Most provinces have some resident-centred care policies, but rules often don’t match new standards in other areas, a nationwide review says.

A nationwide review of nursing homes found most provinces have some resident-centred care policies that meet the new national long-term-care standards, the National Institute on Ageing says, but there’s a lot of catching up to do.

Dr. Samir Sinha, the NIA’s director of health policy research, said rules overseeing Canada’s long-term-care system are generally inconsistent from one province to the next and don’t match the many new standards in areas such as governance, quality improvement or use of trauma-informed care.

Canada’s new voluntary standards, published last January, are meant to elevate the well-being of residents and staff and align rules across the country so that high-quality care isn’t hit-and-miss.

“The report wasn’t built to be a naming and shaming report,” Sinha said. “Thegoal is to really show how unaligned we are as a nation on several things that Canadians and the committees have said are important moving forward.”

Sinha was chair of the Health Standards Organization committee that focused on directives to improve the lives of residents and staff. A second committee worked with CSA Group to create standards for operations, such as building design for small households and infection prevention and control. The NIA’s jurisdictional review assessed provinces using the new rules from the Health Standards Organization. Sinha said provincial governments can use the review to prepare applications for the federal government’s promised $3 billion in funding to help meet the new standards. To do the analysis, researchers at the NIA searched online for legislation, policies, directives and standards that oversee nursing homes in each province and territory. The report’s preliminary analysis was sent to Health Canada and all provincial and territorial governments, asking for feedback. Sinha said the report gives federal, provincial and territorial governments details on where policies align and where more work is needed. Of the 13 jurisdictions, the report said nine responded to researchers with comments and questions: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Prince Edward Island, Northwest Territories, Nunavut and Yukon. Ontario, Sinha said, did not.

Roughly 20 per cent of the provinces and territories have procedures that would meet the new long-term-care standards, the review noted.

“Another 20 per centare barely registering,” Sinha said. “And the majority are kind of in the middle.”

The analysis looked at six general areas: long-term-care home governance; resident-centred care; resident quality of life; assessments and care plans; healthy and competent workforce; and quality improvement.

Ontario and most jurisdictions met the criteria needed for the standards that support “high-quality services that respond to the diverse needs of its residents and workforce.” Alberta and British Columbia, for example, have “effective strategies for recruitment and retention” while Ontario does not, nor does it have procedures that ensure the workforce has access to wellness programs. Only B.C., the Northwest Territories and Nunavut offered such supports to staff.

One exception, in many jurisdictions, was the use of “trauma-informed care.” Researchers said that Quebec, Newfoundland and Prince Edward Island use this approach but Ontario and others do not, although the Northwest Territories and B.C. are “potentially” adding it, the report said.

The understanding of an individual’s past trauma is a key part of person-centred care, so the lack of it, needs to be addressed, Sinha said.

A trauma-informed approach acknowledges that a great many people have, throughout their lives, experienced emotional trauma that can affect their physical and mental health in their later years. Earlier struggles can cause reactions in the later years, particularly among those with cognitive decline. Under certain circumstances, some might lash out at staff or other residents.

By approaching people with an understanding of their history and a sensitivity to the way certain experiences can recreate traumatic experiences, staff can help residents feel safer.

Here’s one example of trauma-informed care:

In the dementia unit of a Toronto-region home, staff sat two German-speaking residents at the same dining room table based on their shared language, without realizing that during the Second World War, one came from a family that fought with the Nazis and the other from a family that hid Jews. When the man whose family supported Jewish people began struggling with anxiety, a manager delved into his personal history. The residents were quickly separated.

All Canadian homes, the NIA researchers found, have policies that promote “least restraint”; provide “continuous learning activities” for staff; and “support the presence of essential care partners in residents’ daily life and care activities.”

Alternatively, the report said no homes had policies to “ensure socio-demographic workforce data” is collected and used to improve working conditions.

Source: Toronto Star

By Moira WelshStaff Reporter

Article originally appeared at: https://www.thestar.com/news/canada/2023/07/05/which-provinces-meet-canadas-new-long-term-care-homes-standards.html

Resources:

A National and International Jurisdictional Review and Comparative Analysis of Long-Term Care Home Legislation, Policies, Directives and Standards with HSO’s 2023 National Long-Term Care Services Standard

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National Long-Term Care Services Standard