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Dr. Jon Gerrard (left); Dr. Malcolm Doupe

By BERNIE BELLAN
Note: For the purpose of brevity, personal care homes will often be referred to as PCH’s in this article.
There are 39 PCH’s in the city of Winnipeg.
On November 23, River Heights Liberal MLA Jon Gerrard hosted a forum at the Corydon Community Centre (River Heights branch) the subject of which was “Improving Care and Preventing Tragedies in Personal Care Homes”.

 

 


In deciding to hold this forum, Dr. Gerrard wrote on his Facebook page: “Aging is an irreversible process. It is important that we, as a society have adequate plans for seniors care, even going so far as to consider that at some point we will all very likely be seniors ourselves. We must ensure that these plans are flexible so that there is the opportunity for seniors of all ages and varied health conditions to receive the required appropriate, compassionate and necessary care they deserve. “A number of issues have been raised recently in the media and through my office about some of Manitoba’s personal care homes. I have heard from too many constituents and other Manitobans of indignities, poor care, and even tragedies in personal care homes here in Manitoba. We need to address these issues and make sure our seniors have quality, respectful care.

Despite my not having any close relatives currently living in a PCH, nor having any particular reason to think that there is something terribly amiss with regard to PCH’s in Winnipeg, I was curious to hear what others might have to say on the subject.

At the same time, there is not a “Jewish” aspect to this article per se. I did consult with certain staff members at the Simkin Centre to ask for their input on certain issues that were raised during the course of my doing research for this article – but only because I happen to know those individuals and sought their input, not because I was concerned that any of the issues raised at the forum related to the Simkin Centre any more than they did any other Manitoba PCH.

As it was – and as I expected, I heard a number of horror stories from some of the individuals who appeared on the panel Dr. Gerrard had gathered – and from some audience members.
The danger in attending a forum of this sort, however, is that statements made by participants can be inflammatory and it is easy to be swayed into thinking that problems which may very well exist in certain PCH’s are widespread across the board.
Participants in the panel that Saturday afternoon included: Connie Newman, Executive Director, Manitoba Association of Senior Centres; Michelle Gawronsky, President, Manitoba Government Employees Union, (also a long-time health care provider in PCH’s, hospitals, and Emergency Medical Services); Dolores Minkus-Hofney, daughter of a parent in a PCH; and Robert Rose, son of a parent in a PCH.

Rather than write a condensed report of what was said, however, I thought it important to touch on two issues that were broached during the discussion: The problem of over medicating seniors, and the difficulty in obtaining information about individual PCH’s.
At the outset, I must establish that no names of any PCH’s were ever mentioned the entire afternoon, even though some serious charges of abuse of residents were leveled by some panelists and audience members.
One panelist in particular, Robert Rose, related a horror story of abuse having to do with his own father that was nightmarish in his telling. Mr. Rose referred to his having dealt with the office of the Public Trustee of Manitoba and leveled some quite serious accusations against that office. I’m not sure whether Dr. Gerrard or anyone else has followed up with what Mr. Rose had to say about the office of the Public Trustee but, if what Mr. Rose had to say is true about how terribly both he and his father were treated by that office, then there should be some sort of inquiry initiated. (Without going into detail, Mr. Rose claims that the director of the PCH at which his father was a resident was fired after that director took it upon himself to reduce the number of medications Mr. Rose’s father was being administered, but without first consulting with the office of the Public Trustee – which had responsibility for Mr. Rose’s father.)

During the course of the panel discussion reference was made to an article published in the National Post (in October 2016) titled “More is not always better: More drugs mean seniors more likely to land in hospital, says study”
The first line of the article reads: “The risk of an elderly person ending up in an emergency department climbs with each additional medication they take, U of T researchers say.”
One of the panelists noted that over medicating of PCH residents “leads to dizziness, confusion, and falls – leading to more prescriptions” in what eventually becomes a “prescription cascade”.
As another panelist said, “when you visit a personal care home and see scores of people starting into space, you assume they have dementia, but how many residents in personal care homes don’t have dementia, but are simply overmedicated?”

If some PCH’s are abusing residents by over medicating them, however, how is anyone to know that – other than relying on anecdotal evidence?
During the course of the afternoon Dr. Gerrard referred several times to a study conducted by Dr. Malcolm Doupe of the University of Manitoba.
According to the university’s website, “Malcolm Doupe is an Associate Professor in the Department of Community Health Sciences, Faculty of Health Sciences, College of Medicine, and a Senior Research Scientist with the Manitoba Centre for Health Policy…Dr. Doupe conducts research in the area of health services utilization and the aging population, investigating risk factors of home care and nursing home use, factors that influence quality care and changes in functional status in nursing homes, and issues related to care continuity for older adults.”
In March of this year, the Manitoba Centre for Health Policy released a lengthy study of PCH’s in this province titled “Strategies for Developing a Personal Care Home Report Card in Manitoba”.
That study noted that “One-quarter million Canadians and 1.4 million U.S. citizens reside annually in personal care homes (PCHs). By 2030, the overall number of people 75+ years old living in both Canada and the U.S. is expected to double. This population growth has enormous implications for future PCH use and is compounded by the fact that people are now admitted into PCHs much later in life and sicker than they were in the past. Assessing the quality of care provided to these frail individuals is of utmost importance.”
The study goes on to recommend that a website be “designed to help people identify PCHs where they or their loved ones would like to live, and to facilitate discussions between residents and providers about the goals of PCH care.”
The study’s authors admit throughout the study, however, how difficult it is to compare PCH’s across a broad spectrum of criteria. What they also say though, is that information that is available about PCH’s is often technical in nature and difficult for the layperson to understand – especially in a time of “duress”, which is often the case when family members are forced to decide whether to place a loved one in a PCH – and, if so, where?
Here is what the study noted comes into play when the average individual is thinking about choosing a PCH: “…users would like more knowledge about the facility layout (e.g., the overall structure and availability of private rooms), food (e.g., quality and whether it is prepared on site, flexible meal times) and laundry policies (e.g., outsourced or conducted on site), plus information on recreational activities and medication practices (e.g., the use of sedatives.)
“Similarly, under the heading of ‘staffing’, Hefele et al. (2016) report that respondents would like to know more about specialized training, certification, background checks, whether more staff work at certain times of the day (e.g., mealtimes), and greater knowledge about how staff treat residents. User groups also stated that more resident feedback (e.g., via satisfaction surveys or anecdotal stories) would be particularly useful. Encompassing these and other themes is people’s desire to learn more about the facility gestalt (e.g., a clearer picture of life in the PCH, for example by describing whether residents are actively engaged or spend most of their time sitting idly).”

Granted, it’s extremely difficult to offer fair and comprehensive comparisons of PCH’s in Manitoba. But, when I did a Google search using the words “personal care homes evaluations Manitoba”, do you know which was the only PCH to offer its standards review for anyone to study the full results? Answer: The Simkin Centre.
In 50 pages of evaluation of endless criteria, the Simkin Centre met all measures upon which it was assessed. Now, in case you’re thinking that the entire purpose of this article was to paint a glowing picture of the Simkin Centre – it wasn’t. I didn’t go searching for any sort of evaluation of the Simkin Centre any more than I was searching for an evaluation of any other PCH in Winnipeg. I was just more than a little surprised to see the Simkin Centre’s evaluation review published online – when I was unable to see a similar evaluation for any other PCH in Winnipeg.


That being said though, perhaps it was unrealistic of me to expect to see PCH’s report what amount to report cards on a wide range of very technical criteria. Still, if all PCH’s were required to publish the results of their standards reviews, one might be able to obtain at least a cursory view of how they fare in meeting the same standards as other PCH’s.
I analyzed the Simkin Centre’s standards review to see whether there was a particular reference to the medication of residents. Here is what the review had to say: “When a psychotropic medication is being used in the absence of a diagnosis of a mental illness, it is to be considered a chemical restraint. Also any medication given for the specific and sole purpose of inhibiting a behaviour or movement (e.g. pacing, wandering, restlessness, agitation, aggression or uncooperative behaviour) and is not required to treat the resident’s medical or psychiatric symptom is considered a chemical restraint. If the medications are used specifically to restrain a resident, the minimal dose should be used and the resident assessed and closely monitored to ensure his/her safety.”
Insofar as residents giving their consent for the use of restraints (either physical or chemical), the standards review noted that the Simkin Centre met the criterion that “There is documented evidence that the resident, if capable, has given written consent to the use of the restraint. Where the resident is not capable, the consent of the resident’s legal representative is documented.”


To be perfectly honest, if one were to look through the 50 pages of the standards review for the Simkin Centre, one would come to the conclusion that the staff at PCH’s are spending an inordinate amount of their time filling out paperwork to insure that they are complying with all government-imposed standards.
So, when a number of panelists at the November 23 forum, along with audience members, voiced the complaint that residents are not given enough attention during the course of the day (the number 3.6 hours of care was referred to several times; apparently that is the amount of time allotted to any resident for care to be given, either by a nurse or a personal care aide), after seeing how many boxes have to be ticked off by staff at a PCH every day – it’s no wonder that both staff and family members (as well as residents) complain that staff are overworked and overburdened with paperwork.


As our population ages (the average life span in Canada has increased from 77 in 1989 to 78.85 in 1999 to 82.3 in 2019), we can expect that the average incoming resident in a PCH will be older and present with more medical issues than used to be the case. It’s not a pleasant prospect, but the least we can hope is that, as many of us face that prospect ourselves, we will be equipped with as much information as possible about which PCH’s offer the best quality of care. As that November 23 forum seemed to indicate, however, not only does the quality of care at PCH’s in Winnipeg vary widely, information about individual PCH’s is extremely difficult to come by.

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