Change in long-term care homes requires holistic response
By Jennifer Brown, AdvocateDaily.com Senior Editor
If adopted, recommendations to address systemic failings identified by a public inquiry into long-term care homes in Ontario could result in new staffing models and improved medication management systems, says Toronto health lawyer Lisa Corrente.
The final report and recommendations of The Public Inquiry Into the Safety and Security of Residents in the Long-Term Care Homes System, led by Justice Eileen E. Gillese, was released July 31 in Woodstock, Ont.
“I think the Commissioner made recommendations that have the potential for strengthening the system to some extent,” says Corrente, a partner with Torkin Manes LLP. “What’s very important to effecting change is whether the provincial government will be taking steps to assist long-term care homes in implementing the recommendations they’ve been offered through increased funding and more flexibility in how to use that funding.”
Corrente participated in the inquiry, representing one of the nursing homes in which serial-killer nurse Elizabeth Wettlaufer murdered a resident.
In June 2017 Wettlaufer pleaded guilty to eight counts of first-degree murder for injecting residents of nursing homes in Woodstock and London with fatal doses of insulin between 2007 and 2014. She was sentenced to life in prison.
“An important result of this inquiry was the key findings that, had Wettlaufer not confessed, the murders would not have been detected, and that the offences were the result of systemic vulnerabilities. There weren’t any findings of individual misconduct,” Corrente tells AdvocateDaily.com.
Gillese’s final report noted that the long-term care system in Ontario is “strained, but not broken.”
In particular, Corrente says the recommendations made around education and training in the sector are important to prevention and detection and deserve consideration.
“The recommendations include the need to build awareness of this phenomenon of health-care serial killers, and that means training not only for long-term care staff but also for others in the sector such as Ministry inspectors, coroners and investigators with the College of Nurses,” she says.
Corrente also points to the recommendations made by Gillese for increased funding from the Ontario Ministry of Health and Long-Term Care for resources such as a pharmacist or pharmacy technician within the home, or to have automated dispensing cabinets that could address problems identified in the inquiry.
“I think her recommendations for increased funding — and flexibility around the way homes are able to use that funding — if adopted by the provincial government could have a positive impact on the way the system is structured. They would allow for broader staffing models and enhanced medication management systems that have not previously been available under the current legislation,” she says.
Currently, long-term care homes are required to have a pharmacy service provider — an external pharmacy that will go into a nursing home periodically to review medications and incidents — but they don’t physically have a pharmacy employee working in the home.
Nursing homes would benefit from having the flexibility to staff differently, with pharmacists or pharmacy technicians on site. Also, long-term care homes could use porters to accompany residents to and from meals or outdoors. A broader spectrum of staff would allow nursing staff more time to focus on direct resident care, Corrente says.
Gillese also asked for a return to greater collaboration between the province and nursing homes.
“Before the Long-Term Care Homes Act, there were compliance advisers, rather than inspectors, who would identify any non-compliance and also give advice. When the Act was introduced, the system changed to one of inspections and enforcement minus the advisory function,” Corrente explains.
For real change to happen, she says the recommendations that came out of the inquiry need to be addressed by all involved in the long-term care system.
“It’s not going to be enough for the individual homes to implement change. It has to be a response from all of the stakeholders, including the Ministry of Health, the College of Nurses, the coroner’s office and the others who were given recommendations,” she says.
This is the first instalment of Lisa Corrente and David Golden’s three-part series on long-term care homes.
Stay tuned for part two where Golden will discuss the top systemic issues the enabled Wetlaufer to continue in her role for years and part three where Corrente will explore best practices for LTC facilities around reference checking, incident reporting and investigations.