New Brunswick seniors advocate Kelly Lamrock has released a progress report on the recommendations made on the death of an elderly man in long-term care after sustaining assaults, showing that only two have been fully implemented nearly a year and a half after the report was released.
Thirteen recommendations were made by former advocate Norm Bosse back in January 2022.
Another two recommendations have only been partially implemented, three were considered limited implementation, two were labeled alternative solutions, one was withdrawn, two were largely implemented and one was not accepted.
“There are several remaining issues that the advocate wishes to bring to the attention of New Brunswickers generally, and the Department of Social Development specifically,” Lamrock said in a media release.
“In the areas of regulating nursing home interactions with families, ensuring that violence in nursing homes has a specific protocol, reporting on violent incidents to families and the public, and robustly funding inspections and reporting, there is much work still to be done,” he said.
Lamrock said there aren’t enough resources for the accountability of long-term care facilities in both the public and private sectors.
“So, there are some areas of real progress. I think the broad concerns I was able to signal to the legislature here, one is: you can have the best policy in the world but if you don’t have enough inspectors and they don’t have the resources to their job, the policy isn’t going to get the job done,” he said in an interview on Thursday.
He said there has been acknowledgement by the department that those resources are lacking.
The recommendations
The first recommendation, to develop evidence-based best safety practices for all nursing homes, has been fully implemented.
Recommendation 7, that the Department of Social Development’s Adult Protection investigations in nursing homes take measures to ensure a comprehensive harm prevention approach informs all investigations to assess and address the risk to all residents, even if the Adult Protection referral relates to only one or a few residents, has also been fully implemented.
The second recommendation, which asked that the Department of Social Development undertake a thorough review of best practices in violence mitigation, and develop a comprehensive policy and practice structure, in collaboration with stakeholders, has only been partially implemented.
Recommendation 12, which asked the Department of Social Development to amend Nursing Home Services practice standards to ensure supportive interactions with family and insist upon the compassionate care needed to uphold human dignity, including throughout the grieving process and in relation to funeral rites, was not accepted by the department.
Lamrock said he was concerned with the partial implementation of recommendation two — which would create protocol for the mitigation of violence — more than a year after the recommendation was made.
“But violence is still its own phenomenon. If you are attacked physically, even by somebody without capacity, that’s devastating and it raises protection issues and we would like to see a specific violence protocol in place when there are physical attacks separate from the issue of whether someone is criminally accountable,” he said.
Deference on private operators
Lamrock said “active participation by the Department of Social Development has shown determined progress,” but there is still more work to be done.
He spoke to a deference by the DSD on progress of certain recommendations of the private operators in the province.
“There has been a reticence on behalf of the Department of Social Development to act that is inconsistent with the public oversight we owe vulnerable seniors in some areas,” he said.
“A deference to the private nature of nursing homes has put seniors at risk, and in many cases this deference has created a chilling effect on reporting negative interactions for fear of retaliation.”
In the report, he adds that there is a public trust that is placed in long-term care homes by the vulnerable person and their family and accountability is owed on issues impacting vulnerable seniors, whether they live in a public or private facility.
“Like I say, maybe we should do this through private delivery, that is something, a question, that can be a little agnostic, but the end result shouldn’t be any different,” he said.
He said while an argument has been made that private long-term care is a business, it should be regulated like the public sector. He said the system shouldn’t be two-tiered.
“But even if you’re using private actors, you’ve got to regulate it the same way you would a public sector organization or frankly, if you don’t want to accept that higher level of accountability, then don’t be in that area of business,” Lamrock said.
He talked about the importance of ensuring vulnerable elderly New Brunswickers deserve the dignity and respect we expect in every other time frame of our life. He said it might be even more important with seniors because sometimes capacity is limited.
“The autonomy to do what we want, when we want, when that’s taken away, it’s it’s got to be terrifying,” he said. “And when there is a system that doesn’t respond promptly and humanely that I think many of us would say, that almost sounds terrifying.”
Lamrock said he hopes even more progress will be made in time for the next update, and he continues to work on a formal investigation into the long-term care system.
“Even if the government uses private operators to provide the service, the trust is still a public one. We note that when nursing homes lack capacity, vulnerable seniors are cared for in public hospitals by public employees. The trivia of who owns the building and signs the paychecks does not alter the public trust involved in caring for vulnerable seniors.”
The New Brunswick Nursing Home Association declined to comment on the report, saying it needed time to review it.
The Department of Social Development said in an email it is committed to continue to work on the recommendations and will take time to review Lamrock’s update report.