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As problems with the province’s long-term care system came into sharper focus this year, the government was still grappling with how to fix numerous issues with home inspections that were identified by Ontario’s auditor general in 2015.
The province was given a laundry list of recommendations on how to improve its inspection process of long-term care homes in a 2015 report by Bonnie Lysyk, the province’s auditor general.
And while the government has made multiple fixes, the Ministry of Health and Long-Term Care has made “little to no progress” on eight recommendations, a recent follow-up report by the auditor general found.
Out of the 30 recommended actions identified in 2015, 10 have been fully implemented by the ministry (33 per cent), 12 were in the process of being implemented (40 per cent), and eight had seen little to no progress (27 per cent).
Ontario’s long-term care system has been under a microscope in 2017. The Wettlaufer Inquiry was launched, created to examine how a nurse managed to kill eight people under her care at three different nursing homes in London and Woodstock.
Elizabeth Wettlaufer, 50, pleaded guilty in June to using insulin to kill her victims; she attempted to kill six others. Her crime spree began in 2007 and didn’t end until she confessed to the murders last fall.
And in Ottawa, an investigation by this newspaper found widespread abuse and non-compliance in Ottawa long-term care homes. An examination of ministry reports dating back to 2012 uncovered 163 reported cases of resident abuse, 2,033 instances of non-compliance with provincial legislation and at least 17 deaths that led to the homes involved being cited for non-compliance.
But while those incidents helped reveal pain points within Ontario’s long-term care system, the province has been working to fix some of the system’s problems.
The recent auditor’s report said the ministry made substantial progress on some fronts.
For example, in 2015, the auditor found that the ministry failed to prioritize inspections based on risk, with resources allocated inefficiently.
Since then, the ministry has changed its approach to inspections, dedicating more resources to homes deemed more likely to be non-compliant with provincial regulations.
And in 2015, the auditor found the ministry had no formal policy on when follow-up inspections needed to be conducted. Some regions of the province prioritized follow-ups based on risk-level, where other regions prioritized according to inspection dates. “As a result, the highest-risk areas were not always followed up with inspections as promptly as they should be,” the 2015 report found.
The ministry has updated its policy and all high-risk non-compliance orders must be followed up on within 30 business days after the due date of the order has passed.
Another biggie for the auditor general in 2015 was how the ministry penalized rule-breaking homes. Back then, the auditor found that homes in one region of the province did not comply with 40 per cent of the compliance orders issued by the province. In another region of the province examined by the auditor, that number plummeted to 17 per cent.
“The ministry did not know the reasons why these homes repeatedly failed to correct certain deficiencies,” the auditor said.
Now, the auditor found the ministry had substantially increased its toolkit of enforcement measures, including levying fines against non-compliant homes, along with giving the ministry the power to suspend an operator’s licence and order interim management. (These new legislative powers were included in the recently passed Bill 160.)
But while the ministry has made strides in some areas, it’s done little in others.
Here is a breakdown of the eight auditor recommendations from 2015 that have seen little to no progress.
1. The ministry is slow to address complaints and critical incidents
In 2015, the auditor found that a backlog of complaints and critical incidents had more than doubled since 2013. The pileup was mainly due to a significant increase in incidents requiring inspections.
Things have not improved since 2015, the auditor found. And what’s worse, the ministry has been unable to determine why, the auditor said.
“While the ministry was able to clear the backlog from 2015, they were not able to keep up with an increase (37 per cent) in the number of complaints and critical incidents requiring inspections in 2016 — from approximately 5,440 in 2014 to 7,475 in 2016,” the report said.
2. Keeping tabs on regional offices
The ministry is not performing audits to ensure regional offices are complying with its updated policies and guidelines relating to compliance order due dates, the auditor found.
Previously, the auditor found there were regional variations in due dates for compliances with orders of similar risks.
Due to a lack of resources, the ministry was unable to say whether there are still variations between different regions.
3. Inspection results are not reported in a timely manner
In 2015, the auditor found that there were significant delays in reporting inspection results to the public and the long-term care homes themselves.
This was partly because the ministry didn’t even have a policy on how quickly this should be done. The ministry has since created a policy but the auditor found that though “regional offices began collecting the necessary data to monitor their actual reporting timelines” only two regional offices were actually using the data to meet targets.
And neither of those offices met their targets a majority of the time.
4. Inspection reports need to provide more useful information
Inspection reports could be a lot more informative, the auditor found.
Other organizations, such as Health Quality Ontario, the Canadian Institute for Health Information and Community Care Access Centres, gather useful information about long-term care.
Reports from those organizations provide information on the quality of care that residents receive in terms of wait times, hours of direct-care per resident per day, staffing ratios, and use of physical restraints and anti-psychotic drugs.
In 2015, the auditor found that the ministry made “no attempt to consolidate and publish its inspection results with other useful information available in these reports.”
That information would help provide a “complete picture” of how well a home is performing compared to other homes or the provincial average, the auditor said.
The ministry has done little since 2015. And as a result, the auditor said, it is “still not possible to compare homes against each other without consolidating data” from a variety of sources.
5. The ministry does not effectively ensure inspectors’ work is up to par
Here’s the good news: The auditor found in 2015 that the ministry had policies in place for management to review and approve inspection reports before they were finalized.
The bad news: The ministry did not actually track whether these were reviews were done.
Not much has changed since 2015. The ministry does not “perform post-inspection audits of inspectors’ work” and does not “document results at its regional offices on a regular basis.
6. Quality assurance
The ministry has made little progress in consolidating and evaluating its results from quality assurance reviews, the auditor found.
“The ministry does not currently perform and document post-inspection audits for the majority of its policies and procedures,” the auditor said.
The ministry plans to address this by hiring more staff.
7. The ministry is not measuring program performance
Is the ministry’s inspection program performing well? The ministry doesn’t know, the auditor found.
“A recurring theme (of the) 2015 audit had been that the ministry had no clearly defined and expected outcomes or targets against which it could assess how its (inspection program) was performing,” the auditor said.
Since 2015, the ministry created targets, but that’s all they’ve done. Which means “it does not regularly monitor and evaluate actual results and take corrective action when the targets are not met,” the report found.
8. Public performance
The ministry does not provide enough public performance measures to be judged against, the auditor found.
However, “the ministry is currently developing a program-level balanced scorecard with a number of key performance indicators, though this project is at a standstill” because of staffing levels, the report said.
And “the ministry has not decided if it will publish its key performance indicators publicly.”
查看原文...
The province was given a laundry list of recommendations on how to improve its inspection process of long-term care homes in a 2015 report by Bonnie Lysyk, the province’s auditor general.
And while the government has made multiple fixes, the Ministry of Health and Long-Term Care has made “little to no progress” on eight recommendations, a recent follow-up report by the auditor general found.
Out of the 30 recommended actions identified in 2015, 10 have been fully implemented by the ministry (33 per cent), 12 were in the process of being implemented (40 per cent), and eight had seen little to no progress (27 per cent).
Ontario’s long-term care system has been under a microscope in 2017. The Wettlaufer Inquiry was launched, created to examine how a nurse managed to kill eight people under her care at three different nursing homes in London and Woodstock.
Elizabeth Wettlaufer, 50, pleaded guilty in June to using insulin to kill her victims; she attempted to kill six others. Her crime spree began in 2007 and didn’t end until she confessed to the murders last fall.
And in Ottawa, an investigation by this newspaper found widespread abuse and non-compliance in Ottawa long-term care homes. An examination of ministry reports dating back to 2012 uncovered 163 reported cases of resident abuse, 2,033 instances of non-compliance with provincial legislation and at least 17 deaths that led to the homes involved being cited for non-compliance.
But while those incidents helped reveal pain points within Ontario’s long-term care system, the province has been working to fix some of the system’s problems.
The recent auditor’s report said the ministry made substantial progress on some fronts.
For example, in 2015, the auditor found that the ministry failed to prioritize inspections based on risk, with resources allocated inefficiently.
Since then, the ministry has changed its approach to inspections, dedicating more resources to homes deemed more likely to be non-compliant with provincial regulations.
And in 2015, the auditor found the ministry had no formal policy on when follow-up inspections needed to be conducted. Some regions of the province prioritized follow-ups based on risk-level, where other regions prioritized according to inspection dates. “As a result, the highest-risk areas were not always followed up with inspections as promptly as they should be,” the 2015 report found.
The ministry has updated its policy and all high-risk non-compliance orders must be followed up on within 30 business days after the due date of the order has passed.
Another biggie for the auditor general in 2015 was how the ministry penalized rule-breaking homes. Back then, the auditor found that homes in one region of the province did not comply with 40 per cent of the compliance orders issued by the province. In another region of the province examined by the auditor, that number plummeted to 17 per cent.
“The ministry did not know the reasons why these homes repeatedly failed to correct certain deficiencies,” the auditor said.
Now, the auditor found the ministry had substantially increased its toolkit of enforcement measures, including levying fines against non-compliant homes, along with giving the ministry the power to suspend an operator’s licence and order interim management. (These new legislative powers were included in the recently passed Bill 160.)
But while the ministry has made strides in some areas, it’s done little in others.
Here is a breakdown of the eight auditor recommendations from 2015 that have seen little to no progress.
1. The ministry is slow to address complaints and critical incidents
In 2015, the auditor found that a backlog of complaints and critical incidents had more than doubled since 2013. The pileup was mainly due to a significant increase in incidents requiring inspections.
Things have not improved since 2015, the auditor found. And what’s worse, the ministry has been unable to determine why, the auditor said.
“While the ministry was able to clear the backlog from 2015, they were not able to keep up with an increase (37 per cent) in the number of complaints and critical incidents requiring inspections in 2016 — from approximately 5,440 in 2014 to 7,475 in 2016,” the report said.
2. Keeping tabs on regional offices
The ministry is not performing audits to ensure regional offices are complying with its updated policies and guidelines relating to compliance order due dates, the auditor found.
Previously, the auditor found there were regional variations in due dates for compliances with orders of similar risks.
Due to a lack of resources, the ministry was unable to say whether there are still variations between different regions.
3. Inspection results are not reported in a timely manner
In 2015, the auditor found that there were significant delays in reporting inspection results to the public and the long-term care homes themselves.
This was partly because the ministry didn’t even have a policy on how quickly this should be done. The ministry has since created a policy but the auditor found that though “regional offices began collecting the necessary data to monitor their actual reporting timelines” only two regional offices were actually using the data to meet targets.
And neither of those offices met their targets a majority of the time.
4. Inspection reports need to provide more useful information
Inspection reports could be a lot more informative, the auditor found.
Other organizations, such as Health Quality Ontario, the Canadian Institute for Health Information and Community Care Access Centres, gather useful information about long-term care.
Reports from those organizations provide information on the quality of care that residents receive in terms of wait times, hours of direct-care per resident per day, staffing ratios, and use of physical restraints and anti-psychotic drugs.
In 2015, the auditor found that the ministry made “no attempt to consolidate and publish its inspection results with other useful information available in these reports.”
That information would help provide a “complete picture” of how well a home is performing compared to other homes or the provincial average, the auditor said.
The ministry has done little since 2015. And as a result, the auditor said, it is “still not possible to compare homes against each other without consolidating data” from a variety of sources.
5. The ministry does not effectively ensure inspectors’ work is up to par
Here’s the good news: The auditor found in 2015 that the ministry had policies in place for management to review and approve inspection reports before they were finalized.
The bad news: The ministry did not actually track whether these were reviews were done.
Not much has changed since 2015. The ministry does not “perform post-inspection audits of inspectors’ work” and does not “document results at its regional offices on a regular basis.
6. Quality assurance
The ministry has made little progress in consolidating and evaluating its results from quality assurance reviews, the auditor found.
“The ministry does not currently perform and document post-inspection audits for the majority of its policies and procedures,” the auditor said.
The ministry plans to address this by hiring more staff.
7. The ministry is not measuring program performance
Is the ministry’s inspection program performing well? The ministry doesn’t know, the auditor found.
“A recurring theme (of the) 2015 audit had been that the ministry had no clearly defined and expected outcomes or targets against which it could assess how its (inspection program) was performing,” the auditor said.
Since 2015, the ministry created targets, but that’s all they’ve done. Which means “it does not regularly monitor and evaluate actual results and take corrective action when the targets are not met,” the report found.
8. Public performance
The ministry does not provide enough public performance measures to be judged against, the auditor found.
However, “the ministry is currently developing a program-level balanced scorecard with a number of key performance indicators, though this project is at a standstill” because of staffing levels, the report said.
And “the ministry has not decided if it will publish its key performance indicators publicly.”
查看原文...
