January 7,
2022
Social Development
Email: Bruce.Fitch@gnb.ca
Email: Eric.Beaulieu@gnb.ca
Email:sd.consultation.ds@gnb.ca
Telephone:1-844-982-1807
Fax:1-506-453-5942
To Whom it May Concern
Reference: Amendments to
the Community Placement Residential Facilities Regulation under
the Family Services Act
General Regulation under the Nursing Home Act, in
connection to the discharge provision of a nursing home resident, and the
changes to of discharge 83-77 under the Family Services Act to discharge of
residents.
The Coalition provides
the following recommendations that the Nursing Home Act and Regulation be
amended as follows:
Recommendation:
That the Act and Regulation define two types of discharge
Rationale
Discharge - voluntary
and involuntary
Should the nursing home resident or next of kin or legal
representative agree that they are to leave the nursing home, this is a
voluntary discharge.
Should the resident or next of kin or legal representative not
agree and believe they should continue to receive nursing home care, this is an
involuntary discharge.
Amendments to the General Regulation under the Nursing
Homes Act
*This
regulatory proposal is linked to a Bill that is currently before the
Legislative Assembly (Bill 80, An Act to Amend the Nursing Homes
Act https://www.legnb.ca/en/legislation/bills/60/1/80/an-act-to-amend-the-nursing-homes-act).
Should the related Bill be amended or defeated, this draft regulation may be
withdrawn from further consideration.
Discharge 9.2 An operator may discharge a resident in any of the following
circumstances:
(a) the resident is a safety threat to themselves, or other
residents or staff and the nursing home is not able to provide the necessary
level of care.
(b) the nursing home is no longer able to meet one or more of the
needs of the resident.
(c) the operator and the resident, and the next of kin or legal
representative of the resident, if any, cannot reach an agreement with respect
to the resident’s care despite taking all reasonable measures to do so; or
(d) the resident has not made full payment for accommodation and
services provided in the nursing home and the operator and the resident cannot
reach an agreement with respect to payments despite taking all reasonable
measures to do so.
Rationale
As part of a nursing home admission, a series of assessments of
the individual needs are completed by the home before admittance. Therefore, it
should be unusual for a nursing home to turn around and say they are unable to
meet one’s needs after admission. Nursing homes are governed by government standards
that require the home to meet the needs of the individuals and to ensure the best
qualified care is provided.
The home has a
responsibility to meet the needs of the individual “If a person is accepted,
essentially, they are saying they are able to meet those needs. They cannot ask
a resident to waive their rights
Challenging behaviors of a resident can be anticipated in nursing
homes and therefore the environment should be designed to minimize them. Staff
should also receive special training in dealing with such behavior.
Nursing Homes
must understand that residents with complex needs require greater care and, as
a result, when questions are asked by next of kin or their legal representative,
this may cause the relationship to break down. Nursing Homes must overcome this.
Families have entrusted the home to care for their loved ones.
With the current crisis facing nursing homes there is the question whether the failure to address the needs to provide a life with dignity and respect that vulnerable seniors deserve has weakened to provide quality care. This can be difficult for families to accept nor should they. The home is the one that is the expert.
November 30, 2021,
Media Release - Quotes Hon. Bruce Fitch Minister Social Development
“Caring for seniors is a priority for our government,
and we regularly review our programs to make sure they reflect the needs of
that sector and the residents served within it,” said Social Development
Minister Bruce Fitch.
“Discharging a resident from a
long-term care facility is always a last resort,” said Fitch. “The Department
of Social Development and nursing homes make every effort to ensure that the
needs of residents are met within our system. A discharge is generally the
exception and only occurs when all other options have been exhausted.”
Recommendations:
a. A nursing home shall not
discharge a resident (eviction) on the basis that the home can no longer
accommodate their needs, claiming that the resident is uncooperative because the individual has become combative.
b. The resident has the right to remain in a
nursing home unless a transfer or discharge “is necessary to meet the
resident’s welfare” or “is needed to protect the health and safety of other
residents or staff.” Proper interventions must be immediately
taken to ensure the safety of residents. and the next of kin or their legal
representative must be promptly notified.
c. 1. This plan must be written up by the nursing home.
2. This
plan must make certain the resident has a place in which to move near family
and loved ones.
3. This
plan must summarize the care and / or services the individual will receive
following discharge.
4. A transfer to the hospital
setting is not acceptable unless the resident requires medical attention.
d. The onus shall be the responsibility
of the home to show just cause of their action to discharge a resident.
e. Discharge of a resident may be decided,
in consultation with the resident, next of kin or their legal representative,
that an alternative setting and services may serve the resident’s needs much
better than remaining in the facility.
f. If the resident has been assessed to
be mentally incompetent and their next of kin or legal representative does not wish
the resident to be transferred to a community setting, the resident will remain
in the facility.
g. The resident and or next of kin or their
legal representative have the right to be treated fairly and to be heard
without reprisals before any final decision is made. Residents, next of kin or
legal representative responsible have the right to appeal the Seniors Advocate
decision.
h. The next of kin or their legal representative responsible must
be advised promptly of the alleged concerns of a resident and the immediate
steps to be taken to address all concerns. Failing this all concerns shall be
thoroughly investigated by the Seniors Advocate office who will decide the outcome
of the investigation with a decision for the resident care.
I. Residents and family council meetings must be held regular to
inform residents about changes in the facility and services. This will also
provide an opportunity for residents to give input on decisions that affect
their lives in the facility.
j. Should the needs of the resident be greater than the facility
is claiming that they are not able to provide, evidence must be provided of the
circumstances that give rise to the concerns. Once it has been proven the home
is not able to meet the needs of the resident, a transfer/discharge may be
necessary for the resident’s well-being to an environment of choice of the
resident or next of kin or legal representative.
k. No resident shall be discharged from a nursing home for
accommodation and services for not being able to meet the cost. This is not an acceptable
solution.
Rational: The current cost of $113 per day is not
affordable to many residents, it is an unfair process as it leaves the spouse
at home having to rely on food banks and other means to meet living needs. The fees
should be based on individual income. https://www.gov.mb.ca/health/pcs/docs/rate_table2021.pdf
l. Special Care Homes rates should be reviewed, and the fees be
regulated based on individual income. https://www.gov.mb.ca/health/pcs/docs/rate_table2021.pdf
m. The Nursing Home Act must be complemented by a concise and
easily understandable residents “Bill of Rights” as noted in the Ontario Nursing
Home Act.
https://www.ontarc.com/residents-bill-of-rights.html
We request that consideration be given to the recommendations in
this document and be notified of its implementation.
Respectfully Submitted
Cecile Cassista,
Executive Director
