The Ministry of Health and Long Term Care is sending inspectors out to conduct investigations which they are not educated and trained to do says the Ontario Public Service Employees Union. Nursing home residents are being placed at risk to save money on inspection.
OPSEU says prior to July 2010, when new laws came into force, nursing inspectors would investigate complaints and critical incidents including issues of abuse or activities of daily living, such as continence care, hygiene, behaviour management, wound management or falls. The nursing inspections require a review of clinical records, progress notes, medication records and a resident"s medical diagnosis.
The other two types of inspectors, dietary and environmental, would focus their inspections only on issues relating to their area of education and training.
“Now these dietary and environmental inspectors are being asked to evaluate the residents’ care records – which are completely out of their scope of practice,” says Warren (Smokey) Thomas, President of the 130,000 member OPSEU. “Not only that, but these inspectors have never had any training in how to navigate the various software programs the homes use in order to review the resident health records. They have little idea whether or not what they are looking at is relevant.”
Environmental inspectors are certified public health inspectors with expertise in infection prevention and control. They look at such issues as maintenance, housekeeping, infection control, safety, building security and pest control.
Dietary inspectors are registered dietitians with expertise in nutrition care and hydration, food production, menu planning and clinical record reviews related to weights and food and fluid intakes for example.
Meanwhile, the nurses are being asked to do inspections that include issues related to pest control, door security, maintenance and environmental infection control – an area of expertise normally covered by the environmental inspectors.
The inspectors say they have to rely heavily on their specialty discipline colleagues for assistance with their inspection reports, to ensure they have captured everything correctly. The inspectors become ultimately accountable for these reports.
“The government is trying to save money by sending inappropriate inspectors out to conduct inspections they are not trained for,” says Thomas. “This completely undermines the process.”
Last year there were nearly 6,000 complaints and critical incidents the inspectors were asked to investigate. That"s on top of the more detailed annual inspections – sometimes referred to as “resident quality inspections” (RQI) which take more than two weeks to complete. With the limited number of inspectors available, many homes will not receive a detailed inspection for years. Most homes in Ontario received their last full inspection prior to 2010.
Last week OPSEU reported the shortage of adequately educated and trained inspectors has led to lengthy delays in investigating these complaints and critical incident reports.
New legislation enacted in July 2010 requires the homes to report many different types of critical incidents such as abuse and injuries – all of which must be investigated. Coupled with increases in complaints regarding resident care issues, the number of inspectors has not kept up with the workload.