PREPARED BY

ELDER ADVOCATES OF ALBERTA SOCIETY

May 2, 2005

WE RECOMMEND THAT THE FOLLOWING BE MADE MANDATORY AND THE NORM IN ALL ALBERTA ELDER CARE FACILITIES:

1. Mandate
   a. psychotropic medication shall not be prescribed or administered without the informed, written consent of the resident, the resident’s guardian or other authorized representative.

   b. diapering of resident (unless incontinent) shall not be carried out without the informed, written consent of the resident, the resident’s guardian or other authorized representative.

   There is far too frequent failure to assist persons to the toilet or change disposable briefs – in a number of facilities it is policy; “Use your (12 hour) diaper” even after a laxative – which causes incontinence and results in residents sitting in urine and feces, increased falls and agitation, mental destabilization, indignity and skin breakdown – infections – cheaper to care for. This is a horror in far too many long term care facilities.

   It should be a given, human right to relieve one self when necessary, in an accepted manner in a bathroom and not in one’s apparel.

   Therefore we recommend that there be toilet brigades in all care facilities to deal with the matter of toileting persons; that all facilities hire staff and specifically train them in lifting and transferring in order to assist persons to go to the bathroom.

   c. permanent relegation of resident to bed shall not be carried out without the informed, written consent of the resident, the resident’s guardian or other authorized representative or two medical doctors.

   d. nurse’s notes and medical file to be available on demand by the resident, the residents guardian or other authorized representative.

   e. establish and maintain a written protocol regarding missing or stolen belongings of residents – a record of the investigation which was cried out concerning the missing items should be available to resident and the resident’s family.

2. Mandate that all facilities provide feeding tables for those who are blind, require assistance or who need to be fed. That there be posted in the sleeping room of those residents who need feeding, the name of the staff person who will be responsible for the feeding of that person that day.

   That the Criminal Code Section # 215 – Duties of persons to provide necessaries, be applied where such provision is not being made.

3. Mandate that all facilties have a Hydration maintenance and Hydration Program. Fluids to be offered mid-morning, mid-afternoon and evening.

   Train staff on dehydration risk factors such as vomiting/diarrhea leading to fluid loss, elevated temperature/infection, cardiac failure, renal disease, confusion, death.

   Train staff on the signs and symptoms of dehydration – dizziness, confusion or change in mental status, decreased urine output, decreased skin turgor, constipation, dry mucous membranes.

   Provide verbal and physical assist as needed to assist resident to drink. The program must be monitored to be certain that in fact staff are ethically carrying out the program.

   Researcher and practitioners have observed that proper hydration is one of the most long-standing problems of institutionalized persons.

4. Mandate that elder care facilities immediately report suspected crimes to law enforcement with fines for non-compliance ranging up to $100,000.00
5. Mandate criminal record checks be required of all staff members in all elder care facilities.
6. Mandate that if anyone is barred / served trespass notice from a long term care facility, it must be immediately reported to and approved by the Senior’s Minister. That an appeal mechanism be incorporated into process.
7. Mandate that persons be bathed when necessary. Lack of bathing leads to indignity and poor hygiene.
8. Mandate that there be provision of physiotherapy and daily, simple exercising (walking, limb rotation), splints for muscle contractures due to strokes or inactivity. This is especially necessary for those who are immediate post stroke victims.
9. Mandate Provision of mental & physical stimulation, failure to do so leads to withdrawal, depression and isolation.
10. Mandate that those who place, frail, vulnerable elderly in close proximity to physically aggressive or violent individuals resulting in injuries and sometimes death, will be sanctioned.
11. Mandate Emphasis on the provision of safe, ethical, compassionate nursing care. Far too often there is failure to provide adequately trained staff – giving wrong medications or failure to give water with medication, painful transfers, negligent care that results in injuries, incorrect body positioning. Which all leads to limb contractures; deadly bed sores which lead to septicemia and death.
12. Mandate adequate staffing levels. Understaffing is a serious problem in Alberta nursing homes which results in warehousing of vulnerable persons. This understaffing results in:
    • failure to provide safe, ethical, compassionate nursing care
    • deadly bedsores
    • failure to adequately feed and hydrate
    • humiliation and diapering of continent elderly
    • neglect
13. Mandate that cameras be allowed in resident rooms.
14. Mandate that residents be allowed the physician of their choice.
15. Mandate that all long-term care facilities be equipped with bidets in order to facilitate proper, perineal hygiene.

Provide comprehensive, inclusive, effective, enforceable protective legislation.

“Many nursing homes have become dangerous places largely because they are under staffed and under regulated”
-TIME magazine, “Fatal Neglect” October 27, 1997 Vol. 150 No 17

Report filed at the Alberta Legislature.

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