Ageing infrastructure, staff recruitment and retention biggest hurdles according to 2019 SHA Long Term Care Facility report

A 251-page report and survey released by the Saskatchewan Health Authority (SHA) on Friday gave a summary of visits to each long-term care facility in the province and overall quality of care assessment by residents and their families.

The report includes the names of those who attended the facilities, general first impressions, the positive work being done by staff – which includes program development, care options, medication and access to things like telephones and WiFi.

It also includes feedback from residents themselves and their families or care givers on where they believe there should be areas of improvement. The SHA has been conducting the visits and the survey since 2013.

The full report can be viewed here.

Concerns Expressed by Residents and Families

At the top of the list of concerns many residents and their families have expressed at most facilities, is the ability to recruit, retain and to adequately train staff, for example at Regina’s Pioneer Village long term care home.

“Staff turnover has resulted in a lapse in training. There is a renewed focus on transfer-lift reposition (TLR) and gentle persuasive approach (GPA). The clinical nurse educator works with the nurse practitioner to set up new education as well as updates. Nurses on shift during evenings, nights and weekends can provide training as well as videos which are available. Daily visual management has not been used consistently in the last 18 months but has been identified as a priority area.”

Access to doctors and pharmacists for timely diagnoses and filling prescriptions appears to be a larger concern at rural facilities, than in larger centres like Regina and Saskatoon. According to the report, nurse practitioners see patients more often, especially in rural care homes.

Programming concerns at some facilities, like Regina’s William Booth Special Care Home, which is listed as a preferred facility with an excellent reputation, has also been raised by family and residents.

“Changing resident/client profiles, do not always fit the Regina program guidelines and concern of increased risk i.e. convalescent program used for young adults with drug and street behaviors, placed with vulnerable seniors.”

While some long term care homes appear to have infection control measures adequately in place, others do not, including the above mentioned William Booth Care Home.

Others on the list include Extendicare Elmview in Regina, the Lumsden Heritage Home, and Extendicare in Moose Jaw where there appear to be mold issues in the tub room.

“Infection control – work required with infection control and long-term care to achieve balance and understanding of 24/7 long term home environment – concerned that some expectations are inappropriate for non-acute, stable environment.”

Another common complaint is temperature control in many of the facilities, including HVAC systems that are either not working, need to be replaced, or aren’t up to current standards.

Many homes are also lacking ceiling tracks and must rely on staff or special lifts to help get seniors out of their beds or to move them.

Ageing infrastructure including leaking roofs, asbestos concerns, cracked floors, window replacement and even electrical and telephone issues remain concerns as in the Bethany Pioneer Village care home, where the “phone system is also beyond repair with constant challenges.”

Porteous Lodge in Saskatoon, another older facility being used as a long term care home, according to the report, was never originally meant to be a care home.

“Porteous Lodge was built in 1958 with the addition of the Villa in 1976. Due to its original purpose as a dormitory, its function is not consistent with the functions required in long-term care. In the lodge, there is a one-shared washroom for 16 residents on each floor.

“Staff commented on congestion and wait times for the elevator. As there is only one in use currently for people it creates a hazard and necessity to move the wheelchairs that get in the way of those exiting the elevator. Funding has been approved to upgrade the second elevator in the near future to help alleviate this concern. The cisco phones are no longer working and cannot be repaired, inhibiting staff communication.”

At times, families and residents have also complained about long wait times for assistance.

“A concern was raised by a resident (Saskatoon Convalescent Home) that at times they wait too long for attention when asking for assistance, especially during shift change and meal times. One of the residents raised a very valid point. The more physically challenged a resident is, the more dependent they are on the care providers to meet their personal care needs. These individuals find delays and gaps in care more challenging because they have no option beyond waiting for a response.”

Minor injuries have also been cited, including cutting fingernails and toenails too close to skin resulting in bleeding, taking off residents’ shirts without undoing buttons , and staff “talking to residents like they are babies.”

Some families, including those at the Herb Basset Home in Prince Albert, expressed doubt about care when they were not visiting the facility.

“Different types of care it seems depending on rotation. Resident expected to wait for care i.e. toileting. Families that visit frequently do not feel that they can go away and trust that the care will be consistent. They feel the need to have ‘reminders’ in place.”

In one case, a question was asked about residents hitting others and what could be done about that.

Other common complaints include lack of food variety, meaningful weekend or evening activities, no WiFi accessibility, and patients wandering the halls.

Positive Family and Resident Experiences

While there were complaints at some care homes about quality of care, others like the Kipling Integrated Health Centre saw feedback that included statements like “Love my home – nurse hugs me when I’m put to bed every night.”

Residents at the the Maidstone Health Complex indicated local EMS sometimes spent time visiting with residents, which was greatly appreciated.

In Saskatoon, the Saskatoon Convalescent Home has special programming geared towards dementia patients.

“The Namaste Program is an international program for end-stage dementia residents. Approximately two hours of daily sensory immersion are provided including hand rubs, hair and nails, doll cuddling, soothing music and smells. Research, staff, and families have identified that the program improves the quality of life for these residents. ”

Feedback from family and residents at the Kindersley Health Care Centre included comments like “Best darn food I ever ate,” and at the Ile-a-la-Cross care home, an effort to include wild fish and game during meals, and tailoring meals to residents was also appreciated.

Visits with pets or allowing pets at some homes like the Regina Lutheran Home, aesthetics services, access to phones and computers, gardens, outings for pub or casino nights, family pot luck nights, and special event recognition were noted as well.

While in some facilities there were noted concerns about infection control, at Saskatoon’s St. Joseph’s Home, it appeared to be at the top of the list.

“Infection control is a large priority at St. Joseph’s Home. They have two ultra violet disinfecting lights. They sanitize every room with this light once a day.”

According to the 2018-2019 SHA Longterm Care Resident and Family Experience Survey, about 85 per cent of residents were generally satisfied with their special care home, a slight decrease from 2016-2017.

Family member satisfaction, according to the survey remained steady at 83 per cent.