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House: ‘inconsistent oversight’ of homes

Health minister Jeanne Atherden this morning conceded oversight of Bermuda's care homes had been inconsistent.

Bermuda's overburdened care home system has been in the news this week, with seniors advocate Carol Everson telling The Royal Gazette many elderly Bermudians were “virtually refugees in their own country” because of the need for more and better managed care homes.

Giving details on the national situation in the House of Assembly today, Ms Atherden said there were 22 care homes for seniors in Bermuda, with roughly 400 beds — two of them opened in the past year.

Ms Atherden acknowledged that there had been an inconsistency in oversight of these facilities — due in part to changing regulatory responsibilities, as well as limited resources.

She said that Ageing and Disability Services had been working towards a policy for consistent registration and monitoring.

“As of March 2016, each care home has been routinely inspected by members of the elder care team at least twice,” Ms Atherden said.

Homes that fall short are earmarked for follow-up inspections.

2015's registration period was the first year that each home received a “report card” allocating status according to minimum standards met.

The 2015 registration resulted in seven homes being registered, 11 getting conditional registration, and two homes not being registered.

After a year of inspections, 17 are registered, four are conditionally registered and one home is not registered.

“We are living longer but not healthier lives and our health declines as we age,” said Ms Atherden. “In the 2011 Health Survey, 29 per cent of seniors reported having a disabling condition that limited their daily activities. Accordingly, as the senior population grows so will the number of people requiring long term care services.

“Changing family structures as well as the emotional and financial strain of caregiving, in part, lead to an ongoing demand for care homes. As a result, rest homes and nursing homes remain a central component of our long term care system. Through the Well Bermuda strategy and the Bermuda Health Strategy, the ministry is working to address these challenges, in part, through the promotion of healthy ageing and ageing at home as a means to reduce the demand on facility based care.

“However, care homes will always play a role in our long term care system and it is essential that they provide quality care in a dignified and respectful manner to all residents.”

Ms Atherden explained that: “Care homes provided a range of medical and personal care services to their residents from minimal personal care in a rest home to full 24 hour nursing care in some nursing homes. The existing legislation requires all care homes to be registered with the Chief Medical Officer and adhere to the standards set out in the regulations.”

The regulations currently provide minimum standards in areas such as:

• Staffing requirements;

• Nutrition;

• Physical environment;

• Health and safety; and;

• Record keeping.

“Since the early 2000s up to today, there had been inconsistency in the oversight of these facilities, their registration process and adherence to regulations,” added Ms Atherden. “Changing regulatory responsibilities and management are in part to blame, as are limited resources.

“As part of the Bermuda Health Strategy my ministry has prioritised improving the oversight of care homes and their standards of care.

“Ageing and Disability Services, with the Elder Care Team, is responsible for co-ordinating the registration, compliance monitoring and complaints handling process for care homes.”

The Elder Care Team is a multidisciplinary group of professionals including the Ageing and Disabilities' Seniors Coordinator and Accessibility Officer and representatives from the Department of Health including:

• Community nursing;

• Occupational and physiotherapy;

• Environmental health; and;

• Occupational health and safety.

“Ageing and Disability Services has been developing the policy and procedures for a consistent registration, and effective monitoring process,” said the minister. “As of March 2016 each care home had been routinely inspected by members of the Elder Care Team at least twice. Homes that are not satisfactorily meeting regulations receive additional follow-up inspections.

“Inspections also take place as a result of Ageing and Disability Services receiving a complaint regarding a care home. All complaints are reviewed by the Senior's Coordinator and investigated by the coordinator or referred directly to another Elder Care team member.

“Over the last year, we have had inspectors visit homes in the morning to see what daily activities are being provided; during lunch and dinner time to assess food quality, and even inspectors going out at 11pm at night to verify night staffing levels. Scheduled and unplanned inspections are essential to ensure homes are continually meeting standards.

“The inspections not only inform administrators of required actions to meet the regulatory standards, but also reveal when training is required. When possible the Elder Care team will organise an in-service training for the home, and the administrator will be directed to other training resources. In addition, Ageing and Disability Services now holds monthly meetings with the care home administrators to provide education and improve their understanding and awareness of best practices in relation to the registration standards.

“This level of monitoring and support is essential to help improve the quality of care in the homes, as evidenced by the 2015 and 2016 re-registration results, but is hard to maintain with current staffing levels.

“The 2015 registration period was the first year a report card was created for each home to indicate how well they met the registration requirements. The report vard allocates a status ranking based on the percentage of minimum standards met. Each standard can be assessed as either being: satisfactory, needs improvement, unsatisfactory. If a home receives ‘needs improvement' or ‘unsatisfactory' for a regulated standard, their total score decreases. The Ministry publishes the general results of the report card on our website.”

The 2015 registration processes resulted in:

• 7 homes being registered and;

• 11 receiving conditional registration status;

• 2 homes were not registered.

After a year of the aforementioned inspections and support, the 2016 re-registration period resulted in:

• 17 homes registered;

• 4 homes receiving conditional registrations;

• 1 home not registered.

“ I must also stress there are many care homes within our community that exceed the minimum standards. These homes are active in their own development and ongoing improvement. They must be commended for their efforts. We intend to update and develop the report vard over time to help indicate areas of excellence as well as the most recent scores of each home.

“As you have heard, we are working hard with existing resources to ensure there is appropriate oversight to ensure compliance with the existing standards. However, these standards also require improvement. The current regulations for care homes are the basics to ensure a safe and hospitable care home. However, residents require more than the basics, they deserve quality care. What defines quality changes over time and our long term care system and regulatory structure must adapt and reflect these changes. Furthermore, the ministry is keenly aware of the limitations of existing enforcement options within the legislation.

“Accordingly, the ministry is actively working on updating the act and regulations.”

This includes:

• Introducing and updating regulations and required supporting standards in accordance with international best practice and our local context;

• Strengthening the functions and enforcement capabilities of the regulatory body to enable more effective and efficient oversight; and;

• Developing standards for unregulated long term care services including: daycare and in home care services.

“Updating this legislation is part of the 2015 Throne Speech commitment to improve the protection of our seniors. The ministry is also working to improve the adult protection system overall, and is building on work done by the Seniors Advisory Council's Senior Law Reform Committee. I would like to take this moment to acknowledge the work submitted by the Law Reform Committee and thank them for their contribution. These projects are in the early stages and the ministry will update the public at the earliest opportunity.

“Updated regulations are essential to setting the standard for care, monitoring, and education by the regulatory authority is a key way to ensure compliance. However, as stated before Government resources are limited. We are working hard to make efficient and effective use of our existing resources. However, the community's role in oversight and improvement is vital. We encourage all listening to help be the eyes and ears for quality care. Report issues of concern to the administrators of the home and to Ageing and Disability Services, and to engage with care homes to bring necessary energy and resources to enrich the lives of residents.

“Furthermore, we would like to acknowledge other collaborative projects occurring within the community. The Bermuda National Standards Committee, in conjunction with Age Concern, is developing a pilot accreditation programme for seniors' services. Accreditation is a recognised means to improve the quality of care provision for services. The ministry has representatives on the working group reviewing the standards for this project.

“Finally, although improving the quality of our rest and nursing homes is essential for current and future residents, there are other substantial issues of our long term care system that must be addressed in order to achieve affordable and sustainable healthcare for all our residents.

“First, the financing of long term care is a critical issue for individuals and families in our community and for our healthcare system as a whole. LTC is costly and we need to ensure there are intentional funding models that recognise access and affordability. Second, as a small community we must ensure we are strategic in the prioritisation and development of the type of care homes, services and workforce required, based on existing and projected population care needs. I want you, my honourable colleagues and the listening audience to be aware that the ministry is working towards addressing these challenges.

“The FutureCare and HIP Personal Home Care Benefit has been a key step in the development of the long term care system. This benefit enables payment for both professional and family caregivers to support people with long term care needs in their own homes. This is an essential step in improving the accessibility of long term care and reducing the demand on residential care facilities. Through this initiative the ministry has been working collaboratively across departments and with other ministries to address standards in care by providers working in private homes. Ageing and Disability Services has started vetting personal caregivers, an unregulated group of providers, who are paid by government benefits or voluntarily choose to register. In addition, the Bermuda Nursing Council is in the process of updating their scope and introducing standards of practice for nursing associates who are a central part of the long term care team.

“Second, as a small community we must ensure we are strategic in the prioritisation and development of the type of care homes, services and workforce required, based on existing and projected population care needs.

“I want you, my honourable colleagues and the listening audience to be aware that the ministry is working with the Bermuda Hospitals Board towards addressing these challenges. In fact, it is one of the key action items in the Bermuda Health Action Plan.

“Overall, although I am pleased with the progress to date in improving standards within care homes, there is still much work to be done in this area, and with the long term care system as a whole. We, as a ministry, are committed to this work and look forward to working with our community partners to achieve these goals for Bermuda.”

To read Ms Atherden's statement in full, click on the PDF link under “Related Media”

Addressing Parliament: Jeanne Atherden, the Minister of Health (File photograph)

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Published June 03, 2016 at 12:00 pm (Updated June 06, 2016 at 7:43 am)

House: ‘inconsistent oversight’ of homes

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