REPORT OF THE GERIATRIC AND LONG TERM CARE REVIEW COMMITTEE: UNFORTUNATE DEATHS

The 19th Annual Report of the Geriatric and Long Term Care Review Committee to the Chief Coroner for the province released in September 2009 reviews several unfortunate deaths and raises the issues we have been struggling to bring to the public's attention.

Specifically beginning at page 33 of the document which can be found at: http://www.mcscs.jus.gov.on.ca/english/office_coroner/PublicationsandReports/GeriatricReport2009/geriatric_care_review_report_2009.html, the Report notes:

"Over the last 20 years, the resident population in long term care homes has changed dramatically. There has been a significant increase in the proportion of residents with complex, chronic medical conditions as well as the high prevalence of dementia with both psychiatric and behavioural complications.

No amount of education and skill-building with long term care home staff can substitute for having an adequate number of staff available to provide the care and supervision to meet the care and safety needs of all of the residents, all the time."

"If there had been adequate staff on duty at the long term care home on the evening of the assault providing increased direct supervision, staff intervention may have prevented the resident altercation which resulted in the subsequent death. If there had been the ability to engage the woman and the other resident in direct supervision and distraction or other activities, the altercation and assault leading to the death may have been prevented."

"Recommendations:

1. Licensed long term care homes in the Province of Ontario are being asked to manage increasing numbers of elderly residents with dementia complicated with behavioural disturbances. Education and skill-building workshops within the existing staffing model are insufficient to assist the staff in meeting the care and safety needs of this resident population. Given the above, the Ministry of Health and Long-Term Care should urgently examine the issue of staff still[sic - skill] mix and staff to resident ratios for the purpose of ensuring that sufficient, adequate, appropriate, and safe care can be provided to elderly residents in licensed long term care homes."

In another case involving the subsequent death of an elderly resident of a retirement home awaiting placement in a long-term care home:

Upon review, it was evident that the private care home did not possess the expertise, care, and services necessary to provide for the woman’s significant care needs. Retirement homes have lower staffing ratios than long term care homes and it is hard to imagine how a private retirement home could meet the care needs of a resident like this woman without significant staffing enhancements.

The circumstances surrounding this woman’s death should alert health care professionals that, despite pressures to move the frail elderly out of hospitals to other settings, such as private care homes to await placement in a long term care home, it is important to remember that these elderly clients are awaiting long term care home placement precisely because their care needs are so heavy that they are difficult, if not impossible, to provide in a community, private care setting.

In another case involving the death of an elderly patient following transfer from acute care hospital to a convalescent long-term care setting:

"The issue of transferring frail, elderly patients from acute care hospital beds to convalescent care is a huge systemic issue in the Province of Ontario and is becoming increasingly problematic. The rationale for convalescent care appears to be the need to free up acute care hospital beds. The concept of convalescent care is excellent, but only if the convalescent care beds are appropriately resourced with adequate nursing and medical personnel and oversight. If convalescent care beds are not adequately resourced, the health and safety of frail, elderly patients will be in jeopardy as was the case for this patient."

We need to continue to advocate for minimum care levels and staffing standards to ensure there are far fewer occasions for a coroner's inquest or report into death in long term care settings.