Just the Facts: Wrklad Issues in Lng-Term Care At SEIU-West, we believe in having an engaged membership. In anticipatin f the Saskatchewan electin n April 4, 2016 we have identified several key issues that matter t yu, yur families and cmmunities. Just the Facts sheets n thse issues are part f the infrmatin, educatin and tls we ffer t help yu make infrmed chices abut vting and getting invlved in the electin. Saskatchewan s lng-term care system is under strain. Lng-term care (LTC) in Saskatchewan: sme facts and figures. LTC = Facility where staff prvides residents (mainly senirs) with significant care, supervisin, and/r assistance that enables them t live as independently as pssible. i.e. desn t include assisted living hmes, where residents prvided nly with husekeeping & meals (these are nt licensed r regulated by the Ministry f Health). Under Sask. law and practice, tw main types: 1. Persnal Care hmes Mre than 250 currently licensed; ttal authrized capacity 3600 residents. Owned & perated by individuals, nn-prfits, and fr-prfits. Nt gvernment funded; lw-incme senirs get Persnal Care Hme Benefit t help cver fees. 2. Special Care hmes: the fcus f this Just the Facts sheet Abut 150 (+ 17 LTC units in hspitals/health centres). Mre than 8700 residents. Owned and perated by either: Health regin Health regin affiliates (nn-prfits, ften church-cnnected) Fr-prfit cmpanies (Extendicare) Funded by health regins: Ministry f Health gives annual perating grant t health regin; regin then decides (based n a frmula) hw much f it t give t LTC facilities. In sme cases these funding frmulas have nt been updated in 20 years, and d nt reflect the current mix and care intensity levels f the residents. Generally, special-care hmes have mre residents, with greater needs, than persnal care hmes. LTC needs and wrklads are rising, but funding fr staff is nt keeping up. In the past 5 years the number f peple in Sask. aged 85+ has increased by mre than 1000. Mre than 500 f these new elderly live in Saskatn Health Regin an increase f 8%. LTC residents have mre acute, cmplex care needs than in the past, which LTC facilities and staff ften struggle t cpe with. Each year in Sask., mre than 3,000 new cases f dementia are diagnsed. It is estimated that 22% f Sask. residents aged 85+ have dementia.
Sme f these increased care needs are due t a shift in care philsphy that places the needs and wants f residents and their families first (treat facilities mre like hmes, respecting residents chice t live at risk ). There is significant evidence frm staff including stries frm SEIU-West members, residents and families, that these factrs have cntributed t increased wrklad, and that a lack f staff is having a negative impact n the quality f care. LTC facilities are hazardus wrkplaces and shrt-staffing is making things wrse. Increased LTC wrklad is impacting the health and safety f LTC staff. SEIU-West analysis f Sask. Wrkers Cmpensatin Bard (WCB) data suggests that LTC wrkers have sme f the prvince s highest rates f back injury and injuries due t assaults. In ur submissin t the 2015 WCB Cmmittee f Review, we shared this analysis, as well as ur finding that the scientific literature shws that wrklad and staffing levels are significant factrs in the incidence and severity f wrkplace injuries. Shrt-staffing has been fund t increase a health care wrker s risk f being the victim f patient/resident/client and visitrperpetrated vilence, as well as their risk f experiencing back pain. Rule changes in 2011 made it easier fr LTC emplyers t get away with shrt-staffing. Until 2011, regulatins gverning special care hmes in Sask. required that facilities caring fr residents needing: Intensive persnal r nursing care (Level 3 r higher) had t have enugh staff t prvide each with at least 2 hurs/day f that care Only assistance with the activities f daily living had enugh staff fr at least 45 mins/resident/day f that level f care Only sme guidance and supervisin had enugh staff t prvide at least 20 minutes f care per resident per day Althugh nt perfect, and bviusly nt adequate, these rules at least prvided a minimum staffing baseline. Hwever, n June 1, 2011, the Saskatchewan gvernment replaced the regulatins with Prgram Guidelines fr Special Care Hmes. All the Guidelines say abut Staffing Requirements is that each facility must ensure the prvisin f quality resident centred care that meets the assessed care needs f the residents, including the expectatin that quality utcmes, quality f care needs and the quality f life needs f residents be cnsidered the pririty when staffing. Accrding t ne Ministry f Health fficial, these changes were made because the ld staffing standards were increasingly nt being met due t the grwing intensity f LTC residents care needs. In ther wrds, rather than prvide the funding needed t meet and enfrce the standards, the gvernment gt rid f them. Mst f the ther requirements f the prgram guidelines cannt be met withut adequate staff t perfrm the necessary tasks. LTC regulatins in Alberta still cntain measurable staffing baselines: LTC facilities are required t prvide an average f at least 1.9 paid hurs f cmbined nursing and persnal services per resident per day. Alberta backs up this regulatin with funding that ges well beynd the minimum: enugh fr 3.6 hurs f care per resident-day, plus an additinal 0.4 hurs per day fr paraprfessinal services such as physical therapy and scial wrk. 2 f 5
2013-16: the gvernment struggles t cpe with a series f grwing prblems. 2013 After mnths f news reprts and public criticism abut the pr state f LTC the Health Minister rdered all health regin CEOs t visit all LTC facilities in their regins and reprt back n the mst pressing cncerns. The CEOs reprts all mentined inadequate staffing, especially t bathe residents mre than nce a week and t respnd t tilet calls in time. The gvernment respnded by creating a $10M Urgent issues actin fund, t act n the mst pressing issues identified in the CEO reprts. Regins culd apply fr mney fr additinal staff and/r equipment such as patient lifts. A small amunt even if spent nly n hiring staff, wuld add abut ne additinal emplyee per special-care hme. Regins ttal requests exceeded $10M. Saskatn Health Reginal asked fr 38 mre care aides, but the gvernment gave them enugh fr just 19. 2014 Mre news stries and criticism, especially regarding a resident s death at Santa Maria LTC facility (Regina). Gvernment asked Ombudsman t investigate the death. By January 2015, the Ombudsman had received s many cmplaints invlving ther facilities that she decided t expand the investigatin t cver the prvince s entire LTC system. By April 30, 2015 had received 89 submissins, including a 50-page brief frm SEIU-West based n cnsultatins with ur members. Highlights f ur brief: Aggressive residents are becming a grwing cncern. Care staff skipping breaks and vacatin time due t their bjective f prviding care, leading t burnut and increased use f sick time. Baseline staffing levels, already t lw t meet residents needs, are regularly nt being met. Shrt-staffing especially cmmn at night: ften nly tw care prviders Licensed Practical Nurses (LPNs) and/r Cntinuing Care Assistants (CCAs) fr 49 residents. Already verwrked CCAs are expected (under new care mdels) t perfrms tasks frmerly dne by Fd Services, Laundry, and Envirnmental Services wrkers. Shrt-staffing and wrklad pressures are preventing prper rientatin f new staff: If I dn t have time t d my wn jb, hw can I train yu t d yurs? May 2015: Ombudsman issues her reprt: Based n what we heard frm lng-term care staff, management and families, Saskatchewan s lng-term care system appears t be under strain. It is nt clear whether the system is structured t meet the needs f residents in lng-term care nw and in the future. Health Ministry is nt ding enugh t ensure that the Prgram Guidelines fr Special Care Hmes are being met and applied cnsistently and equitably acrss the prvince. Gvernment needs t develp and make public a LTC strategy fr the prvince, that answers questins like: Hw many CCAs shuld there be? Shuld there be minimum care hurs? D LTC facilities receive enugh funding t t supprt the level f care required in the Guidelines? The gvernment seems t have largely ignred Ombudsman s strngly-wrded recmmendatins. Nne f the stated gals, key actins, r perfrmance measures in the Health Ministry s Plan fr 2015-16 directly and specifically target wrklad issues in LTC. Instead, the fcus is n new and expanded hme care pilt prjects. 3 f 5
The future: mre and better funding and staffing fr public LTC, r increased (privatized) hme care? Medicare was riginally designed with a fcus n care prvided by dctrs r in hspitals. LTC utside hspitals is nt seen as medically necessary under the Canada Health Act, s ften gets shrt-changed in prvincial gvernment funding decisins. Gvernments are increasingly interested in aging in place strategies that transfer attentin and mney frm LTC t hme care. This is seen in Sask. Health s mst recent strategic plan. The new federal gvernment has als made hme care ne f its tp health pririties. But even if hme care is greatly expanded and imprved, we will still have grwing needs fr facility-based LTC. Private, fr-prfit cmpanies are lbbying t be allwed t step int the LTC gap. The Sask. gvernment has been pening the dr t greater private-sectr invlvement in the building and running f LTC facilities, e.g.: Samaritan Place LTC facility in Saskatn. Opened in 2012. The result f a P3-like arrangement that was criticized by the prvincial auditr fr its secrecy. Swift Current LTC facility. P3, annunced in 2013, currently under cnstructin. Privatizatin is als creeping int the gvernment s hme care strategy: the Health Ministry is expanding its experiments with Individualized Funding Plans, where, instead f being served by a health regin/public emplyee, persns in need f hme care are given funding t arrange their wn supprt services, including recruiting, hiring, and firing their care staff. What Can I D?? Get invlved! Share this infrmatin with family, friends and cwrkers, and use it t start cnversatins abut the issues. Ask questins f the candidates and ther plitical party representatives wh cntact yu abut the issues raised in this Just the Facts sheet. Becme invlved with the party r candidate whse psitins n these issues best serve the needs f yu and yur cmmunity. Write a letter t the editr t yur lcal paper t share infrmatin n issues affecting yur cmmunity. Use scial media t share facts abut issues that matter during the electin. Fr mre infrmatin abut becming mre actively invlved, visit www.purplevtes.ca. Selected Surces Saskatchewan Ministry f Health. Cmmunity Care Branch. CEO Turs f Lng-Term Care Facilities. http://www.saskatchewan.ca/gvernment/gvernmentstructure/ministries/health/ther-reprts/ce-visits-t-lng-term-care-facilities Saskatchewan Ministry f Health. Prgram guidelines fr special-care hmes. http://tinyurl.cm/zaa3dbk 4 f 5
Taking Care: An Ombudsman investigatin int the care prvided t Margaret Warhlm while a resident f the Santa Maria Senir Citizens Hme. Ombudsman Saskatchewan. May 2015. https://www.mbudsman.sk.ca/uplads/dcument/files/taking-care---reprt-en.pdf Fr further infrmatin abut this tpic, including details abut the surces f the infrmatin n this fact sheet, please cntact Karman Kawchuk, Research Officer, SEIU- West, at karman.kawchuk@seiuwest.ca. 5 f 5