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
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
“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.