food unfinished. When they returned to the bedside, the food was cold, or the tray had been taken away.
If patients needed a special diet, frequently, they didn't get it. Many patients were not able to wash their hands before meals and as such received no assistance. A review of patients' case notes showed that most had "not received a thorough nutritional assessment and for those who had been identified as being at risk, care, goal and action planning was inadequate".
Although dietitians visit the wards regularly, their instructions were not always followed. One elderly patient was noted as malnourished on admission but not reassessed until 16 days later. Patients were not weighed when they should have been.
At one hospital, staff told how they sometimes had to prescribe drinking water on medication charts to ensure people get regular drinks.
The report is from the UK. Still, I have no doubt whatsoever that we have the same sorts of problems maintaining the dignity and nutrition of seniors admitted to Canadian hospitals. Canada is experiencing the same sorts of stressors as in Britain: an aging population, lack of hospital beds and a relative lack of health professionals.
In fairness, we do have oversight. Accreditation Canada is a not-for-profit, independent organization that conducts external reviews of the quality of care provided by hospitals, regional health authorities and other health care organizations. But hospital accreditations are announced in advance, giving them time to prepare, and doctors and nurses tend to be on their best behavior. While I have heard of unannounced inspections of nursing homes at the provincial level, these seem exceptional. Unannounced inspections and "secret shoppers" do not seem to be part of the culture of accountability in Canada.
To me, the main message for people who deliver health care here in Canada is clear. We already know that for seniors, being hospitalized can often make their already fragile health worse. For instance, we know that hospitalized seniors can become bed ridden rather quickly simply by not being permitted to walk on the wards. We also know that seniors are especially vulnerable to hospital-acquired infections.
The problems with nutrition uncovered in the UK report represent a third danger to hospitalized patients. The problems with dignity and respect affect both the emotional and physical well-being. If we're smart, we'll use the UK report as a wake-up call for the people who run things in Canada. As our population ages, the sorts of problems uncovered over there will only get worse here.