After months of anticipation, a public inquiry, called for by RNAO, delivered its recommendations for ensuring the safety and security of residents in the long-term care (LTC) system.

Announced by the government in 2017, the inquiry was prompted by the crimes of former nurse Elizabeth Wettlaufer. Over a nine-year period between 2007 and 2016, Wettlaufer killed eight residents at several nursing homes in south-western Ontario by injecting them with insulin.

At a media conference on July 31, inquiry commissioner Justice Eileen Gillese released her report, which contains 91 recommendations that cover measures the Ministry of Health, the College of Nurses of Ontario, home-care service providers, and the Office of the Chief Coroner should adopt.

RNAO CEO Doris Grinspun says the report honours the lives lost and provides a detailed plan of improvements needed to overhaul the sector. It exposes systemic issues that made it possible for Wettlaufer to get hired by an LTC home even though she had been fired from her first nursing job at a hospital after stealing narcotics and using them to try to kill herself. It calls for a requirement that homes adopt better hiring and screening practices, including background checks and improved training with respect to hiring and discipline. And it urges the ministry of health to increase the number of registered nursing staff in LTC homes by conducting a study and publicly releasing the results by July 31, 2020.

“We have long said that regulated staff must be increased in long-term care. It is the only way we can ensure dignified, safe and quality care,” says Grinspun.

RNAO was also pleased to see a recommendation that the government “encourage, recognize, and financially reward long-term care homes that have demonstrated improvements in the wellness and quality of life of their residents.” Grinspun says this addresses a major concern of nurses and nursing home operators. Currently, the government cuts funding to LTC facilities when resident care complexity decreases as a result of implementing best practices. This is because, as residents experience less pressure injuries, fewer falls, and overall improved health outcomes, a facility’s case mix index (CMI) decreases. Since CMI is what is used mainly by government to allocate funding, the overall funding decreases. RNAO says this kind of perverse logic actually discourages some home operators from improving quality of care.

RNAO was granted standing at the inquiry, and was represented by Christine Mainville, Lauren Binhammer and Gabriel Edelson, lawyers with Henein Hutchison LLP.