Health Quality Ontario
In keeping with its mandate to provide the best care experience for older Ontarians, the Ministry of Long-Term Care regularly monitors several aspects of senior care in provincial long-term care facilities. Four of these areas, referred to as “health quality indicators,” are reported on the Health Quality Ontario website, and highlight those that are being managed well and those that need improvement.
McCormick Home’s latest results for the four areas measured, including the treatment of pressure ulcers, use of restraints and incidents of falls, are now available. We are pleased to share these results with you, along with some information on how these results contribute to our efforts to continually enhance the quality of care we provide.
At McCormick Home, the care and safety of our residents is our first priority. We are committed to quality improvement that leads to better resident health and safety and better care performance, and we value Health Quality Ontario’s public reporting effort as an important tool that can be used to inform our quality improvement activities.
We hold ourselves to a high standard and strictly apply the ministry’s definitions related to the health quality indicators. In addition, we continually strive to better understand the ministry’s measurement and reporting criteria as they evolve. As such, our results, and those of other long-term care facilities, sometimes vary considerably from one quarterly reporting period to another, impacting on the averages reported. Please bear with us as we continue to work through this process, and know that we are committed to providing you with clear and understandable information that best articulates how our results impact those in our care. As always, your comments and questions are welcome.
While our numeric results are important to ensuring that we maintain a high level of quality in the services we provide, our focus remains on the individual experiences of care we provide to each of our residents at any given moment. We believe strongly in the importance of person-centred care and practice a philosophy that focuses on individual personhood and dignity in the services we provide.
In addition, we recognize the important role that family members play in the health and wellbeing of our residents. We understand the need to respect a family’s wishes when they make important decisions on behalf of their loved one, and we work to ensure they remain an integral part of our residents’ plan of care.
Since 1985, McCormick Home has been voluntarily participating in rigorous accreditation reviews to ensure compliance with quality care practices. In 2019, McCormick Home was accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for a three-year period, which represents the highest level of accreditation that can be awarded to an organization.
If you have any comments or questions, please contact Tanya Pol, Administrator, at tpol@mccormickcare.ca or 519-432-2648 ext. 2321.
Health Quality Ontario Results for McCormick Home:
Enter “McCormick Home” when you search By Home in Individual Long-Term Care Results
Background
People are living longer, which means that there is an overall increase in residents who are admitted to long-term care homes with pre-existing conditions, such as pressure ulcers. Reports from AdvantAge Ontario (formerly the Ontario Association of Non-Profit Homes and Services for Seniors) state that of the residents in long-term care, 99% cannot eat alone, 99% cannot dress alone, 97% need help toileting and 95% are incontinent.
Health Quality Indicators
Restraints | Pressure Ulcers | Falls | Antipsychotic Use | Pain | Depression
Restraints
In 2018-19, 2% of McCormick Home residents had some form of restraint applied to them, compared to the provincial average of 3.9%.
Although we use the term restraint, we mean to convey an attitude of least restraint; that is, affording the resident the most freedom possible, yet offering the safety they require. For example, seatbelts in wheelchairs and lap trays (for meals or activities) are considered “restraints” unless they can be removed by the resident themselves. It is important to note that these types of devices enable a resident to have more independence and participate more fully in their self care (e.g. eating a meal) and in recreational activities or other activities of daily living. As such, some assistive devices, which are defined as restraints, are important to promoting resident independence.
McCormick Home is committed to complying with the Long-Term Care Homes Act (2007) legislation, aimed at minimizing the restraining of residents and specifying when and how physical devices are to be used in the home.
It is important to know that restraints are not used on any resident unless they have been recommended by a licensed physician and agreed to by the resident’s family/substitute decision maker. In addition, our restraint policy is reviewed annually with all staff as part of the annual education/training review. Training is provided to staff on application, use and associated risks of using restraints.
We acknowledge that there are rare occasions when residents may need to be restrained for their own protection if they are experiencing impaired judgment and/or loss of self control.
The following restraints are prohibited by provincial regulation and are not used in the home:
- Pelvic restraints
- Vest or jacket restraints
- Wrist restraints or any four-point extremity restraints
- Any device that restrains a resident to a toilet/commode
- Any device that requires a special tool to be released (e.g. pinlock restraint)
- Roller bars on wheelchairs, commodes or toilets
- Any device that cannot immediately be released by staff
- Sheets, wraps, tensors or any other type of strips or bandages used other than for a therapeutic purpose
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Pressure Ulcers
In 2018-19, 3.2% of residents at McCormick Home experienced a pressure ulcer that recently got worse, compared to the provincial average of 2.6%.
Pressure ulcers are wounds that are caused by constant pressure or friction on an area of skin. This includes any kind of blister experienced by a resident.
McCormick Home recognizes the importance of preventing pressure ulcers from starting as well as employing methods to heal them quickly. We follow best practice guidelines in wound treatment as established by the Registered Nurses Association of Ontario. McCormick Home employs a skin care expert on site as well as a nurse practitioner who is certified in skin and wound care. The home also works with an outside consultant who specializes in skin care.
We also recognize that there are situations where individual choices by either the resident or family may not support the physical healing of pressure ulcers. In such instances, these same choices often promote a resident’s emotional, spiritual or cognitive health and wellbeing.
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Falls
In 2018-19, 18.6% of McCormick Home residents recently had a fall, compared to the provincial average of 16.6%.
A fall is defined by the Ministry of Health as “an unplanned change of position from a higher to lower level.” McCormick Home strictly applies the ministry’s definition of a fall. This includes reporting all occurrences, such as a resident’s sudden shift in position while remaining seated. A resident does not have to land on the floor to be considered as having fallen.
At McCormick Home, keeping residents safe from falls and fall-related injuries is a priority. We are committed to ensuring that all falls are reported accurately and promptly, and according to ministry guidelines. In addition, a person’s ability to make choices when it comes to safety is carefully balanced with the need to keep them from harm.
McCormick Home proactively manages the prevention of falls by assessing each resident for their fall risk level and identifying a customized care plan that outlines ways to prevent falls. Families are notified about the care plan and are asked to consider supporting the suggested strategies that are not covered by OHIP, such as hip protectors and non-skid footwear.
McCormick Home places a high priority on keeping residents active and independent for as long as possible, while maintaining a safe environment. A key aspect of this effort involves our Nursing Restorative Care Program, a customized care plan designed to maintain or restore a person’s ability to participate fully in daily living activities. Participation in this program exposes participants to a higher risk of falls, but enables them to experience the benefits of exercise and enhanced independence.
In order to reduce the amount of falls, we undertake a number of proactive measures, including:
- Identifying the fall risk level of each resident using a Fall Risk Assessment Tool on an ongoing basis
- Holding regular Fall and Injury Prevention Committee meetings to review incidents and to research new ways to prevent falls and their related injuries
- Incorporating fall prevention strategies into the home’s mandatory staff education program
- Developing a customized care plan for residents identified at a medium to high risk of falls, including appropriate recommendations regarding hip protectors, safety floor mats, restorative walking programs, physiotherapy, bed rails, non-skid footwear, alarm systems and/or staff monitoring
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Antipsychotic Use
In 2018-19, 22.6% of McCormick Home residents were prescribed antipsychotic medications, compared to the provincial average of 19%.
McCormick Home is committed to working with our licensed medical practitioners to reduce the use of anti-psychotic drugs. The home does not administer any medications, including anti-psychotic drugs, unless they have been prescribed by a licensed physician and agreed to by the resident’s family/substitute decision maker.
McCormick Home has established the Antipsychotic Drug Rounds Team — a working group consisting of the home’s pharmacist, a registered nurse, our statistics coordinator and members of the home’s behavioural support staff to review the use of antipsychotic medications in the home on a bi-monthly basis. The team reviews each resident’s medications and makes recommendations to reduce or discontinue antipsychotic drug use based upon their findings. In addition, the medical director has requested that the home’s team of physicians document the specific reason for every prescription on each resident’s quarterly medication review so that antipsychotic drug use can be monitored more closely for its intended purpose.
There are times when anti-psychotic medications are prescribed by physicians to manage responsive behaviours as a result of symptoms related to dementia (e.g., hallucinations, delusions, aggression) or to manage depression or anxiety disorders should anti-depressants prove ineffective.
McCormick Home’s first approach to managing responsive behaviours is through non-pharmacological interventions, such as those supported by the Ontario Behavioural Supports Program. This program involves caring for seniors with cognitive impairments who exhibit responsive behaviours and is based on understanding a person’s history, interests and physical needs. A care program that meets these needs is then developed to either prevent responsive behaviours from occurring or to lessen their severity. McCormick Home employs a team of in-house specialists in behavioural support approaches and provides related comprehensive training and education for its staff.
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Pain
In 2018-19, 0.8% of McCormick Home residents experienced pain, compared to the provincial average of 5.2%.
For reporting purposes, pain is measured by frequency and intensity. It refers to any type of physical pain or discomfort in any part of the body that may occur when the resident is at rest or with movement. Pain may be localized in one area or may be more generalized; it may also be acute or chronic, intermittent or constant. Because the pain experience is personal and subjective, pain is whatever the resident says it is.
In the long-term care reporting model, pain is recorded over a seven day look-back period. If the resident states that he or she has pain, the indicator for pain is marked yes. If the resident is non-verbal, indications that pain may be present include moaning, crying, wincing, frowning, guarding or protecting an area of the body, lying very still, or decreasing or changing their usual activities.
In order to ensure a comprehensive approach to reporting pain at McCormick Home, all nursing staff as well as direct care providers, including physiotherapists, foot care specialists, physicians and life enrichment staff, are asked about a resident’s pain status.
Pain is coded using two approaches: First, it is determined as being present, not present, present daily or less than daily. Second, it is defined as being mild (the resident is able to carry on with daily routines, socialization and sleep), moderate (some disruption to daily routines is indicated) or strong (pain is at its extreme, interfering with daily routines, socialization and sleep).
All residents who are coded for pain receive a full pain assessment to determine the cause of the pain as well as a treatment plan. In many cases, medications are reviewed and necessary adjustments are made in order to reduce the pain and enhance the resident’s quality of life.
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Depression
In 2018-19, 37.3% of McCormick Home residents experienced depression, compared to the provincial average of 22.8%.
At McCormick Home, we recognize that depression is a serious issue. We also understand that depression can at times be a symptom of dementia. In addition, as physical ability declines, a person’s ability to express or communicate emotions can be impacted. This lack of response can often result in a person being labelled as “depressed.”
In order to reduce the number of our residents who have displayed symptoms of depression (e.g. uttering negative statements; displaying persistent anger; expressing unrealistic fears; uttering repetitive health and anxiety complaints; displaying sad, pained, worried or flat facial expressions; crying or exhibiting tearfulness), we have implemented a well-received one-on-one visiting program to provide residents with an opportunity for individual attention and to express their emotions and thoughts. In addition, we have conducted a quality improvement study to enable us to better understand and identify residents who are at risk of developing depression before it sets in.
We recognize that through the practices established by the ministry’s Behavioural Support Ontario program, which is designed to help decipher and address responsive behaviours such as aggression and withdrawal with redirecting techniques, some depressive symptoms can sometimes be used to communicate that a resident is in physical rather than psychological pain. As such, we employ the BSO approach to discern how to best respond to a resident’s expression, be it verbal, physical or emotional, and have experienced considerable success in this area.
