In its current formulation, this Registry serves no purpose.  It does not “Establish a licensing body, such as a college, that will develop a process of registration, accreditation and certification for all Personal Support Workers” as we requested in our Petition.   The current research supports our request.  Dr. Samir Sinha** recently presented the Ontario government with a comprehensive report, Living Longer, Living Well.  The recommendations cover health and wellness, social services, and community living for older Ontarians.

Dr. Sinha's key recommendations include the following:

• The Ministry of Health and Long-Term Care should provide more support to its Personal Support Worker (PSW) workforce by strengthening its new PSW Registry by requiring mandatory registration, requiring a common educational standard for all future registrants, and developing a complaints process that can protect the public and the profession.

•  The Ministry of Health and Long-Term Care, in  collaboration with the  Ministry of  Training, Colleges and Universities, should support the preparedness of all future health and social care providers to meet the evolving care needs of older Ontarians by requiring that core training programs in Ontario for physicians, nurses, occupational therapists, physiotherapists, social workers, pharmacists, physician assistants, paramedics, personal support workers, and other relevant health and social care providers should include relevant content and clinical training opportunities in geriatrics.

2. On May 16, 2012 the ministry announced that over the next three years, Ontario will help 90,000 more seniors get the care they need to live comfortably in their homes by adding three million more hours of personal support worker care. Having the support of PSWs enables seniors, people with physical disabilities and those with complex needs live independently at home – rather than in a hospital or long-term care home.  Increasing PSW hours ensures access to the right care at the right time, and in the right place.  

This is a wonderful initiative, but it does not address the needs of 78,000 residents who are already in LTC homes.  It does not address the needs of 35,000 others who are on long waiting lists and need beds in long-term care because of complex health issues and behavioural challenges.  Residents are being admitted to LTC homes with much higher physical, psychological and emotional needs.   Even the very best home care possible won’t eliminate the need for LTC.  Caring for an incontinent senior with dementia and various physical limitations is a 24 hour job 7 days a week.  The reality is that there will always be a need for LTC homes, no matter how much money we put into home care. In addition this equates to only 0.64 hours or 38 minutes of care per senior per week, which is hardly sufficient to keep them “living comfortably in their homes”

Moreover, an investment in better home care will not keep our loved ones safe.  The recent murder in a LTC facility has alerted the general public to the dangers of understaffing and inadequate training.  We are failing our vulnerable elderly residents.  We are endangering their lives and making their final days – a misery.  We are very far from the ideal of providing access to the right care at the right time and in the right place.

3. The ministry created Behavioural Supports Ontario (BSO) to respond to the needs of individuals with challenging and complex behaviours wherever they live, at home, in long-term care (LTC) or elsewhere to mitigate the strain for their families, healthcare professionals, and the healthcare system.  The ministry is committed to working with the LHINs to ensure that LTC homes and community providers sustain their BSO health human resource capacity, including PSWs, to meet the needs of individuals with challenging and complex behaviours.

The BSO program is a consultative process to help staff deal with residents with behavioural issues.  This is another good initiative but it does not provide additional staff in long-term care homes.  It doesn’t address the previous commitment that the government made to “Immediately increase the number of paid hours of nursing and personal care per resident per day to 4.0 hours (as promised in 2008)”  and as we requested in our Petition.  It does not address the need to increase the amount of direct hands-on personal care time.  There are insufficient numbers of support staff to assist our loved ones with the necessities of daily living (eating, toileting, dressing, etc.) and to protect them from harm.  

4. Since 2010/11, the ministry has invested approximately $58.5M in BSO to support the redesign of service delivery across the province and the hiring of staff resources.  $43.5M of the $58.5M is invested in health human resources which include specialized nurses, PSWs, and other healthcare professionals.

Any additional investment to services in this area is positive, but is this new funding, or simply money taken from elsewhere and “shuffled” into long term care?  It does not address any of the points raised in our Petition.  Moreover, the escalation in incidents of reported abuse spotlights the need for an increase in direct care hours to monitor and protect residents. There are also issues with the compliance department of the ministry and the lack of follow-up with the LTC facilities that have failed to protect the residents in their care.  Significant new funds are required in order to meet these needs.   

5. In January 2013, the ministry announced base funding of $3.5M to support the training and recruitment of PSWs allowing LHINs to fund PSW salaries from the previously established 2008 level of $40,000 to current levels.  After meeting their FTE targets, the LHINs can use this funding for training BSO staff.

How far does this commitment go towards our request to “Develop a plan to phase in future increases so that the number of paid hours per resident per day of nursing and personal care is 5.0 hours by January, 2015” as we requested in our Petition?  The Ministers response seems convoluted, and makes no commitment to address an actual increase in hands on care through increased staffing levels.

Many jobs in LTC are part-time and even some full-time positions are poorly paid.  The current situation negatively impacts the consistency and quality of care.

6. Since 2003 there are 10,000 more staff in LTC homes and we continue to work towards enhancing the care and services provided to residents in LTC homes.  As part of the commitment made in Ontario’s Action Plan for Health Care, released January 2012, the government is developing a Seniors Strategy to build on investments and the need for improvements in LTC.  

Any increase in staffing totals is positive but statistics should be reviewed and evaluated in context.  What are the total FTEs (Full Time Equivalents)? How do the numbers compare to the increase in LTC residents during this time period?  How has the ministry factored in the increase in the acuity levels of the majority of LTC residents?  What is the average number of direct hands-on personal care hours per resident per day in each LTC home now?

•         Does the ministry have any data on this?

•         If not, why not?

•         If so, where is it published? 

Family members and friends are missing critical and crucial information. We hope that you will join us in asking these important questions. We hope that you will join us in shining a light on the needs of our loved ones. We do not want our friends and family members to be considered disposable because they are old or sick.  We hope that you will support our request for better care. Our advocacy work has the support of the Ontario Health Coalition, the Gerontological Nurses Association of Ontario, OPSAWA (personal support workers) and many other groups and organizations.  

Through our petition and on-going campaign, we are urging the government to: 

1. Immediately increase the number of paid hours of nursing and personal care per resident to 4.0 as promised in 2008.

2. By January 2015 increase the number of these hours to 5.0 per day.

3. Establish a licensing body to develop a process of registration, accreditation and certification for all PSWs.  

We are asking you and your colleagues in the Provincial Parliament of Ontario to deliver on promises made. Our most vulnerable citizens deserve to be cared for in a safe, comfortable, home-like environment.1  

We have prepared a list of research studies which support our petition.  This is available for your reference on request to the undersigned.

Thank you for your support.  

Carol Adamson

On behalf of Family Council Network 4 Advocacy Committee

Carol.adamson@cogeco.ca 

 905-331-0319

1 Preamble to the Long-Term Care Homes Act

**  Dr. Samir Sinha

Director of Geriatrics at Mount Sinai and the University Health Network hospitals in Toronto  since 2011.  Dr . Sinha is a Rhodes Scholar with a Master's in Medical History and a PhD in sociology, both from Oxford, and a fellowship in geriatrics from Johns Hopkins.

Dr. Sinha is Canadian-born and comes from a family of doctors.  Both his Indian parents are doctors in Winnipeg,  his older brother is a cardiologist at Johns Hopkins. His maternal great-grandfather was surgeon-general in Uttar Pradesh (one of the Indian States.)

At Mount Sinai, he has transformed the way health care is delivered to those aged 65 and up to allow many of these to return home to live  independently and with the highest quality of life.

Seeing this success, Deb Matthews,  Ontario Health Minister, in Spring 2012, invited him to lead Ontario's "Seniors Care Strategy".  Dr. Sinha's report, "Living Longer, Living Well" forms the framework of  the new Seniors Care Strategy.  It covers health and wellness, social services and community living and was delivered before Christmas 2012.