Deep in the second volume of the BC Ombudsperson’s recently-released second report on seniors’ care, is an interesting and important discussion about large-scale staff replacements and other substantial changes at residential care facilities.
Under the current legislative framework governing most care facilities for seniors, a facility operator must notify its regional medical health officer four months before the operator decides to reduce, expand or “substantially change” the nature of the accommodation or services provided at the facility. According to the Ombudsperson’s report, uncertainty regarding this requirement has led to “inconsistent compliance.” For example, there is no government policy on whether a mass replacement of staff constitutes a substantial change in the facility, though, the report notes, “logically it would seem that would be the case.”
As the report explains, these significant replacements of staff, usually via contracting out or contract flipping, result in equally significant negative impacts on residents – especially the most vulnerable – and their families:
Mass replacement of staff can occur when facility operators switch from contracting with one private service provider to another. Such turnovers can disrupt the lives of seniors in residential care, especially those residents whose care needs are complex. Over time, long-term staff acquire specialized knowledge of these needs, so the simultaneous replacement of many employees can make it difficult for the seniors because continuity of care is disrupted. This is particularly the case for residents with dementia. It can also be stressful to families since they often need to provide extra support to their relatives during such transitions.
Given that large-scale staff replacements have become “a regular recurrence in recent years,” the report makes a number of recommendations to address the negative impacts of mass turnovers, including the following:
- Ensure that the 4-month notice requirement applies to large-scale staff replacements, and make sure operators are complying.
- Develop safeguards to ensure that seniors are not adversely affected by large-scale staff replacements.
- Require operators to notify residents, families and staff promptly of a decision to undertake a mass staff replacement or other substantial change.
Although these are all commendable recommendations, I wish the report would have included one more. To my mind, the best way to eliminate the negative effects of mass staff replacements, is, well, to eliminate mass staff replacements. This could be accomplished in a number of ways, including through legislative or other restrictions on cost-driven contracting out and contract flipping, or by ensuring, preferably through legislation, that existing staff are not impacted by these changes.
As an individual, quoted in the report, put it:
Staff do not want to work in a facility that has this kind of job uncertainty. … This impacts seniors in terms of the lack of continuity of their care. … There are many examples of significant problems for residents created in circumstances where new staff have no personal connection to the residents, or where new staff are unfamiliar with the needs of residents. … The point is that these problems do not exist in facilities that do not engage in contract flipping.