Nfld. & Labrador

Nutrition problems at long-term care facilities outlined in AG report

Newfoundland and Labrador's auditor general's report outlined a number of issues around nutrition for residents at long-term care facilities in Eastern and Western Health centres.
Terry Paddon delivers his auditor general's report Thursday in St. John's, finding a number of issues with nutrition at long-term care facilities in Eastern and Western Health. (CBC)

Newfoundland and Labrador's auditor general's report outlined a number of issues around nutrition for residents at long-term care facilities in Eastern and Western Health centres.

Auditor General Terry Paddon released a report Thursday that looked at 10 different programs and Crown agencies, and which included 32 findings on nutrition in long-term care facilities at Eastern Health and Western Health.

A number of issues were found when it comes to nutrition for residents at some long-term care facilities, including a lack of consistent policies and meals that were not in accordance with Canada's Food Guide.

Long-term care facilities with Eastern Health and Western Health were covered in the review, with five facilities reviewed as a sample group and 55 resident files reviewed.

The report stated that while the Department of Health and Community Services developed operational standards in 2005, those have not been updated to ensure national best practices were incorporated.
The auditor general's report, released Thursday, looked at 10 different government programs and Crown agencies. (CBC)

The review found the department did not conduct a formal review of the operational standards every two years as required, and the two regional health authorities established policies and procedures for practices without guidance from the department, resulting in inconsistent policies.

When the review looked at a sample of resident medical files, it found admission checklists and resident care plans were not always completed, and needs assessment with the resident and their families were not always done.

At Eastern Health, there was no formal policy on feeding assessments, which is used to assess a resident's feeding capabilities and whether they required a referral to a dietician or therapist.

Initial assessments sometimes not done

Eight of 25 residents reviewed at Western Health did not have quarterly feeding screenings done, and two of those eight residents did not have initial assessments done upon admission. The report stated this could mean resident feeding issues were not identified or addressed.

The sample of files reviewed showed residents were not always weighed upon admission — or monthly — in accordance with the respective policies at Eastern and Western Health and as a result, unplanned changes in a resident's weight would not be identified in a timely manner.

At the St. John's Long-term Care Facility, residents were not always being assessed on a quarterly basis for the risk of pressure ulcers, as required by Eastern Health policy.

When it comes to the menus at two long-term care facilities involved in the review, the master menu was not always being reviewed and revised annually by a registered dietician, as required.

At four facilities reviewed, residents were not being provided with recommended daily food servings for each of the four basic food groups established in the national food guide.

As well, there was insufficient information about the meals being provided or failed to record what was served to residents at four of the facilities reviewed.

Prescribed meals often not delivered

Kitchen and dining areas observed at the five facilities reviewed were clean and regular inspections were performed, but issues around food safety training, temperatures, maintenance and cleaning schedules were identified.

Hygienic practices were put in place by the health authorities, but hand hygiene training and audits in the kitchens were not always being done.

When it comes to residents being provided with meals required, the review found 28 of 52 residents were not being provided meals prescribed in their dietary plans.

Residents were not always supervised while eating, another requirement outlined with the department's standards, as well as health authority policies.

In addition, nursing staff responsible for supervising residents while eating did not always receive annual training in foreign body obstruction.

Official complaints were only on file at the St. John's Long-term Care Facility, but Eastern Health staff indicated complaints were either reported verbally or through emails, but not tracked as required.

"As a result, we could not determine the true extent of complaints and whether the facility was responding to these complaints in accordance with … policy," the report stated.

The report recommends the Health and Community Services department should conduct a formal review of operational standards for long-term care facilities. Eastern Health and Western Health should also develop food and nutrition service policies and procedures consistent with those standards.

Both health authorities should ensure resident assessments are conducted, as well as ensure the meals on menu comply with Canada's food guide and are regularly assessed by a dietician.

Meals being provided to residents should be in accordance with their prescribed meal plans, and served at the appropriate temperature, the report states.

Other issues outlined

The annual auditor general's report reviewed several government departments and programs. Among the report's findings:

  • Significant questions were raised about how the Department of Transportation and Works hires external consultants. For instance, the audit found that provincial guidelines for hiring were not followed, and that the consultants were "not hired competitively through an open, fair, and transparent procurement process." 
  • Regional health authorities issued eight licence renewals to personal care homes, even thought "critical deficiencies" that had been flagged in fire and life safety inspection reports had not been corrected.
  • Half of 14 reviewed programs that offer financial assistance to businesses do not have documented objects, which made it difficult for auditors to determine whether they were actually working properly. 
  • The Department of Advanced Education and Skills spent $4.9 million to implement a case management system it had obtained from Nova Scotia, although the government wound up spending $14.2 million altogether to make the system meet the department's needs.

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