Resident blames understaffing for troubles at long-term care home

Bonnie Belec
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Pauline Porter says staffing levels at a long-term care facility in St. John’s are creating a dangerous situation for residents.
Living at the Hoyles-Escasoni Complex for the past six months, the retired licensed practical nurse said she fears it’s only going to get worse if the provincial government doesn’t stop cutbacks and do something to increase staffing levels at the facility.

Pauline Porter has been a resident of the Hoyles-Escasoni Complex for the past six months. She said she’s concerned staffing levels at the long-term care facility aren’t enough to meet the needs of residents. — Photo by Bonnie Belec/The Telegram

“I was a victim of it twice,” Porter told The Telegram Wednesday.

“I’ve been over-medicated twice this summer. The first time it was a very high dose. Then I was given another resident’s medication along with my own because they are trying to rush through their work.

“This is what happens when they don’t have enough staff to do what they need to do,” Porter told The Telegram Tuesday.

The 61-year-old, who suffers from chronic pain, said it isn’t the fault of casual staff or nurses on the units, both of which she said are in short supply. Porter lays the blame at the feet of the government and Eastern Health.

“It’s impossible for them to do everything when there is never a full staff complement,” said Porter.

“So that means someone has to be last to get their medications and someone has to be last to get out of bed if they need help, because there’s not enough staff to do it all, and it all comes down to the almighty dollar,” Porter said.

Concerns about the care residents at the Hoyles-Escasoni Complex are receiving were raised in The Weekend Telegram when Ken Kavanagh, whose elderly mother is also a resident there, said he was angry because his mother was fed spaghettios as a meal and she was being left in bed for hours before staff were getting her up, cleaned and dressed for the day.

Health Minister Susan Sullivan and Eastern Health have said none of the issues raised about the long-term care facility are as a result of cutbacks in health care.

Alice Kennedy, vice-president of long-term care with Eastern Health, told The Telegram Tuesday that staffing levels are based on a model of care designed around residents’ needs, and every effort is made to ensure that model is met, but it can be challenging.

“We have all of our permanent, full-time positions filled. Relief staff is a challenge, but we are recruiting and trying to fill those temporary positions,” said Kennedy.

“We are working to hire more relief staff and we do have a significant number of relief staff already, but unfortunately we don’t have enough to meet the demands when we have high rates of absenteeism and leave. Unfortunately, even though we do have a fairly large number of relief staff in some homes, it is still not adequate when you have peaks in absenteeism,” she said.

The president of the union representing some of the workers at long-term care facilities told The Telegram Monday Eastern Health should give more people permanent status, which would make it easier to hire and retain employees.

“They’re hiring people and giving them temporary status, which means those individuals are expected to be at home by their phones, on standby day and night, never knowing when they’re working. And after a while, people say, ‘I’m not doing this anymore,’” said Carol Furlong, president of the Newfoundland Association of Public and Private Employees.

Kennedy said in the case of Hoyles-Escasoni, there is a temporary float pool used to fill in for people who are off on extended leave with schedules, and there is also a pool of people to fill in for short-term leave calls.

“We try wherever possible, when we know we give staff a schedule, but if you get half a dozen sick leave calls you have to have a pool to respond to that short-term leave,” she said.

On Monday, Furlong also said Eastern Health has a policy of not replacing the first person off on leave.

Kennedy said it’s not a policy as such.

“We do not have a policy of not replacing. We do try to replace. When we have difficulties getting people in to provide relief that is something we do, and we have had discussions with the union around this, and when we absolutely can’t get anyone one in, and all of the relief staff are utilized, they are replaced at overtime rates and replaced,” she said.

On top of these staffing issues, Furlong said the union found out that some of the staff at Hoyles-Escasoni are being loaned to another long-term home in St. John’s.

When asked about it Wednesday, Kennedy said it has happened when administration is left with no other options.

“We have several occasions where staff from Hoyles-Escasoni have been shared with another long-term care facility,” she said, adding the facility is also managed by Hoyles-Escasoni.

“And it was only done when there was absolutely no alternative to get staffing to provide coverage at that other site. The Hoyles-Escasoni was not left short staffed to provide staff there. I’m aware of one occasion where the Hoyles-Escasoni site was short as well,  but the decision had to be made by management looking at both sites as to what was the best way to ensure care could be provided safely at both sites,” Kennedy said.

Originally from the Northern Peninsula, Porter spent two years at the Hoyles-Escasoni Complex in the early 2000s following major back surgery. She worked in Ontario for 21 years before returning home a few years ago. Her mother became ill and was placed at the Hoyles-Escasoni Complex where she died last year.

“Mom was there for two years, and I noticed a difference even from when I was in 10 or 12 years ago, but the staffing issues weren’t as bad when mom was here than it is now,” Porter said.

“Now it’s my God, it’s dangerous. It is a danger zone. I can’t stress it enough. Both the Department of Health and administration need to do something before they got a disaster on their hands,” she said.

Organizations: The Telegram, Hoyles-Escasoni Complex, Newfoundland Association of Public and Private Employees.Kennedy Department of Health

Geographic location: Ontario

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Recent comments

  • Kathy Noble
    October 09, 2016 - 10:51

    I have notice a drop in the level of care just in the past few mouths as well...and the staff are run off their feet doing their absolute best. Let's begin again, with discussing the so called "model of care". If we look around the world to see how our precious elders are cared for, we need to hang our heads in shame. We have fabulously caring, knowledgeable, and capable people who would love to be respected and have those they care for respected as well. Time to shift the paradigm and treat people, who are closing in on the end of their lives with the humanity and compassion we all deserve. They are full of wisdom, humour and strength and we have so much we could learn. Would gladly lend my energy and voice to advocate to see movement in the right direction.

  • karen
    October 27, 2013 - 19:48

    Nurse staffing in long term care, as well as in acute care hospitals is frequently & randomly short. Management are working with a staffing model that was established by government, one that is fundamentally flawed because it is strongly based on financial justification of human resources and not equated with capacity to keep patients/residents safe. What do professional nursing associations have to say on this point? I understand that nurses' primary duty, whether in mangagement or direct-care, is to keep patients safe? Are nursing managers being co-opted by government and staffing models to work as financial managers of a squeezed system rather than leaders of safe patient/resident care?

  • robroy
    October 09, 2013 - 20:45

    from all the comments I have seen so far there seems to be truths and uneducated comments made here The biggest one is about emotions. I just retired from eastern health and in long term care Hoyles actually and let me reassure you that there is no staff that don't get emotional with the residents and families.I have laughed cried and comforted with families and some have been there 20 years or more so NOT all are transitional. As for care I will be the first to admit that it has suffered I will however NEVER admit that anyone went anymore than 24 hours with out a bath. I will defy and call anyone a liar who says this They may not get in a bath tub but they will get a bed bath and their hair will be washed. staff at Hoyles are demoralized to the highest degree. Every staff member in that institution loves their job but because of management they hate showing up Everyone is constantly looking over his or her back. As for medication that's the Drs I would love for someone who has the smarts to investigate eastern health when it comes to Hoyles Escasoni Its a huge spot and I don't think there are to many management there who are have the personality to do their job One would think a resident care manager would be a nurse. When it comes to questions about meds or medical suggestions and your manager can't answer where do u go? Hold your heads up high staff of hoyles escasoni you are number 1

  • All Falling Apart
    October 09, 2013 - 19:13

    It's not just long term care. Take a look at the HSC stroke unit. They have only one part-time physiotherapist. Patients blatantly do without adequate rehabilitation due to upper management's budgetary constraints. So much for Canada's recommended best practice stroke guidelines( Frontline staff do their best to provide medical care and a caring environment for patients, but when the resources are not available, it results in disgruntled staff and patients who miss out on valuable services.

  • Alice Apple
    October 09, 2013 - 16:49

    How much does it cost per month to keep a person in Hoyles-Escsoni as compared to a facility such as Chancellor Park?

  • Disappointed
    October 09, 2013 - 16:30

    So if "its not a policy as such" what is it a directive by management that there will be no 1 on 1 coverage for shortages unless approved because of a reduced budget... Somehow government and managers of these facilities have made decisions based on reduced funding... that destroys the basic dignity of the most vulnerable in our society. All I've heard from government and managers are excuses while our seniors are subjected to substandard care... Substandard because while staffing levels are supposedly established by national standards, we have heard that there serious concerns with leave... so to operate below standard levels means these facilities are operating at substandard levels.... and our loved ones are suffering.

  • Hurtin' Unit
    October 09, 2013 - 16:08

    The residents are not the only ones who suffer here. Nursing staff that work in this depleted environment are also prone to burnout, soft tissue injury, and stress. How does the policy of not covering sick leave shortages help this situation? I can tell you from experience it does not, if you care, and you work hard for your residents your efforts are never enough to do what needs to be done, you are left defeated at the end of the day.

  • Susan Williams
    October 09, 2013 - 15:10

    I couldn't agree more. These discussions and statement if facts are by no way a means of pointing fingers of blame. It is all to evident that the current system that is in place is not working - and deteoriating very quickly. My mother has been over medicated, and I all too often find myself looking for her possessions that have disappeared from the locked ward. How many times do you have to walk in and find her sitting in a soiled pad of urine and feces before you start to wonder - how ling has she been sitting like this? How long before she would have been changed? I commend 80% of the staff who are truly dedicated to the residents to whom they look after; but it just isn't good enough anymore. We as a civilized society should hang our heads in shame for allowing these residents to be degraded in such a manner. What if it was you who was living like this - How would you feel? A concerned and loving daughter who carries a broken heart for her mother and the way she has to live out her last years of life!

  • Robyn Beck
    October 09, 2013 - 14:55

    I work in long term care and if the staffing levels were up, there wouldn't be so many sick calls. Most of the staff off work are off due to injury at work because the workload is so heavy!!!!!

    • Hurtin' Unit
      October 09, 2013 - 16:14

      This is the absolute truth, working this way is not sustainable, and a very hard way to take care of human beings...

  • graham
    October 09, 2013 - 14:22

    As to being overmedicated, eastern health recently have new guidelines..... you can ask about the med side affects!. Many meds used on seniors, especially patients with some dementia are toxic to brain cells. Yes, that means they are poisonous!. The damage they do depends on one age , sex, dosage and other factors. Also none of the public realize that some of these meds are toxic, and are used as sedatives, or to manage the patient. There should be a requirement for informed consent before administering these dangerous drugs. And the fewer nursing and support staff, the more these drugs get used. There should be strict formal protocol, not just a doctors opinion, before using these drugs. Formal protocol would require documentation of the need and advantages, risk versus the negative and dangerous side effects. Where's the charter of rights when it applies to patients with some dementia? Cutbacks and efficiencies are on the backs of the old and ill. Bad drugs, insufficient personal care, poor quality food.... and they are unable to complain. It is shameful, if not criminal.

  • Brenda
    October 09, 2013 - 13:50

    Not only are they understaffed they are hiring incompetent staff. And dare you complain or speak up for you relative and you are told you are an "Angry Family". This came from the management.

  • Virginia Waters
    October 09, 2013 - 11:59

    Hoyles-Escasoni is considered the entry point for seniors by Eastern Health. All seniors' homes in the system are struggling with space, staffing and menu issues. But their problems pale in comparison with H/E. It is a cluttered, dirty old placet hat is now being replaced but should have been replaced a long time ago. The families of most residents, like the staff themselves, are constantly looking for a transfer. Staff are so demoralized that some don’t take their responsibilities seriously. Given its transient nature and deplorable physical state, staff avoid investing emotionally in residents. When my mother was there, family struggled constantly with staff to ensure she could get out of bed everyday. The food was very unhealthy. Like Mr. Kavanagh, we raised the issue of salt with management. On Sundays they served Jiggs Dinner. Most old people love Jiggs Dinner but, ironically, many found it so salty that they turned it down – and these are people who like their salt! One Sunday I strolled through the unit asking residents and staff alike about the numbers of people who ate the dinner and those who refused. I concluded that a third to a half rejected it (which was also borne out by the wagons full of uneaten or half eaten meals). Many of these people are already being treated for hypertension - the last thing they need is a meal that contains well over a day's recommended salt intake. We arranged a meeting with the dietician. Her only response was that taste issues (i.e. seasonings including salt) were largely left up to the cooks. She acknowledged that some cooks liked their meals salty. It would be interesting to see the correlation between cardiac arrests and the salt content of the meals that proceeded them. No doubt spaghettios and the like will shave a few dollars off meal costs, but its value as a mechanism for thinning out the resident population ahead of time is priceless. As for Ms. Porter's concern that present conditions at the home could bring tragedy, the reality is that needless deaths occur daily now in all government's seniors facilities. Eastern Health and the Minister of Health will insist that its not about money, but in the great majority of cases it can be traced back to a lack of money. And as more of the baby boom moves into care, it will only get worse. There are a few things seniors and those approaching their senior years need to keep in mind. The first is that the health and safety net you have always assumed would be there for you - won't. The second is that it's never too late to take responsibility for your own health. If you are prepared to go against almost everything government has told you about how to stay healthy, you can extend the quantity - and more importantly - the quality of your remaining years. It means eating whole, wholesome foods (not bread and spaghettios), exercising every single day for an hour or two, and staying engaged in everything going on around you. And finally, if you must go into one of these substandard facilities then make sure you have someone - a dedicated family member or friend - who is prepared to play bad cop on your behalf. Anyone who knows these places will tell you it is still the squeaky wheel that gets the grease,

  • Bay Nurse
    October 09, 2013 - 11:49

    It is sad to see our seniors neglected and left in bed for long periods of time-- sometimes unclean. All nursing homes are understaffed and it is caused by government budget cutbacks. The Minister of Health should have a medical background and have more supervision.

  • East End Boy
    October 09, 2013 - 10:30

    So glad to see that the public is now learning what staff have seen for some time: staff are doing the best with what they have, but are rushing through care to meet the needs of all residents, which leads to injury and mistakes made in haste. Any concerns brought to management are usually dismissed and nursing staff are told to "suck it up" as that's just the way things are. Our province's seniors deserve so much better...

  • saelcove
    October 09, 2013 - 10:02

    There are a lot of sons and daughters that could help but would rather complane , To busy enjoying life

    • Allan
      October 09, 2013 - 20:47

      Couldn't agree more saelcove. Far too many children are ignoring the people who brought them into this world, raised them, cared for them and provided for them. When there parents need them...too bad Mom & Dad: "We have a trip to Cuba planned; I have to work because we need another BMW; I have my own life mom and dad." A nursing home should be considered only when a parent's needs go beyond what the average person is capable of providing. The younger generation is far too selfish and the psychology industry is telling them it's all a-ok.

  • Gerri
    October 09, 2013 - 09:19

    I am not in the public service but I whole heartedly agree with Carol, there needs to be more permanent positions created in the health care system to meet the demands of our sick and aging society. The general population and voters of this province need to stand up and demand better health care for our people. What else do we have if we don't have our health?. Would we not prefer to have more of OUR taxes directed towards health care so we could have a better quality of life.?? Would we object to our taxes being raised (within reason) to provide this very necessary service to us all? How many people do you see each and every day of the week in the waiting rooms of the two hospitals (and the Waterford) waiting for tests or to see a doctor. The waiting period to see some specialists can be up to two years. People are suffering and dying due to insufficient health care (I know because I've had many family members and friends fall victim). Our tax dollars can be spent on many things...NONE of which are as important as health care. We (the province) can effect change, if we demand it...however, we need to do it as a whole...otherwise..we get bandaid solutions in order to silence, and ensure votes in upcoming elections. We have power as a whole....let's use it. I can't think of a single more important issue to address...if we do not have our health we can offer nothing to family or society in general....only what we cost them..

  • CS
    October 09, 2013 - 09:18

    With all due respect, Alice Kennedy, vice-president of long-term care at Eastern Health, what does it mean "its not a policy as such." Family members have been told that this is the case... and when administration does attempt to find relief if their is a second shortage is to find relief by going through the units asking staff currently working if they want to work beyond their regular shift to cover off shortages. It is disgraceful who there is an attempt here to skew the truth.

  • Peter
    October 09, 2013 - 06:48

    I take exception to Alice Kennedy's comment that, because two facilities are under one management team, they THINK it's OK to solve one facilities crisis at the expense of another's. I have union background and have never heard of this type of action being taken before; it flies in the face of NAPE's collective agreements.......THERE ARE NO TRANSITION AGREEMENTS WITH EASTERN HEALTH!! Furthermore, when staff are bounced from one facility to another "when there was absolutely no alternative", is any consideration given to an orientation to the site / procedures / residents / safety, etc. To be thrown into a situation that is already chaotic due to shortages doesn't even remotely consider the safety of the staff in question OR, more importantly, those vulnerable individuals whose care their charged with!