Potential conflict of interest involving Ontario nursing home inspectors a ‘big problem’: experts

WATCH ABOVE: A Global News investigation has revealed that a number of Ontario inspectors have previously worked for some of Canada’s largest for-profit seniors homes. And as Morganne Campbell reports, some experts believe this represents a conflict of interest that is too great a risk for thousands of vulnerable citizens.

The day before Linda Cottrell’s father died of COVID-19 she remembers frantically calling his long-term care home, Orchard Villa, for 13 hours trying to find answers.

“Our entire family just felt like it was a war zone over there. We didn’t know what was going on,” Cottrell told Global News. “I called for 13 hours and no one answered.

“The phones rang and rang and rang,” she said.

“No one telling me what was going on with my dad. I was desperately trying to talk to him.”

Cottrell’s father Manuel Marques, 93, died on April 20 – one of at least 78 who succumbed to COVID-19 at the home. She remembers him as a “gentle soul” with a bubbly sense of humour, and always concerned about the well-being of his family.

Orchard Villa, the nursing and retirement home in Pickering, Ont., experienced one of the worst COVID-19 outbreaks in the country. Now, Cottrell and advocates for seniors are sounding alarms about possible conflicts of interest relating to nursing home inspections.

In May, the home was at the centre of a damning report from the Canadian Forces, and this fall has been the focus of Ontario’s long-term care commission where family members described filthy conditions at the facility, overcrowded rooms and some who alleged loved ones were denied access to life-saving treatment.

A few months later, ministry inspectors flagged 24 infractions at the home in a July inspection report, based on 11 complaint logs, including observations from the Canadian military.

Yet, in September another inspector found only two infractions, based on three complaint logs. They were related to failures by staff to respond with proper care for residents who fell down and failures to properly ensure residents were properly fed and hydrated.

But something else stood out for Cottrell about the September inspection report. The inspector had previously worked for a seniors residence that is now owned by Southbridge.

Cottrell said she was surprised.

“It’s such an obvious conflict of interest,” she said. “You can’t do an objective third-party assessment of a situation if you have any kind of ties with that organization.”

READ MORE: A nursing home worker cared for a resident with COVID-19. Then she got it herself

This case isn’t unique.

Using social media profiles, Global News has identified at least 18 long-term care inspectors who have previously worked in the for-profit industry, including some of Canada’s largest for-profit long-term care homes, like Revera, Chartwell, Sienna Senior Living and Extendicare.

Nursing home inspectors who previously worked in the for-profit sector and are now responsible for investigating the industry are part of a “big problem” that raises questions about the quality of inspections and potential bias, say experts.

“I really wonder about the objectivity of many of the people that are doing and the pre-existing relationships that could be influencing that,” said Kerry Bowman, a bioethicist at the University of Toronto.

“It doesn’t meet the criteria of objectivity.”

Documents reviewed by Global News show the September inspection report, which found the two violations, was completed by the former director of care at Craiglee nursing home located in Scarborough. According to provincial inspection records, Craiglee has been repeatedly cited for violations of neglect, lack of infection control, medication dispensing errors, and poor wound care.

A spokesperson for Southbridge said it purchased Craiglee Nursing Home in November 2012 and the former director of cases “has not been employed at the home at any point during Southbridge’s ownership” and has never worked for the company.

Candace Chartier, a senior official with Southbridge, said the company “takes all allegations of neglect seriously.”

“When inspectors identify an area of improvement, we work to take immediate action, including efforts to ensure that the matter is resolved before the inspectors leave the home,” she said in an email. “Corrective actions can include on-going education of staff on our Falls Prevention Policy and the Skin and Wound Care Policy.”

Bowman said although it’s vital to hire inspectors who have an in-depth knowledge of nursing and infection prevention, having former employees conduct inspections at homes they previously worked in is “ethically problematic.”

“Their objectivity may be coloured by the fact that they’re only looking at one side of this,” he said, speaking generally about inspectors who have previously worked in the nursing home industry. “They’re looking at what it is like to run a rather than what it’s like to live in .”

READ MORE: Orchard Villa families detail conditions at facility before long-term care commission

A spokesperson for the Ministry of Long Term Care declined to answer questions about what checks and balances are in place to ensure the more than 140 inspectors in the province are conducting quality inspections.

“To qualify to work as a Long-Term Care (LTC) home inspector individuals are required to be registered as a Registered Nurse with the College of Nurses of Ontario, a Registered Dietitian with the College of Dietitians or hold a current certificate of competence with the College of Physiotherapists of Ontario, or be certified as a Public Health inspector,” said Rob McMahon in an email, adding that all ministry employees are required to promptly disclose any actual, or potential, conflicts of interest to their managers.

“All inspectors submit a resume to the Ministry, which would disclose their previous work history; thus, their manager would be aware of where they had previously worked.”

When asked about the inspection completed at Orchard Villa, McMahon said “It would be inappropriate for the ministry to comment on human resources matters.”

Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, said there is a “significant problem” with nursing home inspectors investigating their previous employers and the province needs to provide more oversight.

“I think that there is a lot of bleeding back and forth,” she said.

In some cases, when a former employee of a facility may be returning to conduct an inspection, Meadus said it’s “human nature” for that person to have some sympathy for the difficulty of running the long-term care home.

Both Meadus and Bowman said it raises questions about whether every infraction is being caught, and how thorough the inspections are. Both said inspectors with previous work experience in the for-profit sector shouldn’t be disqualified from working for the ministry.

“I think it is very difficult to keep those two things separate, but especially when you’re going into a home that perhaps, you know, is the same company that you worked with,” she said. “How do you know if the inspector is doing a good job?

“What kind of quality control does the ministry have to ensure that when an inspection is going in that they are making the appropriate findings?”

Meadus and other advocates have called for an increase in resident quality inspections (RQIs) at the province’s 626 homes. Generally, nursing home inspections are either classified as complaint and critical incident inspections, which are reactive, or RQIs, which are more comprehensive and unannounced.

Cottrell said her allegations of filthy conditions and neglect at the home were never properly investigated.

“ said she couldn’t speak to those because they had occurred prior to her inspection,” she said. “I was so frustrated that surely would have known that an inspector was coming. So why wouldn’t they clean up?”

Southbridge said that a number of steps have been taken to improve infection prevention at the home, including hiring additional staff.

“We take all concerns regarding our homes seriously, including those expressed by the families and the CAF report,” Chartier said in an email. “Our top priority at all times is providing frontline care services to our residents, and we always work to ensure we keep families as up-to-date as quickly as possible.”

In April the military was called in to help Orchard Villa and four other Ontario nursing homes amid the first wave of COVID-19 outbreaks.

The “gut-wrenching” 23-page report written Brig. Gen. Conrad Mialkowski said patients at Orchard Villa were left in soiled diapers, caregivers were exhausted and the facility had “cockroaches and flies.”

Orchard Villa given approval to expand

Despite the problems at the home, last month Doug Ford’s Progressive Conservative government granted permission for Orchard Villa to expand with 87 new spaces. The new spaces at home will bring its total capacity to 320.

Melissa Miller, a lawyer representing 30 families involved in a lawsuit against the home which alleges gross negligence and breach of contract, said her clients are furious that the home was given the green-light to expand even as the long-term commission has yet finished their work.

“I think it’s cause for concern,” Miller said, speaking about issues around potential bias of nursing home inspectors. “I think in an environment where we are questioning the systemic foundation upon which the most vulnerable people in our society are relying on for their care and we see something like this, we have to wonder how effective those inspections are.”

READ MORE: Ontario’s worst hit nursing homes and who owns them

She called the province’s decision to allow Orchard Villa to expand “a slap in the face” to every family who had a loved one die at the home, often in isolation, from COVID-19.

Chartier said Southbridge has learned “important lessons” from the first wave of COVID-19 at Orchard Villa, which will be included in the design of the new spaces.

“While the project is in the initial stages of planning, it will meet all standards set out in the Ontario Long-Term Care Home Design Manual, which will assist in enhancing infection prevention and control,” Chartier said. “Once completed, all 256 beds at the new home will be A-class beds.”

Chartier declined to comment on the lawsuits the company would address “the allegations through the proper legal channels.”

In November, the Ford government announced that as part of a larger initiative to add nearly 3,000 new or upgraded spaces to long-term care homes as part of a $1.75 billion investment.

“With this announcement, our government is taking another step towards creating a 21st-century long-term care sector that provides the highest quality of care for our most vulnerable people, where and when they need it,” said  Minister of Long-Term Care Merrilee Fullerton, in a statement.

Despite promises from the government to build an “iron ring” around nursing homes, more than 100 homes are currently battling an outbreak of the novel coronavirus among staff and residents, according to figures from the Ministry of Health.

More than 270 long-term care residents died from COVID-19 in November alone, according to provincial data.

Cottrell said there needs to be a “complete overhaul” of Canada’s nursing care sector, including how homes are inspected.

“I have no idea how on earth these places passed inspections,” she said. “I saw with my own eyes … it was just it was chaos. I don’t know what else to say about it, except that I am appalled. I’m just appalled. And I and I have no faith in those inspections that occurred, even pre-pandemic.”

© 2020 Global News, a division of Corus Entertainment Inc.

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