Blog | December 05, 2013

Study finds Alberta private facilities offer 30 per cent less care than recommended North American standard

By Matt McClure, Calgary HeraldAlberta’s private nursing homes are operating with staffing levels that are dangerously inadequate, says one of the continent’s top researchers into long-term care.Statistics compiled and analyzed by the Parkland Institute show that for-profit homes in the province offered nearly 30 per cent less care by registered nurses than the recommended minimum in a North American standard commonly used by the care industry.Charlene Harrington, a University of California at San Francisco professor who is lead author of the paper that established the standard of 45 minutes of registered nursing time per resident per day, said she was shocked to hear that Alberta regulations only require about 25 minutes and that private facilities averaged less than 33 minutes during the 1999-2009 time frame.“That’s pretty dangerous,” Harrington said in an interview.“There are hundreds of research papers that show that when you have staffing levels that low you’re going to have lots of…instances of neglect.”The comments come in the wake of a provincial investigation that found a private facility in Calgary left a 73-year-old resident in a soiled diaper for two days earlier this year despite the fact she was suffering from bed sores.Violet MacDonald later had to be rushed to hospital with severe blood poisoning after staff at McKenzie Towne Care Centre failed to change the dressings on the oozing, putrefying sores for a further two-day period.An investigator under Alberta’s Protection of Persons in Care Act found the Revera Inc. facility had failed to provide MacDonald with necessary medical attention, although her report did note the woman’s suffered from mild dementia and occasionally refused care.“It’s no excuse to say a patient refused care,” Harrington said.The PPIC director ordered McKenzie Towne to revise it policies on wound management and geriatric mental health assessment.Daughter Cassie Liska said her mother never fully recovered from the severe septicemia she suffered last February, and remained bed ridden until her death in late October. No cause of death has been provided to the daughter.“If individuals made mistakes they ought to be held responsible,” said Liska, “but my larger concern here is the system that failed my mom.”The Parkland Institute report released earlier this month also uses Statistics Canada data on overall nursing home staffing to show that private operators in Alberta have far fewer people to care for ailing seniors than do non-profit or publicly operated facilities.The North American standard developed by Harrington’s team calls for a minimum of nearly 250 minutes of direct care by nurses and aides per resident per day, while Alberta’s regulations only appear to mandate 114 minutes.During the decade-long time frame of the study, private nursing homes in the province averaged 176 minutes, or 30 per cent less than the recommended minimum.Not-for-profits averaged about 205 minutes and publicly-run homes, like those run by Carewest, averaged 246 minutes.“Violet MacDonald’s case is a tragedy,” said study co-author David Campanella, “but it’s no surprise that it happened at a for-profit facility in Alberta.”Alberta Health Services, which funds and inspects nursing homes, said individual providers determine how many and what type of employees they need to meet care standards set out in their contract.It said targeted monies provided to care facilities between 2006 and 2009 allowed the average amount of care in all nursing homes in the province to rise to 216 minutes per resident per day.There were 141 cases of abuse like Macdonald’s in the province’s care facilities in 2011-12, but it’s not known how many occurred last year because PPIC’s annual report has not yet been released.Wildrose critic Kerry Towle lambasted the provincial health department for the overdue numbers.“These cases of abuse are incredibly serious,” Towle said in a prepared statement, “and Albertans and the ministry should be aware if any trends, negative or positive, are occurring.”Health Minister Fred Horne dismissed suggestions Tuesday that nursing home residents are suffering because private providers are skimping on staffing.But he told reporters he did telephone Revera’s chief executive, Jeffrey Lozon, at his Toronto-area head office to express his dismay at MacDonald’s care.“Regardless of whether someone refuses treatment, there’s absolutely no excuse in this province for an outcome like we saw,” Horne said.“If the review I’ve asked for determines we don’t have people…who can deliver what Albertans expect and deserve, I will find new providers and put them in place.”Patricia Pelton, acting chief executive of the Health Quality Council of Alberta, said Horne has not yet asked her watchdog agency to assess Revera’s performance or the staffing levels mandated by government at nursing homes and overseen by Alberta Health Services.“We’re still scoping out our terms of reference,” said Pelton, “but the letter from the minister asks us to look at monitoring and the adequacy of quality assurance processes used by AHS in its delivery of continuing care.”Wholly owned by the federal government’s Public Sector Pension Investment Board, Revera is the retirement fund’s single largest real estate asset. The company operates 242 retirement and long-term care centres around the continent, including 15 in Alberta.Joanne Dykeman, Revera’s vice-president of clinical services and quality, said the McKenzie Towne facility reports quarterly to AHS on its staffing levels.“The home follows and meets the accountabilities required,” Dykeman said.“Every senior care provider in Canada would likely tell you they need more funding, but we also respect the limitations…and certainly our job doesn’t change based on resources.”Since MacDonald’s incident, she said AHS’s annual reassessment of McKenzie Towne’s mix of cases resulted in a funding reduction that forced the facility to reduce the number of health care aides it has to care for about 150 residents.Dykeman was unaware if police had been notified of MacDonald’s case, but she said she did know they are “working very closely with PPIC” on the implications of its report.She said AHS plans a monitoring review of the McKenzie Towne facility shortly.“This incident was very troubling and as a provider we take it very seriously,” Dykeman said.“We welcome this oversight and we’re committed to quality and continuous improvement.”AHS officials said they have staff at McKenzie Towne reviewing the facility’s operational [email protected] files from Darcy HentonRead the article at The Calgary Herald.