Canada: Top 5 Things To Know When A Loved One Is In A Nursing Home In Ontario

Last Updated: July 23 2018
Article by Melissa Miller

When an elderly person contemplates entering a long-term care facility, they may have some fairly significant fears. They will be leaving behind the home they know. They may be possibly moving away from a neighbourhood or community where they have friends and existing support networks. Most of all, there is the realization that living independently is not something they can or should do any longer – that is, they require some level of assistance to more closely monitor their well-being.

Acknowledging that this assisted support is necessary also means thinking about what will happen if your loved one does not receive appropriate care and are unable to alert their caregivers or family.

In a previous blog post, Top 5 Things to Consider When Looking for a Nursing Home in Ontario, I listed the top five things to consider when deciding on a nursing home or long-term care facility for an elderly parent or loved one. In this post, I outline an addition five things you should know once your loved one is in care. The common thread throughout is knowledge, communication and awareness of the potential for neglect or abuse so you can properly advocate for your loved one's best interests.

1) The Care Plan

A resident's care plan is the most important document associated with their stay in a long-term care facility. In fact, it forms part of the residents' Bill of Rights as part of the provincial regulations under the Long-Term Care Homes Act, 2007. Within 24 hours of being admitted, regulations require an initial care plan to be created and communicated to the facility's staff. During a two-week period, a minimum of 23 different assessments are conducted to help prepare a more complete initial plan of care within three weeks of residency. A full written plan of care is required within six weeks of residency.

The assessments used to create the care plan can include:

  • Physical and functional ability. This assessment determines the appropriate kind of assistance required for activities related to daily living, such as hygiene and grooming;
  • Mood and behaviour. Assessments may gauge patterns of wandering, variations of function based on time of day, responsive behaviours, potential behavioural triggers and risks the resident poses to themselves or others.
  • Nutrition and medications. An assessment will record vital statistics, note risks and restrictions relating to nutrition care, and outline required drugs and treatments.
  • Continence. Assessing a resident's ability to control their bladder and bowel.
  • Cultural, religious, spiritual, and/or age-related preferences and needs. These assessments support comfort by identifying customary care.

The creation of the plan requires input from the resident or a substitute decision maker and any other person a resident or substitute decision-maker requests to be a part of the process. Combined with information obtained through assessments on their needs, this involvement ensures their goals, preferences and directives are made known to facility staff and other care providers.

The care plan must be assessed for effectiveness and revised as needed, and at a minimum, the plan must be reviewed twice a year. Once your loved one is in care, you should observe whether their appears to be compliance with this plan of care, ask to be made aware of any updates, and express a desire to see the plan updated if you or a supplementary caregiver identifies a changing need or circumstance.

If you believe the care plan is inadequate or that a facility is not complying with directives or fulfilling their responsibilities, you can lodge a complaint with the Ministry of Health and Long-Term Care.

2) Nanny/Granny Cams

While the province of Quebec has recently created regulations to govern the use of recording devices in its long-term care facilities and nursing homes, Ontario does not have anything comparable and no guidelines appear to be imminent. This is a shame, since there are many legal complexities to take into account if you are considering taking this step to monitor your loved one's care – too many complexities to adequately cover in this blog.

Installing a camera may help you identify if your loved one is being neglected or abused by staff, other residents, or anyone else with access to the facility. However the right to privacy of other people within the facility (or roommates sharing a space) is a concern, and it is a criminal offense to record the audio of a private conversation unless at least one party present consents. If a resident is not present when a conversation is recorded, or not able to consent to an audio recording, there may be legal consequences. This can be further complicated by the fact that a resident may not have the capacity to consent to the audio recording in the first place.

There may be pushback from the home about the presence of the camera, but for the time being, as long as there is no audio recording, the camera should be allowed. Many cameras will only turn on and record when movement is sensed in the room. Lack of movement in the room can sometimes be an indication in and of itself about lack of care.

3) Substitute Decision-Making And Consent

It advisable for a resident in care to consider designating a power of attorney or substitute decision-maker to ensure the residents' wishes are respected and that their caregivers act in their best interests if they are not in a position to give consent. I discussed this further in a previous blog, Top 5 Things to Consider When Looking for a Nursing Home in Ontario.

An acting attorney for personal care or substitute decision-maker has the right to be informed of changes to a residents' plan of care, and to be consulted in the case of certain medical interventions. However, an individual's capacity to make a decision relating to health care is not a blanket consideration. An individual's capacity to make their own health care decision is specific to the decision being made. For example, someone may have the capacity to decide what they wish to eat, or whether they need to use the restroom, but not be able to understand and appreciate the benefits or risks of a procedure or medication. It is important to monitor whether the staff at the home make an effort to determine what your loved one's wishes are to the best of their ability and avoid blanket assumptions of incapacity.

4) Physical Checks

When you, supplementary care providers or the residents' other loved ones visit them in a nursing home or long-term care facility, you may consider doing a physical 'check-in' with them to check for any signs of neglect.

Pressure ulcers (bedsores) appear when pressure against a portion of skin reduces blood flow to the tissue, causing damage. People most at risk of developing them tend to have conditions which severely limit mobility or constrain the ability to shift positions. These ulcers can develop quickly, and the presence of one does not immediately mean your loved one is not receiving adequate care and attention. However, multiple sores, poor healing of sores,severe or frequent sores are a cause for concern that should be addresses with staff.

While some residents will be able to communicate quite clearly if they are unhappy with the care, many residents are not able to communicate at all. In situations where communication is an issue (such as after a stroke or a loved one with dementia or Alzheimer's) it is important to monitor your loved one's demeanour for signs of distress. Changes in mood, emotional reactions to certain staff members or other residents, and other subtle changes in behaviour may be an indication of neglect or abuse.

Monitoring for signs of weight loss among residents is also an important task. Although weight loss may be a sign of an underlying medical condition, often it relates to malnutrition and dehydration. Sometimes staff will note that a resident is "refusing food." But this refusal may not be intentional. Staff may not be providing the resident with enough time to chew, swallow, or decide to eat. They may come across a resident sleeping during meal time and not waking them up or returning later with food. Moreover, the resident may be having difficulty feeding themselves, which could look to staff as if the resident does not want to eat it. Observed weight loss should prompt a discussion about whether nutrition or a diet plan requires changing, including blending food to make consumption easier, or supplementing meals with enriched products such as Ensure.

5) Communicate With The Treatment Team

If you are concerned that your elderly loved one may be suffering from neglect by staff, your first course of action might be to talk with them to learn why this might be the case. The vast majority of personal support workers and long-term care facility staff members choose these occupations because they genuinely care about helping people.

If a staff member is falling short of the standard of care they should be providing, it can suggest they are overworked. Moreover, high turnover in staff or management may indicate larger institutional problems which can eventually adversely affect residents. Become an advocate for your loved one. Rather than only identifying problems within a facility or the management of your loved one's care, try to offer solutions and provide support to staff when possible. If you believe that the care plan should be changed or updated, request a meeting with the director of care.

If you are still unsatisfied with the level of care after communicating with the treatment team, consider a transfer through LHIN to a different home, or lodging a complaint with the Ministry of Health and Long-Term Care.

Conclusion

In spite of your best efforts to choose a nursing home or care facility that best meets the needs of your loved one, or advocating on their behalf with staff if you identify problem areas with their care, you may find your elderly parent or loved one is living in an unhealthy environment with abuse or neglect.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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