Health Minister Jeanne Atherden told MPs, “we are living longer but not healthier lives” in Bermuda, “and our health declines as we age”.

In a Ministerial Statement delivered in the House of Assembly on Friday, the Minister provided an update on the Government regulation of rest homes and nursing homes in Bermuda.

While generally “pleased” progress thus far, she said there’s still much work to be done when it comes to improving standards.

“This is an essential component of our long term care system, about which the community has expressed concern, and the Ministry has been working to improve,” she said.

“I thought it important that this Honourable House and our listening audience are informed of the work being done by the Ministry and the progress made so far.”

She noted the 2011 Health Survey showed 29 percent of seniors polled reported having “a disabling condition that limited their daily activities”.

“Accordingly, as the senior population grows so will the number of people requiring Long Term Care services. Changing family structures as well as the emotional and financial strain of caregiving, in part, lead to an ongoing demand for care homes,” said Ms Atherden.

“As a result, rest homes and nursing homes remain a central component of our long term care system. Through the Well Bermuda strategy and the Bermuda Health Strategy, the Ministry is working to address these challenges, in part, through the promotion of healthy ageing and ageing at home as a means to reduce the demand on facility based care.”

While “care homes will always play a role” in Bermuda’s in long term care system, she said: “It is essential that they provide quality care in a dignified and respectful manner to all residents.

“Currently there are 22 care homes in the community with approximately 400 beds in total. Two homes opened in the last year.

“Since the early 2000s up to today, there has been inconsistency in the oversight of these facilities, their registration process and adherence to Regulations. Changing regulatory responsibilities and management are in part to blame, as are limited resources,” Ms Atherden said.

“As part of the Bermuda Health Strategy my Ministry has prioritized improving the oversight of care homes and their standards of care.

“Over the last year, we have had inspectors visit homes in the morning to see what daily activities are being provided; during lunch and dinner time to assess food quality, and even inspectors going out at 11pm at night to verify night staffing levels. Scheduled and unplanned inspections are essential to ensure homes are continually meeting standards.”

The Minister was questioned at length by a host of Opposition MPs during the Questions Period. Bermuda Real will have more in part two of this a report.

Minister’s Statement in full:

Mr Speaker and Honourable Members,

I stand before this Honourable House to provide an update on the regulation of rest homes and nursing homes. This is an essential component of our long term care system, about which the community has expressed concern, and the Ministry has been working to improve. I thought it important that this Honourable House and our listening audience are informed of the work being done by the Ministry and the progress made so far.

Mr Speaker, we are living longer but not healthier lives and our health declines as we age. In the 2011 Health Survey, 29% of seniors reported having a disabling condition that limited their daily activities. Accordingly, as the senior population grows so will the number of people requiring Long Term Care services. Changing family structures as well as the emotional and financial strain of caregiving, in part, lead to an ongoing demand for care homes. As a result, rest homes and nursing homes remain a central component of our long term care system. Through the Well Bermuda strategy and the Bermuda Health Strategy, the Ministry is working to address these challenges, in part, through the promotion of healthy ageing and ageing at home as a means to reduce the demand on facility based care. However, care homes will always play a role in our long term care system and it is essential that they provide quality care in a dignified and respectful manner to all residents.

Mr Speaker currently there are 22 care homes in the community with approximately 400 beds in total. Two homes opened in the last year.

Care homes provide a range of medical and personal care services to their residents from minimal personal care in a rest home to full 24 hour nursing care in some nursing homes. The existing legislation requires all care homes to be registered with the Chief Medical Officer and adhere to the standards set out in the Regulations. The Regulations currently provide minimum standards in areas such as:

  • Staffing requirements
  • Nutrition
  • Physical environment
  • Health and safety; and
  • Record keeping

Mr Speaker since the early 2000s up to today, there has been inconsistency in the oversight of these facilities, their registration process and adherence to Regulations. Changing regulatory responsibilities and management are in part to blame, as are limited resources.

Mr Speaker, as part of the Bermuda Health Strategy my Ministry has prioritized improving the oversight of care homes and their standards of care.

Ageing and Disability Services, with the Elder Care Team, is responsible for coordinating the registration, compliance monitoring and complaints handling process for care homes. The Elder Care Team is a multidisciplinary group of professionals including the Ageing and Disabilities’ Seniors Coordinator and Accessibility Officer and representatives from the Department of Health including:

  • Community Nursing;
  • Occupational and Physiotherapy;
  • Environmental Health; and
  • Occupational Health and Safety.

Mr Speaker, Ageing and Disability Services has been developing the policy and procedures for a consistent registration, and effective monitoring process. As of March 2016 each care home has been routinely inspected by members of the Elder Care Team at least twice. Homes that are not satisfactorily meeting Regulations receive additional followup inspections.

Inspections also take place as a result of Ageing and Disability Services receiving a complaint regarding a care home. All complaints are reviewed by the Senior’s Coordinator and investigated by the Coordinator or referred directly to another Elder Care Team Member.

Over the last year, we have had inspectors visit homes in the morning to see what daily activities are being provided; during lunch and dinner time to assess food quality, and even inspectors going out at 11pm at night to verify night staffing levels. Scheduled and unplanned inspections are essential to ensure homes are continually meeting standards.

The inspections not only inform Administrators of required actions to meet the regulatory standards, but also reveal when training is required. When possible the Elder Care Team will organize an in-service training for the home, and the Administrator will be directed to other training resources. In addition, Ageing and Disability Services now holds monthly meetings with the care home Administrators to provide education and improve their understanding and awareness of best practices in relation to the registration standards.

This level of monitoring and support is essential to help improve the quality of care in the homes, as evidenced by the 2015 and 2016 re-registration results, but is hard to maintain with current staffing levels.

The 2015 Registration period was the first year a report card was created for each home to indicate how well they met the registration requirements. The Report Card allocates a status ranking based on the percentage of minimum standards met. Each standard can be assessed as either being: satisfactory, needs improvement, unsatisfactory. If a home receives ‘needs improvement’ or ‘unsatisfactory’ for a regulated standard, their total score decreases. The Ministry publishes the general results of the Report Card on our website.

Mr Speaker, the 2015 Registration processes resulted in:

  • 7 homes being Registered and
  • 11 receiving conditional registration status
  • 2 homes were not registered

After a year of the aforementioned inspections and support, the 2016 Re-Registration period resulted in:

  • 17 Homes are Registered
  • 4 Homes have received Conditional Registrations
  • 1 home is not registered

I must also stress, Mr Speaker, there are many care homes within our community that exceed the minimum standards. These homes are active in their own development and ongoing improvement. They must be commended for their efforts. We intend to update and develop the Report Card over time to help indicate areas of excellence as well as the most recent scores of each home.

Mr Speaker, as you have heard, we are working hard with existing resources to ensure there is appropriate oversight to ensure compliance with the existing standards. However these standards also require improvement. The current Regulations for care homes are the basics to ensure a safe and hospitable care home. However, residents require more than the basics, they deserve quality care. What defines quality changes over time and our long term care system and regulatory structure must adapt and reflect these changes. Furthermore the Ministry is keenly aware of the limitations of existing enforcement options within the legislation.

Accordingly, the Ministry is actively working on updating the Act and Regulations. This includes:

  • Introducing and updating Regulations and required supporting standards in accordance with international best practice and our local context;
  • Strengthening the functions and enforcement capabilities of the regulatory body to enable more effective and efficient oversight; and
  • Developing standards for unregulated long term care services including: day care and in home care services.

Updating this legislation is part of the 2015 Throne Speech commitment to improve the protection of our Seniors. The Ministry is also working to improve the adult protection system overall, and is building on work done by the Seniors Advisory Council’s Senior Law Reform Committee. I would like to take this moment to acknowledge the work submitted by the Law Reform Committee and thank them for their contribution. These projects are in the early stages and the Ministry will update the public at the earliest opportunity.

Mr Speaker updated regulations are essential to setting the standard for care, monitoring, and education by the regulatory authority is a key way to ensure compliance. However, as stated before Government resources are limited. We are working hard to make efficient and effective use of our existing resources; however the community’s role in oversight and improvement is vital. We encourage all listening to help be the eyes and ears for quality care. Report issues of concern to the Administrators of the home and to Ageing and Disability Services, and to engage with care homes to bring necessary energy and resources to enrich the lives of residents.

Furthermore we would like to acknowledge other collaborative projects occurring within the community. The Bermuda National Standards Committee, in conjunction with Age Concern, is developing a pilot accreditation program for seniors’ services. Accreditation is a recognized means to improve the quality of care provision for services. The Ministry has representatives on the working group reviewing the standards for this project.

Finally Mr Speaker, although improving the quality of our rest and nursing homes is essential for current and future residents, there are other substantial issues of our long term care system that must be addressed in order to achieve affordable and sustainable healthcare for all our residents.

First, the financing of long term care is a critical issue for individuals and families in our community and for our healthcare system as a whole. LTC is costly and we need to ensure there are intentional funding models that recognize access and affordability. Second, as a small community we must ensure we are strategic in the prioritization and development of the type of care homes, services and workforce required, based on existing and projected population care needs. Mr Speaker, I want you, my honourable colleagues and the listening audience to be aware that the Ministry is working towards addressing these challenges.

The FutureCare and HIP Personal Home Care Benefit has been a key step in the development of the long term care system. This Benefit enables payment for both professional and family caregivers to support people with long term care needs in their own homes. This is an essential step in improving the accessibility of long term care and reducing the demand on residential care facilities. Through this initiative the Ministry has been working collaboratively across Departments and with other Ministries to address standards in care by providers working in private homes. Ageing and Disability Services has started vetting personal caregivers, an unregulated group of providers, who are paid by government benefits or voluntarily choose to register. In addition, the Bermuda Nursing Council is in the process of updating their scope and introducing standards of practice for Nursing Associates who are a central part of the long term care team.

Second, as a small community we must ensure we are strategic in the prioritization and development of the type of care homes, services and workforce required, based on existing and projected population care needs. Mr Speaker, I want you, my honourable colleagues and the listening audience to be aware that the Ministry is working with the Bermuda Hospitals Board towards addressing these challenges. In fact, it is one of the key action items in the Bermuda Health Action Plan.

Overall, Mr Speaker, although I am pleased with the progress to date in improving standards within care homes, there is still much work to be done in this area, and with the long term care system as a whole. We, as a Ministry, are committed to this work and look forward to working with our community partners to achieve these goals for Bermuda.

Thank you Mr Speaker.

By Ceola Wilson

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