Several staff members at a Chatham nursing home have blown the whistle on their employer due to a lack of proper staffing that has led to many residents not receiving adequate care.
According to two Ontario Ministry of Health and Long-Term Care reports published on June 19, the Copper Terrace Long Term Care Facility has been issued over 20 citations for not complying with the province’s Long-Term Care Homes Act (LTCHA), following inspections conducted at the nursing home between May 13-30 of this year. The citations were also issued for failing to meet compliance orders that had been issued following previous inspections.
The most recent inspections were conducted after the ministry received at least five complaints from different staff members voicing concerns about low staffing levels in the home, specifically for registered nursing staff.
It is mandated by the LTCHA that all long-term care homes must have at least one registered nurse (RN) at the facility at all times.
Information gathered by the ministry showed that on 15 out of 20 calendar days in May, Copper Terrace did not have an RN in the building for at least five hours of a 24-hour period. As well, between May 21-27, the nursing home failed to staff an RN in the building during the day shift for two out of seven calendar days, and during the evening shift for five out of seven calendar days.
"We know we have an RN and an RPN issue at Copper Terrace, absolutely... we are working very hard on an alternate staffing plan for when staff either don't come into work, or if we're just short in our roster," said Mary Raithby, CEO of APANS Health Services, which operates the nursing home. "I am not minimizing my registered staff issue, it is significant."
However, Raithby pointed out that Copper Terrace has utilized agency nurses, which are outsourced temp nurses who come from an outside agency to work at the nursing home. According to Raithby, agency nurses are not considered official staff and do not meet the requirements of the LTCHA.
Despite outsourcing staff, complaints from employees at the nursing home stated that under-staffed conditions at the long-term care facility have led to numerous residents not being administered their medication. In one reported instance by the ministry, there was a resident who did not receive one required medication for 21 straight days.
"Regardless of staffing challenges, our staff try really hard to make sure people get what they're supposed to get when they're supposed to get it. So yes it is concerning to me... but it was a Tylenol," said Raithby. "I'm not minimizing that, because if it's ordered, there's obviously a reason to have it."
However, the ministry also documented numerous other incidents where residents did not receive any of their medications at all, during some daily med passes.
According to Raithby, the average long-term care resident requires 10 medications a day. In one of the inspection reports, the ministry said not receiving medications as prescribed can contribute to "increased risks" for residents.
It was also reported to the ministry that a staff member had discovered sealed packaged medication strips, that were meant for residents, that had been improperly disposed of in the container meant for used syringes. Documents showed that a staff member had marked the discarded medications as "administered" or "refused" resulting in nine residents not receiving their medication on four different dates. The ministry also learned similar incidents occurred multiple times during the month of March, and an internal investigation was conducted.
Staffing concerns have plagued Copper Terrance for well over a year, with inspections from 2018 detailing similar instances of improper staffing procedures. To make matters worse, last year, the nursing home eliminated three RPN positions and cut another 28 hours from the service unit, which impacted personal support worker (PSW) positions. The cuts resulted in the nursing home's unionized employees holding a rally back in October of 2018 to protest the job losses.
"Part of the challenge for us is recruitment, the other piece of that, obviously, is retention," said Raithby, and added that absenteeism also creates challenges for staff.
She said many homes run by fellow colleagues of hers also have staffing challenges similar to Copper Terrace.
However, this does not appear to be the case in Chatham-Kent. So far in 2019, the six other long-term care homes located in the municipality have not received a single non-compliance order from the ministry for failing to adequately staff their facilities.
"I'm really happy for them, but I don't know what they're doing [differently], so maybe they can call me," said Raithby.
Despite the staffing issues that have been identified repeatedly by the ministry, Raithby said Copper Terrance continues to accept new residents to fill the 138 beds within the for-profit nursing home.
A decision to cease admissions at the nursing home, for any reason, would have to be made by the Ministry of Health, according to Raithby.
In addition to the more recent reports, a complaints inspection was also completed by the ministry in February 2019, which detailed improper staffing practices where the required RN shifts were being covered by registered practical nurses (RPN). As well, the staff experienced "work overload," which resulted in 37 incidents where residents were not bathed between January 1 and February 3. During the same period, the ministry found residents were not receiving their meals in a timely manner, especially at breakfast.
Also during the month of January, the ministry said there were instances where some residents would have to wait 30 minutes or more for a nurse to respond to their call bell. During the inspection, the ministry also found that seven residents were not receiving consistent toileting or continence care assistance from staff due to staffing shortages.
In an emailed statement to Blackburn News, the Ministry of Health said it is continuing to "monitor the critical incidents and complaints" at Copper Terrace and is "addressing the high-risk concerns."
"The ministry has met with the licensee [APANS Health Services] to discuss the severity of these repeated non-compliances and has reinforced expectations," the ministry said in its statement. "Copper Terrace will continue to be closely monitored and next steps will be determined for the outstanding orders."
Raithby said since the inspection in January, Copper Terrace has met a number of the requirements that had been outlined by the ministry. This included creating around seven new RPN and PSW positions this year, and hiring to fill those positions.
"Our staff work really hard to make sure the residents are getting good care. I don't want people to think that they come to Copper Terrace and it's this horrible nightmare -- it's not," said Raithby. "We're working really hard as a team to continue to build excellent care [and] excellent support for the residents and the families.
"I know right now people are going to have concerns, but I want to assure people that we're not taking our responsibility lightly. We are working very hard on getting into compliance and staying in compliance."