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An Inside Look At
The Continuing Care Experience in Alberta
An Analysis of Family Feedback
By:
The Citizens' Watch Network, Continuing Care in Alberta
www.continuingcarewatch.com
August 2006
Contact
Bev McKay
Email
feedback@continuingcarewatch.com
An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
Table of Contents
Introduction and Preparation............................................................................ 4
Summary of Analysis and Key Findings ............................................................5-6
Common themes
Other relevant findings
Summary Chart of Case Examples (Deficits in Care)..........................................6-19
Chart of Identified Responsibilities Assumed by Families...................................19-20
Concluding Comments.....................................................................................20
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
Acknowledgement
This analysis would not have been possible without those families who offered Citizen
Watch their testimonies of a loved one's experience within Alberta's continuing care
system. Their thoughtful comments, perspectives, shared observations and knowledge
provided an insightful look into life inside some of the province's care facilities. The
Citizens' Network extends thanks and gratitude to all those who contributed.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
An Inside Look At The Continuing Care Experience in Alberta
I.
Introduction
At the February 2006 media launch of this website, the Citizens' Watch Network called
on families to send us confidential feedback on their loved one's experiences in a
continuing care setting in Alberta for review and analysis. The first testimony arrived
within two days of the press release. By mid July 2006, we had received reports from 22
families (and friends assuming a family role) and 4 front-line staff.
Although the number of responses was small in comparison to the number of families
with a loved one in a continuing/long term care setting, this feedback contained sufficient
pertinent information to develop a framework and database for the analysis. The reports
we received from both families and care staff provided an opportunity to examine the
quality and adequacy of resident care across a number of facilities as well as the
standards, practices and conditions under which the care centres operate. It also
enabled us to explore the involvement of family members and what they experienced
when they brought concerns to the attention of nursing staff, facility management,
regional health authorities and/or provincial government officials and agencies. In
addition, it allowed for a look at some of the broad system issues.
Given the small sample size, our findings cannot be considered an accurate reflection of
the day-to-day experiences of all individuals residing in continuing care settings
throughout Alberta. None-the-less, information gleaned from this feedback is instructive
and revealed a number of common themes and issues. It further reinforces the urgent
need for far more corrective measures by all parties concerned to protect the rights and
well being of dependent and vulnerable individuals in care settings.
II.
Preparation
Submissions from families were sorted and filed according to the relevant Regional
Health Authority. Feedback from front-line staff was separated out, reviewed and logged.
Information in the reports was scanned for the care centre's name, the type of setting
(e.g. traditional long-term care facility, assisted living, public lodge, group home, etc.)
and ownership status i.e. private, voluntary and public. Reported experiences of
residents were identified, categorized and summarized along with reported care
outcomes. Incidents described as causing harm or posing risks to residents were
flagged. Contributing factors, identified directly by families and/or in official investigative
reports provided by some families, were summarized in point form. Themes or trends
were colour-coded and compiled as part of the overall findings. Another scan was
conducted to identify personal sentiments, perspectives, advocacy efforts and relevant
experiences of the contributing families. Information was then reviewed and analyzed by
an ad hoc Working Committee of the Citizens' Watch Network.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
III. Summary of Analysis and Findings
The 22 testimonies by families dealt with residents in 21 continuing care
settings within the jurisdiction of 4 Regional Health Authorities.
13 of the care centres (60%) were owned and operated by private for-profit
companies (private enterprise); 6 by non-profit charities (private voluntary); and
2 by Regional Health Authorities (public).
The majority of these testimonies (18) described experiences of residents in
traditional long-term care facilities (i.e. nursing homes and auxiliary hospitals),
1 related to experiences in a group home, 1 to a personal care home and 2
related to "assisted living" settings.
53 reported experiences of deficits in care were identified in the 22
submissions, as well as a number of case related care outcomes and
contributing factors reported by families. These deficits related to ten different
aspects or categories of care:
· Medication management (10)
· Oxygen therapy management (3)
· Changing health status (6)
· Hydration (5)
· Nutrition, including feeding practices (5)
· Toileting assistance and incontinence care (7)
· Personal hygiene (2)
· Care plan and care planning (3)
· Call bell system (3)
· Safety and security (9)
Common themes identified in our sample of family feedback were:
1) A range of unaddressed care deficiencies seriously compromised the
health, safety and well being of identified residents.
2) A consistent critical shortage of qualified professional and non-professional
care staff on site was perceived by families as the key issue impacting the
quality of care and quality of life of residents.
3) Reported experiences often reflected a complete departure from identified
appropriate or responsible care practices.
4) Family monitoring and intervention were critical to residents receiving
necessary medical, nursing, or acute care services.
5) Families' reported observations of health decline in a loved one were often
not taken seriously or acted on, particularly in a timely manner.
6) Families' advocacy efforts to protect or improve the quality of care of a
loved one or other residents were often futile.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
7) There often appeared to be no effective authority or process that families
could turn to for resolving care deficiencies that posed risks to residents.
8) In general, nursing staff were perceived as doing their best to fulfill their
responsibilities under very difficult circumstances..
9) The facilities' attending physicians and Medical Directors appeared to have
a minor role in the care and assessment of residents.
10) The majority of stories reflected a tragic breach of trust by those charged
with the care and protection of residents in continuing care settings.
Other relevant findings were:
1) Many families/friends assumed new and unexpected responsibilities
Many family members and friends had taken on a wide range of new and
unexpected responsibilities during a loved one's stay in the facility in order
to compensate for gaps in hands-on care and oversight. (A list of some of
these responsibilities can be found on pages19 and20.)
2) Feedback from front-line workers echoed feedback from family/friends
While not the primary focus of this analysis, feedback also was received
from 4 front-line workers in 3 traditional long term care facilities in 3 RHAs:
2 facilities were owned and run by private companies and 1 by a charitable
organization. Submissions from these workers echoed many of the
experiences and issues reported by family members, identifying both site
specific and broader system issues affecting the quality of care and quality
of life of residents. These included:
1) Unreasonably high workloads given the complex and high care
needs of residents, too few and/or unsuitable or unskilled staff
and high staff turnover;
2) Site or care organization specific policies and practices (e.g.
rationing supplies such as diapers, financial incentives);
3) Manager and management attitudes and practices (e.g.
tolerating misconduct, ignoring reports of abuse/neglect); and
4) The inadequacy and ineffectiveness of current regulations,
oversight and inspection processes.1
1 Some of the actual comments by front-line workers can be found on the Citizen Watch on Continuing Care
web-site at www.continuingcarewatch.com under section "Feedback" entitled Quotable Quotes from Front-
Line Workers.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
IV. Summary Chart of Case Examples
The following chart summarizes reported resident experiences with deficits in care, care
outcomes and contributing factors reported by families to Citizen Watch Network. It is
organized based on 10 aspects of care identified in submissions by families.
1.
MEDICATION MANAGEMENT (10 identified cases)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
DOSE ERROR
This incident led to an investigation.
Long-term care
At admission to the facility, the resident
The family writes: "It was an
facility
was taking 6 tablets of methotrexate
oversight on the part of everyone
once a week to treat her rheumatoid
involved her MD, the pharmacist,
arthritis. The family writes: "She had
nursing staff at the facility. The
been on this drug for years." Within 5
dosage had been recorded and
days of admission, the resident
confirmed incorrectly by her
developed a sore throat and was
physician on admission and no one
prescribed an antibiotic. However, "the
caught it. All of these professionals
sore throat worsened to the point where
should have been fully aware of
she could hardly swallow, and within a
how this chemotherapy drug is used
day or two had also developed a rash
when treating rheumatoid arthritis,
which spread to her entire body." At that
and known that it was the wrong
time, an RN mentioned a possible
dosage."
reaction to the methotrexate, but didn't
follow through on her suspicion.
By the 9th day, the resident "was
extremely weak, could hardly talk, was
in a lot of pain, hadn't eaten for days,
nor drank much." The RN on duty
asked the family "why she was on
methotrexate and what the dosage
was." When the family provided the
information, the RN indicated the
resident had been given 6 pills every
day for 9 days instead of 6 pills one
day a week. The family called the
doctor-on-call who advised immediate
hospitalization. Because of resident's
critical condition, the family slept on the
floor of her hospital room for several
days.
The family writes: "She was passing
blood and tissue in her stool, her mouth
was a mass of ulcerated flesh, she was
in a near coma-like state. We almost
lost her."
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
2
OVER MEDICATION
An investigation report provided
(The use of psychotropic drugs as a
by the family includes these
Long-term care
chemical restraint)
findings:
facility
"It is evident that the resident was
The resident went from walking
very sedated for a period of time
independently on the day of admission
and that, rather than nursing care,
to being physically restrained in a geri-
sedation was being used to manage
chair by the 3rd day and unsteady on
the resident."
her feet by day 4 with physician orders
for increased sedation. Continued use
"Staffing in this facility is not at a
of these sedating drugs over time led to
level to provide the direct
numerous falls resulting in serious injury
supervision that this resident
requiring admission to acute care.
needed."
"Registered nurses informed
investigating members that they do
not have time to check residents on
a daily basis."
"Restraining the resident through
chemical and physical restraint
appears to have weakened the
resident and increased her number
of falls."
3
OVER MEDICATION
The casual attitude and seeming
A family member made friends with
Long-term care
lack of appropriate response by
facility
many of the residents in the facility
staff to the resident's reaction to the
where her own mother lived.
medication, as well as the possible
The family writes: "A lady my mother's
lack of awareness by the resident's
age liked to visit with us and chat."
family of the significant change in
her condition
One day, the family found the woman
"slumped over in her wheelchair in what
appeared to be a very sedated
condition." When she expressed
concern to nursing staff, "I was told that
medication was given because, `she
was too much trouble to bother with'."
A few days later, the family member
observed the head nurse standing over
the woman saying, "She is way, way too
medicated". The family writes: "The
following week, she was almost
comatose in appearance with a large,
nasty-looking black bruise on one side
of her face. Alarmed, I asked staff if
they had notified her family about the
bruise and was told, `Yes.' I was not
able to learn what caused the bruise
and could not get the family's address
or telephone number. A short while
later, the woman died."
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
4
FORCED FEEDING OF ORAL
An investigation report provided
MEDICATION
by the family includes these
Long-term care
findings:
facility
The forced feeding of an oral
medication by a personal care aide
"There are few professional staff
(witnessed by the resident's family)
available (at this facility) to carry out
caused the resident to choke and
professional nursing duties. Nursing
aspirate resulting in life-threatening
duties are being delegated to
complications
untrained and poorly prepared non-
professional staff."
"The team leaders at the facility are
personal support aides who only
have a day and half of training in
the administration of medications."
"These staff members have very
limited knowledge about the
medications, their names and their
correct use."
"A staff member was not assigned
to remain with the Resident in her
room to ensure that she would have
no further problems related to the
aspiration experience."
"The Resident did experience
further problems related to the
aspiration of medications: 1 ½
hours later, staff found her in
respiratory distress, very
diaphoretic (sweating) with mottled
extremities and a pulse of 152."
"Once contacted by staff, the family
had to insist that a physician be
called and, once staff contacted the
physician, medication and treatment
were ordered."
5
NO MEDICATION
The family member felt her requests
The resident's repeated requests to
Long-term care
were ignored because she wasn't
facility
staff for pain medication to treat her
the legal representative of her loved
headaches were reportedly
one.
disregarded. The family's requests of
nursing staff to inform the doctor of the
resident's constant pain were also
"ignored." Finally, at the family's
insistence, the nurse on duty called the
doctor who ordered a daily pain
medication.
The family observed the medication
was not consistently provided as
directed by the resident's physician.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
6
NO MEDICATION
The family hired a private companion
Long-term care
facility
for the resident. During a phone call to
the companion, the family heard the
resident "shrieking in pain." The family
called the nursing desk to request the
resident be given "an injection of pain
medication."
The family writes:
Staff on duty appeared unfamiliar
"They said they had no order from the
with the resident's medication
doctor. I knew it was there but they
profile and her medical condition
would not look."
that made verbal communication
impossible.
The companion also went to the desk
several times to request pain
medication for the resident, but "the
nurse said he needed to finish his paper
work."
The family goes on to say, "In the same
incident, the day nurse asked (the
resident) if she was in pain. Since she
could not speak, this was a ridiculous
question."
7
MEDICATION NOT TAKEN
Not identified
The family found the resident's pills
Long-term care
facility
under the bed.
8
MEDICATION NOT CONSISTENTLY
The family writes:
ACCESSIBLE
"Staffing levels of both professional
Long-term care
facility
A terminally ill patient was placed in a
nurses and personal care
long-term care facility.
attendants did not allow for the
frequent checks required to see if
The family writes: "My loved one's
more pain medication was needed."
need for care and pain management, I
am sure, put an added strain on the
understaffed facility. I stayed in my
loved one's room for the last 12 nights
of his life. His mental condition made it
impossible for him to use the call bell if
he needed pain medication.
I frequently had to wander the halls in
search of a staff member."
9-10
MEDICATION ADMINISTERED
Attending physician did not adhere
WITHOUT CONSENT
to the requirement of obtaining
Long-term care
informed consent prior to treatment.
facility
In 2 separate cases, mentally-
incompetent residents were
NOTE: "In the absence of a medical
administered psychotropic drugs
emergency, a doctor cannot treat
without the knowledge or informed
someone without first obtaining
consent of the residents' legal guardian
consent." [Source: Seniors and the Law: A
/substitute decision-maker
Resource Guide, Alberta Civil Liberties
Research Centre]
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
2.
OXYGEN THERAPY MANAGEMENT (3 identified cases)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
DEPLETED OXYGEN SUPPLY
No one seemed to take
The family found the resident's oxygen
Long-term care
responsibility for monitoring the
facility
tank empty on numerous occasions.
resident's oxygen supply, or
Sometimes, the family found the canula
ensuring continuous supply of
had not been placed on the resident's
oxygen or proper functioning of
face or the oxygen had not been
equipment.
turned on or the equipment had
broken down. On one occasion, the
family observed an RN replace the
tank, then leave the room without
ensuring the equipment was
functioning. When the family checked,
no oxygen was flowing to the resident.
Although the family reported each
incident to the charge nurse and facility
management, the problem continued to
occur.
2
DEPLETED OXYGEN SUPPLY
Not identified
The family reported finding the resident
Long-term care
facility
without oxygen "several times."
3
NON-RESPONSE TO ALARM
Care staff appeared to have little
A family twice heard a high-pitched
Long-term care
motivation to provide care.
facility
alarm that had been ringing for about
five minutes. Concerned, the family
"went to investigate - both times it was
the same resident gasping for breath as
her oxygen was not working, and she
begged me to help her."
The family writes: "When I went to get
help, the answer was the same both
times, `yes we heard it' and then they
did nothing. So each time I created a
loud enough conversation that I believe
they went just to shut me up."
3.
CHANGING HEALTH STATUS (6 identified cases)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
UNDETECTED/DELAYED RESPONSE Not identified
The family alerted nursing staff to the
Long-term care
facility
resident's "odd" behaviours as a
symptom of recurring urinary t1
r 1
act
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
symptom of recurring urinary tract
infection. Two days later, the resident
was transferred to acute care; the family
described her condition on admission
as "so bad she vibrated on the bed" and
"she couldn't swallow." The resident
remained in hospital for one month.
2
UNDETECTED/DELAYED RESPONSE The family felt the untimely
response to the resident's condition
The family alerted nursing staff to traces
Long-term care
and delayed treatment contributed
facility
of pus in the resident's dark-coloured
to unnecessary risks.
urine as symptoms of recurring urinary
tract infection. One week later, a
The family writes:
urinalysis was ordered. Test results
confirmed urinary tract infection.
"How do we bring these things to
their attention so they are
addressed in less time than a week
or a week and a half?"
3
UNDETECTED/DELAYED RESPONSE
The family observed the resident
Long-term care
The family felt their concerns,
facility
"grimace as if in pain and grab weakly
observations or suggestions were
at his lower abdomen." The family
often dismissed, ignored, or
repeatedly alerted nursing staff to their
considered unimportant.
suspicion of a urinary tract infection.
Approximately 9 days after the family
reported their observation, the
resident's condition had deteriorated to
the point where "he wasn't eating" "his
breathing was very shallow and rapid"
"his tongue and mouth were covered in
sores." At about this time, the attending
physician told the family he suspected a
bladder infection; he ordered antibiotics,
oxygen and a urinalysis "which came
back completely foul."
On inquiring whether the resident
needed to be hospitalized, the family
was reportedly told the care would be
the same at the hospital as at the
facility.
The resident died at the care centre
within 11 days of the family reporting
their observation ... and within 67 days
of entering the facility at which time "he
was a walking, talking, self-feeding,
happy individual."
4
UNDETECTED/NON-RESPONSE
Perceived lack of skilled,
knowledgeable or motivated staff
The resident had "two SEVERE falls
Long-term care
facility
within a month." The family writes:
"No one recognized the serious change
in him after his second fall - incapable
of speech - drooping head - unable to
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
walk. . . And no one saw anything
seriously wrong when he started to
have small seizure-like movements,
accompanied by CONSTANT twitching,
almost constant sleeping, no response."
5
DELAYED/NON- RESPONSE
Not identified
One day the family found the resident
Long-term care
facility
"scrambled" "out of it" "almost
hallucinatory." Almost two weeks
later, the resident was admitted to
acute care at the family's request.
Laboratory results confirmed an
infection in the resident's foot had
spread to the bone. At the time of
hospital admission, the facility had not
informed the family of the infection.
6
EVICTION / INABILITY TO "AGE IN
PLACE" AS HOME CARE NEEDS
In the family's opinion: "Home Care
Personal care
INCREASED
controls everything and pretty much
home
serves as the warehouse for
Increasing care needs of the resident
seniors. They know seniors are too
triggered a decision by Home Care to
poor to fight them."
transfer her from the personal care
home to a nursing home. However, the
family member refused to place her
mother in a nursing home.
The family writes: "Upon being
evicted, mom was hauled off to a
hospital in an ambulance. The hospital
tried everything to bully and coerce me,
including threats, to commit her." When
the family member finally took her
mother home to care for her, "the doctor
refused to give me any medication or
prescription for her."
4.
HYDRATION (5 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1-2-3-4
DEHYDRATION
One family member identified the
failure of staff to respond to her
Four submissions revealed residents
Long-term care
concerns related to the need for
facilities
had suffered dehydration. The following
more fluids. The family writes:
are some excerpts from the families'
"Intravenous [for hydration] was
stories.
only given at night. Why does it take
two weeks of questioning to get it
1. "During his time in the holding unit,
given round the clock?"
he was taken to hospital due to
dehydration."
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
2. "It was a struggle to get him to eat,
but he sucked juice boxes dry. Was he
dehydrated again?"
3. "I feel medications administered
without consent, dehydration and lack
of attention to her thyroid brought on the
crisis that led to removal of her
gallbladder."
4. "The dehydration worries us as we
have lost an uncle to dehydration in
care. He died when they attempted to
rehydrate for the second time and it
caused a heart attack."
5
REHYDRATION
The friend indicated there seemed
to be a lack of policies and
A close friend described many problems
Long-term care
procedures and/or staff were not
facility
she observed with a resident's
familiar with clysis management
experience with "hypodermaclysis" - a
and/or policies.
procedure used for rehydration. This
entails infusing IV fluids directly into
tissue.
Examples included:
When the friend reported "redness" at
the site, an RN reinserted the clysis in
the resident's leg then left the room.
Within 10 minutes, "a large bubble" had
developed on the leg causing
discomfort. The family reported the
problem to the RN who then changed
the site.
Sites of insertion were often not rotated
as recommended: "The clysis had been
in her abdominal region for a couple of
weeks. She had bruising due to this.
There was definitely discomfort."
"The night nurse came in to check the
site. It was extremely red and the date
on the site was past due for changing."
"We found another [new] site on her
body. The day nurse had not removed
the old site or switched the IV bag."
Another time, the clysis bag ran out of
fluid, causing air in the tubing that
needed to be corrected. The RN had a
great deal of difficulty trying to fix the
problem and had to call another RN to
assist her.
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An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
5.
NUTRITION ...FEEDING PRACTICES (5 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1-2-3-4
INADEQUATE ASSISTANCE /
INAPPROPRIATE FEEDING /
Long-term care
INAPPROPRIATE FOOD
facility
Two families reported these 4
mealtime practices at the same
facility:
1. "Most of the residents were given
Families identified understaffing and
no assistance at all because there were
inadequate staff training and
not enough care attendants available.
supervision related to feeding
Again and again, I watched residents
methods as possible contributing
being rolled away from uneaten meals." factors.
2. "I saw them (personal care aides)
shoveling in food with a big spoon.
There was no patience to allow for the
residents to eat at a normal pace.
Scoop shovel, scoop shovel without
letting them finish their first mouthful."
3. A resident refused to eat the rest of
her meal after nearly choking on "an
overlarge spoonful of food that had been
put in her mouth."
4. A resident put aside the ham
served with his meal because pork is
The facility was unable or unwilling
forbidden in his culture. This "left him
to accommodate cultural
with almost nothing to eat." No
requirements related to food.
alternative food was served.
5
RISK OF NOT BEING FED
Family noted the facility is
understaffed.
The family writes: "Our loved one often
Assisted living
facility
has to remind staff that his GI (gastro-
intestinal) feed hasn't been given."
6.
TOILETING ASSISTANCE AND INCONTINENCE CARE (7 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1-2-3-4-5-6-7
UNTIMELY OR NO ASSISTANCE
WITH TOILETING /
6 Long-term
INAPPROPRIATE INCONTINENCE
care facilities
CARE
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Seven submissions identified the
following experiences of residents:
Families identified understaffing and
1. Having to wait "far too long to get
the use of diapers for the sake of staff
help with toileting or a change in
convenience (as opposed to resident
underwear."
need) as possible contributing factors.
2. "Not making it to the bathroom in
time and the humiliation and
frustration that comes with that."
3. Being told by staff to "go ahead
and go, you've got Depends on."
4. Being left in a feces-soiled diaper
"for two hours."
5. Being told by staff "they have to
wait `til the meal is over before they
can be taken to the bathroom."
6. Being found by the family or the
hired companions "at least five times
in the last two weeks soaked in urine
and covered in dried feces."
1 Assisted living
7. Staff having "to use paper towels
facility
on residents' buttocks when the
resident doesn't have the funds to buy
the appropriate products and the care
facility does not provide them."
7.
PERSONAL HYGIENE (2 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
SERIOUSLY INADEQUATE
The family identified "inadequate
staffing" as a key deficiency.
The family writes:
Long-term care
facility
"Her basic hygiene was not good.
Her teeth were not brushed ... her
hair not combed. She often wore the
same clothes for days until I asked
the PCA to put them in the wash."
2
SERIOUSLY INADEQUATE
The family said the facility is
understaffed.
The family writes:
Long-term care
facility
"He is often not shaved which tells me
his face was not washed and teeth
not brushed. Towels in his bathroom
do not appear to be used. On one
occasion, he didn't have a shower for
16
Conducted by Citizen Watch, Continuing Care in Alberta
www.continuingcarewatch.com
An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
9 days. I called the head nurse on day
9 and demanded he be showered."
8.
CARE PLANS AND CARE PLANNING (3 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
NOT READ
Not identified
The resident suffered macular
Long-term care
facility
degeneration causing significant
vision loss. A PCA admitted to the
residents' family that she was not
aware of the resident's vision
problem. When the family indicated
this information should be
documented in the resident's care
plan, the PCA indicated "she didn't
have time to read all the Care Plans."
2
UNTIMELY PREPARATION
According to the family, "there is a
lack of [appropriate] policy and
"The timeframe for setting up a care
Long-term care
procedure - or if polices are in place,
facility
plan for (the resident) was six weeks." the follow-up is inadequate."
3
NO CARE PLAN
An investigation report provided
by the family noted:
The resident moved from one facility
Long-term care
facility
to another. The care plan that had
"Investigators were unable to find
been developed by the previous care
evidence that any plan was being
centre for the resident was placed in
used to guide the care being provided
her file at the new facility. During the
to the resident. They were also
resident's three-month stay at the
advised by staff that they were having
new facility, no new care plan was
difficulty establishing and adjusting
developed.
care plans as the residents' needs
changed and they had no time to do
so."
9.
CALL BELL SYSTEM (3 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1-2-3
DIFFICULT TO USE /UNRELIABLE
Three submissions noted the
All long-term
following:
care facilities
1. The resident had difficulty using
the call bell, would become frustrated
and call out for help; was reportedly
"deemed a nuisance for doing so."
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Conducted by Citizen Watch, Continuing Care in Alberta
www.continuingcarewatch.com
An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
2. The facility had an "ongoing
problem with the call system"
requiring the family to walk the halls
to find staff.
3. The facility's call bell system
"seemed to have a mind of its own."
10. SAFETY / SECURITY (9 case examples)
Identified
Care Experiences and Outcomes
Contributing Factors
Cases
(Reported by Families)
(Reported by Families or in Official
Reports Provided by Families)
Care Setting
1
The resident wandered out of the facility
The family said the facility is
unnoticed on numerous occasions.
understaffed.
Long-term care
Twice the resident was found by the
facility
river about ½ km. from the facility.
2
A family member heard a resident call
The family identified understaffing
out for help. "Staff members were too
as a significant risk to the safety of
Long-term care
far away to hear her calls." The family
the resident.
facility
writes: "She would have died had I not
been there to summon staff."
3
A family member heard a resident
The family reported the facility is
"yelling for help for some time." On
understaffed.
Long-term care
looking in on the resident, the family
facility
found her "tangled up in her bedding
and hanging upside down over the side
of her bed."
4
The family found the resident with
The facility's investigation report
"multiple bruises on her knees,
provided by the family
Long-term care
shoulders, chest, arms and face."
concludes:
facility
The resident was transferred to acute
"While it is impossible to know
care for assessment at the family's
what exactly occurred, the most
request. Facility staff and administration
likely possibilities are that (the
could not explain the cause of the
resident) either experienced an
injuries. Although the facility undertook
interaction with another resident
an investigation at the family's request,
which resulted in her bruises, or
no definitive conclusions could be
she may have turned abruptly in her
drawn as to the cause of the
sleep and struck the protective side
unwitnessed event.
rails of her bed."
5
The family observed a new staff
The family noted the new staff
member use unsafe methods to transfer member did not follow the facility
Long-term care
the resident from a chair to her bed.
policy or the two-person transfer
facility
The improper maneuver of the
instructions on a chart posted
mechanical lift hurt the resident enough
above the resident's bed
to cry out.
suggesting he did not receive
adequate training or orientation.
6
A resident fell in her room in the early
The facility was perceived as not
morning. No staff member checked "to
providing the services it promised.
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Conducted by Citizen Watch, Continuing Care in Alberta
www.continuingcarewatch.com
An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
Assisted living
see why she was not at breakfast which
facility
she never missed." Following another
fall, the resident "lay in her room far too
long" before being found.
7
The family found the resident "half way
The family reported the facility was
out of bed. Due to the resident's
understaffed to the point of being
Long-term care
physical impairment, "it would have
unsafe for residents requiring a high
facility
taken her a long time to move that far."
level of care.
From the family's perspective, "it was
obvious no one had looked in on her for
some time." The family was asked to
buy a bed alarm. "It was used once then
disappeared within two weeks of
purchase."
8
The family writes: "My daughter found
The family identified "minimum
her grandfather lying in his bed with his
staffing standards" as a contributing
Long-term care
intravenous pole across his neck and
factor.
facility
his catheter tube pulled out. This left her
to wonder how long he would have
been left like that had she not been
there to notify staff."
9
The family writes: "I am never sure if
The family identified the lack of
there will be enough staff to monitor the
adequate qualified staff as a
Group home
residents, let alone take care of them."
potential risk to the residents.
V.
Chart of Identified Responsibilities Assumed by Families
Responsibilities Assumed by Families
Overseeing the health and care of a loved one and reporting problems; diarizing
deficiencies in the care and services; keeping track of medications and monitoring for
symptoms of adverse effects; challenging the overuse of high-risk psychotropic drugs;
Assisting with the care; exercising a loved one in the absence of a physiotherapist;
purchasing equipment, supplies or medications not provided by the facility; hiring
private care to compensate for the inadequate services of the facility;
Checking the working order of facility equipment and reporting problems;
Checking on residents who call out for help and summoning staff to respond; reporting
concerns about the health and safety of other residents to nursing staff; portering
residents to the dining room and serving meals;
Informing the physician about the resident's medical condition;
Finding their way through the process of moving a loved one out of the facility when it
proved incapable of providing safe, adequate or appropriate care;
Maintaining bedside vigilance in a crisis situation; being the voice and decision-maker for
a dependent loved one;
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Conducted by Citizen Watch, Continuing Care in Alberta
www.continuingcarewatch.com
An Inside Look At The Continuing Care Experience in Alberta: An Analysis of Family Feedback
Documenting incidents and reporting them to facility administration; requesting and
reviewing a loved one's medical records;
Calling for an investigation when things went wrong; taking additional steps if investigative
decisions, processes or results were perceived inadequate, flawed or unfair; and
Writing letters of concern to the Premier, responsible Ministers and their MLA.
VI. Concluding Comments
The common themes and key findings derived from our analysis of feedback to Citizen
Watch (gathered between February 2006 and July 2006) reinforce and add substance to
concerns and issues identified in many other testimonials, consultations and reports.
These findings emphasize the urgent need for effective remedial measures to protect the
rights and well being of dependent and vulnerable individuals "in care" and their families.
We hope this report based on feedback from families, friends and front-line workers will
help overcome the societal blinders, prejudices and practices which appear to be
allowing the current situation to go uncorrected.
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Conducted by Citizen Watch, Continuing Care in Alberta
www.continuingcarewatch.com