Statements on Long-Term Care Homes

Markhaven Home for Seniors

It is of utmost importance that the families and friends of our residents have confidence in the measures we have in place to provide a safe and home-like environment for the seniors who call Markhaven their home. Everything we do, each day, is about providing care to our residents.

In the latest email to us you have outlined several issues that concern us which are addressed in this response.

We understand that footage obtained from the family of a resident who passed away has been forwarded to you. To date, we have not seen this video recording.  We would request that you provide us with the footage so that we may review it and take appropriate action.  If warranted, we will share it with the appropriate authorities, so that they are able to investigate appropriately. We will cooperate fully in any investigation should that be determined to be necessary. We are charged by the Ministry of Health and Long-Term Care (MOHLTC) to ensure that we provide our residents with a safe and comfortable home. We have also reached out to the family and have asked them to share the video and to discuss their concerns further with us.

In the interim, and in accordance with our accountability to the Local Health Integration Network (LHIN) and the MOHLTC, we have reported the issues raised to the MOHLTC so that they are able to review the care in question as well.  There have been several reviews conducted already by independent medical professionals that determined that appropriate care was provided in this instance, but they did not have access to this new information.

You also shared with us several incidents relating to staff workload that you witnessed in the home of our residents. Markhaven provides a safe and comfortable working environment for all of our staff. Anyone in the LTC sector would agree that more staff are needed. We provide the best possible care for our residents with the funding received from the Ministry of Health for not for profit homes. Both major Long-Term Care Associations, organizations representing the sector, have put forward budget recommendations, which we endorse, on the need for increased funding for staff in homes across Ontario.

Lastly, I and industry colleagues with whom we’ve had discussions wish to express our collective concern about the manner in which Markhaven was entered and the audio/video recording of residents who call Markhaven their home without their knowledge or permission. We have an obligation to protect the 96 people entrusted to our care. In addition to their safety and comfort we are expected and obligated to protect their privacy. It is out of this concern that we request that in the future, the policies and protocols of Markhaven Home for Seniors are respected and adhered to; specifically that permission to enter the facility is requested in advance and that it occur only as accompanied by a staff member. This incident represents a breach of protocol and the resident bill of rights, which we are required to report to the MOHLTC.

Ontario’s Ministry of Health and Long-Term Care

Minister Elliott is committed to ensuring that residents in long-term care homes are safe and live with dignity, and takes these issues very seriously.

The Ministry of Health and Long-Term Care firmly requires all long-term care homes to provide appropriate levels of staffing to meet the assessed and changing needs of residents. Long-term care homes must have an organized program for nursing services and personal support services with a written plan. This staffing plan must provide for a staffing mix that is consistent with residents’ assessed care and safety needs and that meets the requirements set out in the Long-Term Care Homes Act, 2007 and Ontario Regulation 79/10.

Our government was elected to put the people of Ontario at the centre of a sustainable health care system. We will continue to listen to patients, families and frontline providers as we develop our long-term transformational health strategy. Together, we will create a health care system that works for the people of Ontario.

Newfoundland Central Health

Central Health has a resident-centred care approach for all its long-term care (LTC) residents. Bathing in LTC includes showers, tub baths, full body sponge baths, and/or bed baths. The type of bathing and frequency is dependent on individualized resident care plans, resident preferences, ability to participate in the activity, national and international standards, and best practices.

Residents in Central Health’s LTC facilities are provided with a full tub bath once a week. In addition, every morning each resident’s personal care and nursing care are provided by the bedside – including a full body sponge and/or bed bath. For LTC residents, full body sponge baths and/or bed baths have a number of benefits. This resident-focused approach to personal grooming is ideal for LTC residents who experience physical pain getting up and getting out of bed, may be disoriented and/or prone to falls due to lack of balance and strength, or have dementia (as the bathing activity is both physically and emotionally demanding).

Each resident’s care and service needs are, at a minimum, reassessed on a quarterly basis.

Central Health follows the Provincial Long Term Care Operational Standards for Newfoundland and Labrador

We are fortunate to have full staffing levels at all our long-term care facilities, which is consistent with staffing ratios in all of our 11 LTC homes in Central Health. Nursing care is provided on a 24-hour basis by Registered Nurses (RN), Licensed Practical Nurses (LPN), and Personal Care Attendants (PCA).  All staff have been trained in the Gentle Persuasive Approach, which is a core competency of the dementia care training model.

All residents in long-term care require a higher level of personal and/or medical care than can be provided at home or in personal care homes. Outside of that shared need, residents and their conditions and needs can differ greatly. That’s why Central Health has a resident-centred approach to care. Individual care plans recognize and respond to residents’ physical, psychosocial, spiritual, and recreational needs – recognizing the uniqueness of each resident as a person with a life story.

While some long-term care residents live with some form of dementia, this is not the case for all residents. To ensure that residents living with dementia are comfortably and respectfully care for, a number of techniques and approaches can be adapted. These can include bathing techniques (e.g. bedside bathing can be comforting, and reinforces a sense of security and dignity), adaptive clothing (e.g. zippered backs to reduce incidence of inappropriate undressing to ensure dignity and respect), non-pharmacological therapeutic interventions based on individualized assessed needs (e.g. a paintbrush and safe hand tools for a resident reliving an earlier carpentry career), and other evidence-based best practices.

Some residents living with dementia can be combative. This behaviour can escalate as the disease progresses, and can be challenging for the resident, caregivers, and other residents. Some residents with advanced dementia can experience severe behavioural and psychological symptoms. These residents live in the protective care units of our long-term care facilities.  Following the Gentle Persuasive Approach to dementia care, plans are in place to mitigate risks to self and others (other residents and staff). Regular safety checks/monitoring and risk-safety plans are developed and adjusted as a resident progresses in his or her dementia.

Central Health has implemented a Falls and Injury Prevention Program, which is an important component of the Healthy Aging Strategy. This program is based on components of the Canadian Falls Prevention Curriculum.