Wednesday, May 04, 2005

Quebec government's scathing report on Jewish Eldercare Centre (JEC): "...fundamental disrespect for the rights of residents ..."


At 4:56 PM, Blogger jewishwhistleblower said...


Nursing home vows to shape up
Inspectors issue scathing report; Jewish Eldercare Centre hasn't corrected serious problems found in 2003, report says

The Gazette

Thursday, April 28, 2005

Standards of care at the Jewish Eldercare Centre still have serious shortcomings but should be brought completely into line with a series of recommendations from a fresh - and scathing - Quebec Health Department probe "by the fall," executive director Michel Amar said yesterday.

At least, "that's our target," Amar added.

"We agree there is still a lot of work to be done. ... The work is not finished."

An investigation more than two years ago by the Protecteur des usagers en matiere de sante et de services sociaux, the Health Department's user-protection arm, pinpointed wide-ranging problems at the 320-bed institution on Victoria Ave.

Those problems included a fundamental disrespect for the rights of residents and their family members, and the absence of a home-like environment.

The long-term care facility is the second-largest public Jewish centre in Quebec, with a $20-million annual budget.

Residents have an average age of 86. More than 70 per cent suffer from dementia.

A toughly worded follow-up report last month by the user-protection agency was made public this week.

It concluded that the centre still hasn't corrected "numerous clinical and organizational deficiencies" identified in August 2003, and has made "little progress" toward providing residents with "more dignity and respect" - despite a promise of change by the centre's management in September 2003.

Amar, who became executive director in June 2001, disputed that contention. A mission statement and code of ethics have been adopted, he said, stating that "the residents have choices and rights, and all those choices and rights have to be respected and their autonomy has to be maintained and improved if possible."

Almost all senior management has been replaced during the past two years, Amar added.

"A quality-assurance committee has been put into place," mealtimes and bedtimes adjusted and heated food carts added, he said.

In common areas, however, lucid patients remain grouped with those with dementia. "We are looking right now at this issue," Amar said.

In their latest report, investigators found that centre staff continued as recently as last fall to awaken some disoriented patients at 5 a.m., turn on their room lights, change their diapers, insert their false teeth and prop up their beds to prepare them for a breakfast served only several hours later.

Amar insisted that such early wakeups had already been banned, in 2003.

He said, however, that staff "in one particular unit of the eight we have" reverted to the early wakeups without management's knowledge.

"That's what the Protector saw when they came," Amar said.

The early wakeups have now "absolutely, completely ceased. We did not wait for the report to act on that."

In an unusual move, Quebec has named a special non-voting member, Leonard Vincent, a health-care specialist, to the centre's board of directors for the next six months.

Amar said the centre is also working with a special support team while complying with instructions that Vincent be provided a monthly update of improvements.

May 5, 2005
26 Nisan, 5765

Quebec overseeing management of JEC until care improves

Staff Reporter

The executive-director of the Jewish Eldercare Centre (JEC) acknowledges that the care of its 320 residents should be improved, but places much of the blame for a highly critical government report on employees who are reluctant to change their routines and attitudes, as well as a perennial shortage of staff, especially registered nurses.

Michel Amar said he recognized the JEC was lacking a “home-like environment” when he assumed his post in June 2001, and said steps to change this had been taken long before the investigation. These included a complete change in the top administrators and a determined effort to eradicate an “entrenched mindset” among staff and have them put residents’ wishes ahead of what may be convenient for them.

Over 70 per cent of residents, whose average age is 86, have dementia. The investigation was conducted as a result of complaints from the users’ committee, which is currently composed mainly of relatives of residents.

“We still have a lot of work to do… But for us, the quality of life of residents is of the utmost importance and we are committed to making all necessary changes,” Amar said.

He added that what was done already was accomplished despite the JEC’s having a $1.5-million operating deficit when he came on board. For the past three years, the budget has been balanced, he said.

However, nurse’s aide and union leader Ricardo McKenzie said the work schedules are decided by management to “make up for” staff shortages and provide no advantage to the staff. He contends the real problem is a lack of resources, which is common to all public long-term care institutions.

Amar also said the situation is partly due to the difficulties associated with the merger of the Jewish Nursing Home and Jewish Hospital of Hope to create the JEC. This occurred “on paper” in 1995, but in fact only after he was hired.

For six months, the JEC will have an observer, Leonard Vincent, appointed by the Ministry of Health and Social Services, sitting on its board of directors to see that the changes recommended in the report are implemented. He is to report monthly to the minister, Philippe Couillard, on the progress.

In addition, a three-member team, with expertise in management, also from the ministry, are on-site full time for three months.

This was the second investigation of the JEC by the Health and Social Services ombudsman in two years, following complaints from the users’ committee about the quality of life and services, and the lack of response from the management and board. The latest report says no concrete improvement has been found since 2003.

This investigation was carried out by three persons who spent a total of 78 hours at the JEC from October to December, spread over all shifts, on weekdays and weekends.

The report cites numerous “major, chronic weaknesses,” both administratively and clinically, and emphasizes the lack of “respect and dignity” in handling residents. It describes in detail an “impersonal and infantilizing” care routine, that gives little consideration to what the residents want or to maintaining what capacities they still have.

These include such practices as waking and dressing patients at 5 a.m. and putting them to bed at 5:20 p.m., overuse of restraints, leaving them for hours in a “noisy and depressing” common room in front of a television and a failure to stimulate them or even take them for walks. The report also finds the architecture and physical setting inappropriate. (The JEC’s two pavilions were opened in 1993.)

The report said professionals do not intervene enough, caregivers lack adequate training in gerontology, and staff do not work in an interdisciplinary fashion. Another shortcoming noted was that families are not consulted or informed enough.

The report, however, does not mention abuse or major neglect, and notes that generally the staff show regard, even warmth, to residents and families.

“We do not question the goodwill of these employees; rather we note that the quality of their work is limited by the administrative, clinical and organizational practices of the institution, which do not foster the development of a quality living environment for residents.”

Users’ committee member Laura Blutstein said the report is “right on. For years we’ve been telling the administration and board that these problems exist, but they were unresponsive and negated them. The report now validates our experiences.”

Blutstein’s father, who died last year, was a resident for four years. She is one of two users’ representatives on the board. She said she stayed on to work for change and hopes all stakeholders will now work together to make the residents’ lives more pleasant.

“I don’t believe the problem is totally money, as we are always told. It’s a question of how you deliver services within the structure you have,” she said.

McKenzie said “the staff does not find the situation any more acceptable than those who are denouncing it. Our union has, on multiple occasions, denounced these types of situations that occur at numerous long-term care institutions… Our members find their work satisfaction in the quality of services they give to users.”

McKenzie objected to the impression left that staff has little regard for the residents. “The great majority of the staff has a great respect and gives a lot of attention to the persons in their care. Some even buy, with their own money, toilet articles that are no longer provided by the institution.”

Often they receive testimonies of satisfaction from family members or donations to the JEC foundation are made in appreciation, he said.

Amar stressed that the choices of residents or of those speaking for them will come first from now on. “If a resident wants breakfast at 8 instead of 7, or a bath on Tuesday instead of Thursday, we will accommodate that.”

But he added that things may not be as bad as portrayed. An anonymous survey of family and friends conducted in January and February found that 88 per cent would recommend placement at the JEC.

Amar was also firm that the users’ committee should not be dominated by residents’ relatives, but rather by residents themselves, as the law stipulates, and he intends to see that happen.


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