Safety and care problems at Ottawa nursing homes
August 23, 2017
OTTAWA – The four long-term care facilities run by the City of Ottawa have been found non-compliant with legislation governing long-term care homes more than 200 times over the past five years, including numerous incidents of patient abuse, according to a review by the Ottawa Citizen newspaper.
From 2012 to 2016, city-run facilities Garry J. Armstrong, Peter D. Clark, Centre d’Accueil Champlain and Carleton Lodge were found non-compliant 222 times. That number jumps to 260 when available data from 2017 is included.
On Wednesday, following a Citizen story that revealed the City of Ottawa had been slapped with an “unheard of” blanket order from the province to improve safety and care at three of its four facilities – Carleton Lodge was excluded – city hall said it is moving to deal with the problems.
Councillors were sent a memo by Mayor Jim Watson and Councillor Diane Deans, who heads the committee in charge of long-term care, outlining steps the city is taking to address the ministry’s order, along with a review the city is doing of its facilities.
The blanket order from the province follows a string of incidents, including the repeated punching of one resident by a caregiver and head injuries suffered by another resident that were later covered up.
Those two incidents at Garry J. Armstrong – the assault of Georges Karam (pictured) by a personal support worker and the cover-up by a support worker of a violent fall suffered by François Bisson – are two of the more egregious examples of malfeasance at city-run facilities, but they offer only a snapshot of the issues facing city homes.
The Citizen reviewed hundreds of pages of Ministry of Health and Long-Term Care inspection reports about the city’s four facilities to determine the number of times each was found non-compliant.
A facility can be found non-compliant for a number of reasons, ranging from a mild infraction – a failure to offer patients a snack in the afternoon and evening, for example – to something much more serious, like a failure to prevent patient-on-patient sexual abuse.
The Citizen’s audit shows that since 2012, there have been at least 19 incidents of patient abuse – either sexual, physical or verbal – that have led to a non-compliance order being issued against a city-run facility.
Eight cases involved staff-to-patient abuse while nine involved patient-on-patient abuse. (Two other, separate incidents involved a patient’s family member abusing another patient.)
Carleton Lodge was found non-compliant in an April 7, 2015 inspection report, after a staff member wrapped a humiliated resident in a bed sheet and forced them to eat in a public dining hall.
In March 2014, the resident said a personal support worker wrapped the resident in a bed sheet with “only a continence product underneath,” even though the resident protested and said they wished to wear pants instead.
The support worker didn’t comply, and took the resident into the dining room for breakfast, said the report. The resident was then left in a hall, wrapped in a bed sheet, until lunch time – when the resident was again taken to the dining room, still in the bed sheet.
The resident said they felt embarrassed and humiliated by the experience. The program manager of personal care, who was away at the time of the incident, said it was “not appropriate,” and that this type of treatment could be considered “emotional abuse.” Three staff members who were involved – two support workers and one nurse – were disciplined.
Centre d’Accueil Champlain
In a Dec. 23, 2016 report, the Centre d’accueil Champlain was found non-compliant on multiple counts after one resident allegedly sexually assaulted another while they slept.
In an interview with an inspector on Sept. 2, 2016, a personal support worker said she discovered a resident in a room, touching a fully dressed resident without their permission as the person slept.
The resident was surprised and stormed out of the room angrily after the worker intervened and questioned what was going on.
A nurse said the on-call manager and police were not contacted because the staff member stopped the resident from further “non-consensual behaviour.” The resident in question had already been under supervision due to previous sexual incidents.
The home was found to have failed to promote a zero-tolerance policy for abuse and neglect of residents, and to have failed to immediately report and investigate the incident.
The director should have been immediately notified of the alleged sexual assault, said the report, but wasn’t because the on-call manager was never informed by the nurse. Police should have also been notified, said the report.
The Peter D. Clark care home
In an Aug. 4, 2016 inspection report for Peter D. Clark, a resident was hospitalized after complaining about terrible pain in their foot for almost 13 days straight – which turned out to be a “foul smelling” ulcer.
In a period between March and April 2016, the resident, who was at risk for ulcers, complained about pain in one foot, which staff treated with drugs. About two weeks later, however, the resident began complaining about the pain again, this time for several days straight. Drugs were given again with various results.
On the 17th day after the resident initially complained, a personal support worker found dried blood on the resident’s sheet, and a nurse found an opening in the resident’s foot from a pre-existing corn/callus. It was cleaned and dressed.
In the four days following, the resident complained about immense pain, and that their whole body was aching. On the 22nd day after the initial complaint – and seven days after the skin on the resident’s foot had opened up – a support worker found a “blackened foul smelling” ulcer wound, which was treated by a physician.
Two days later, the resident was taken to hospital, where they stayed for at least eight days. The resident was still in hospital by the time the inspection report was released.
The program manager said the nursing staff did not follow the home’s policy and procedure with the resident’s foot when they saw the corn/callus. When it opened up, the report said, no “wound assessment tool” was conducted.
The manager also noted the resident had been complaining of pain for at least a week prior to the opening of the wound and that a clinical assessment should have been completed.
The Citizen began investigating incidents of abuse or neglect in Ottawa’s long-term care homes after Karam was punched nine times by a personal support worker at Garry J. Armstrong, which was caught on camera.
The documentation of abuse by inspectors at city-run facilities led to the Health Ministry’s blanket order to improve safety and care, known as a “director referral order.”
These orders are exceedingly rare and only occur in cases where there is a chronic history of non-compliance. A Citizen review of all 28 long-term care facilities within Ottawa reveals only three such orders have been issued since 2012 – two at the Saint-Louis Residence and one at Manoir Marochel, all in 2016.
Although the order is rare, its effect is questionable, said Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly.
Trying to enforce them is a problem, she said. There are currently no real penalties, “although that could change in the future.”
There are provisions in the law to withhold funding, she said, adding, “I am not aware of this ever having happened.”
A chronically non-compliant long-term care home could be issued a “cease admissions” order, meaning no one could be admitted until problems are resolved. Another option to enforce compliance would be a voluntary management agreement, under which a management company is hired by the home in the hope of helping it resolve the ongoing problems.
The City of Ottawa appears to be taking the order seriously.
The memo sent by Watson and Deans asks staff to update council on 14 different items regarding long-term care in a presentation for the city’s community and protective services committee before mid-September.
The city’s top bureaucrat, city manager Steve Kanellakos, has been asked to oversee the file.
A number of the items for review focus on abuse prevention as well as training for long-term care workers.
Consultation with stakeholders, including residents and families within each of the city’s four long-term care homes, is planned for this fall, the memo said.