Focus on care, not on unnecessary government paperwork.
Overregulation and compliance measures are affecting direct care hours.
In many cases, frontline health care workers are personally shouldering the burden of the administrative work added to their duties as a direct result of regulatory requirements set out in the Long-Term Care Homes Act, its Regulation and other legislation introduced by the former government over the past 15 years.
What is the administrative burden?
All of Ontario’s long-term care homes are required to provide information and data to the Ministry, Local Health Integration Networks and Health Quality Ontario in more than 60 areas of operation in monthly, quarterly and annual submissions. And not only is this information submitted to these agencies, it must also be made available for unscheduled inspections (on average a home is inspected more than five times per year), which can involve as many as three inspectors and last up to 10 days. On average, homes are subject to 43 days of inspection per year.
But the majority of homes are in good standing. In fact, the Ministry’s own data indicates that the vast majority of homes are “low risk” and that Ontario is performing better than other provinces in key areas of quality. And the Long-Term Care Homes Act is widely considered one of the toughest pieces of long-term care home legislation in the world. Ours is the only area of the health system that is subject to such rigorous inspections, which adds to an already-strained work environment.
The previous government, through the Strengthening Quality and Accountability for Patients Act, intended to make the inspection program even tougher by including new financial penalties and increased inspector powers. It also sought to remove the right to representation for staff and leadership, and remove due diligence measures of board members. These changes are proving truly destructive to long-term care, particularly in the context of our current workforce challenges. If these policies are implemented, it will drive good people out of long-term care and make it even harder to attract new people.
Eliminating redundant, excessive reporting.
It takes significant staff resources to fulfill all the activities associated with completing forms, entering data, submitting reports, and chronicling resident care and performance information.
Almost 95% of the information homes must report on is directly related to the provision of nursing and personal care services. In other words, nursing and care staff must take time away from direct care activities to report on the care they are providing. This is not to say that activities should not be recorded; rather, that redundant and excessive reporting should be eliminated. For example, the reporting requirements introduced in 2010 by the Long-Term Care Homes Act only adds to what is already required by professional colleges and standards of practice. The result? Direct care staff in long-term care homes now spend hours per day completing mandatory documentation requirements at the expense of providing more direct care to residents.
Providing care, not documentation.
Doing the additional administrative work just for care planning documentation can add an hour and a half of nurse time to complete each resident assessment, over and above what is already required by professional colleges and standards of practice. The cost of doing two common types of reporting – RAI MDS and RAPS – is estimated to consume more than 1 million care hours and $50 million annually.
But beyond cost is the loss to resident care, which is the key measure of quality of living in long-term care. Every hour diverted from direct care to meet these information obligations is a loss in meaningful interactions with residents.
|Recommendation||Estimated Annual Cost|
|1.||The Ministry should move to a more balanced approach to inspections and incorporate an incentive-based system.||No additional cost.|
|2.||The Ministry should conduct a legislative review of the Long-Term Care Homes Act to limit the unintended administrative burden that compliance has on homes so that they can better focus on advancing quality care to seniors in need.||No additional cost.|
What government can do about it:
We strongly urge the government to move ahead with these changes and only target high-risk homes and issues. We also need to change the approach of levying fines for issues that are out of a home’s control, such as the need for a 24/7 RN when there are significant workforce shortages. Change has to be the ultimate goal in getting to a quality-based, resident care system.
For instance, Ontario’s new government could revise the previous government’s decision to hire an additional 100 inspectors to inspect homes on an annual basis and move to a risk based system. The potential cost savings from this decision alone will ensure sustainability, value for money and free up time to care for residents.
The new government has the opportunity to reduce red tape and address the fact that long-term care in Ontario is overburdened with documentation and restrained by rules and inspections.