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December 20,200 1

Mayor Bob WadeCity Hall - 1st Floor71 Main Street WestHamilton, OntarioL8P 4Y5

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Dear Mayor Wade:

R e : Residential Care Facilities Schedule 20 and $50 Per Bed Inspection Fee

The Ontario Residential Care Association (ORCA) is a voluntary, non-profit association thataccredits retirement homes across the province. ORCA sets standards, uses a peer-reviewsystem of inspection, and an independent third-party to grade the surveys. ORCA then awardsthe accreditation to those retirement homes that pass our accreditation process. Three hundredretirement homes.in Ontario, including six homes in Hamilton, voluntarily comply with oursystem of accreditation. All ORCA member homes must maintain their accreditation throughon-going inspections to remain in the association. Those homes that fail their accreditation areexpelled. ORCA also operates the province-wide, Retirement Home Complaints Response andInformation Service, funded by the Ontario Ministry of Citizenship.

Along with Ed Bryja and Claire Aiken from Highgate, A Retirement Residence, I met with youto discuss Hamilton’s by-law and inspection fee on July 9,200l. At this meeting, we expressedour concern with Hamilton’s intent to set a new by-law for retirement homes and the decision toimpose a $50 per bed inspection fee. On this issue, ORCA has met with city staff, CouncilorsCaplan and Bain, and your Medical Officer of Health. Our member homes have contacted alltheir councilors directly to make their position clear. We are now aware that by-law 156 waspassed by Council on July 10,200 1 and is referred to as Schedule 20 - Residential CareFacilities.

ORCA’s position on Schedule 20 is simple.

1 . ORCA standards are far more comprehensive and appropriate for retirement homes thanHamilton’s which are designed for lodging homes - see attached comparison

2. Hamilton’s inspection system costs $50 per bed per year while ORCA’s costs $25 perbed per year. As well, Hamilton charges for the number of beds a home could have.rather than what it does have. ORCA homes have been charged for 40% more beds thanthey actually have. Hamilton would charge a 100 bed home $7,000 per year whileORCA would charge $2,500.

3. ORCA offers extensive retirement home operating manuals, training and education aspart of its membership fee. Hamilton offers none of this.

ONTARIO RESIDENTIAL CARE ASSOCIATION

2 155 leanne Blvd. Suite 2 18, Mississauga, Ont. 15K 2K8 Phone: (905) 4030500 Toll free: 1 (800) 361-7254 Fox: (905) 4030502

4 . Hamilton’s Public Health Department is having difficulty meeting their mandatoryprogram requirements - see attached Hamilton Spectator article. Inspecting furtherretirement homes will exacerbate this problem.

5. ORCA’s standards are provincial in scope as they are being implemented in 300retirement homes across Ontario. This is the only standardized system of accredi&ion inOntario.

The effect of the Hamilton by-law on ORCA accredited homes will be to lower their standardswhile charging them more. This is not progress.

ORCA Recommends:

1 . That Hamilton accepts ORCA’s system of accreditation as the Region of Kent-Chathamdid in 2001. The six accredited homes in the New City of Hamilton should be consideredin compliance with Hamilton’s by-law.

2. That Hamilton foregoes the $50 per bed inspection fee for accredited homes. ORCAmembers are willing to continue to pay the annual license fee and to comply with foodsafety, fire and building inspections.

Please review the attached comparison between ORCA and Hamilton’s standards. I will be intouch with your office in the New Year to request a meeting. In advance, I may be reached at905 403-0500 x222. -

cgj!gjFExecutive Director

Attach (2)

PC. Councilor Marvin Caplan, Ward 1 Councilor Murray Ferguson, Ward 12Councilor Andrea Horwath, Ward 2 Councilor Russ Powers, Ward 13Councilor Bernie Morelli, Ward 3 Councilor Dave Braden, Ward 14Councilor Sam Merulla, Ward 4 Councilor Margaret McCarthy, Ward 15Councilor Chad Collins, Ward 5Councilor Tom Jackson, Ward 6Councilor Bill Kelly, Ward 7Councilor Frank D’Amico, Ward 8Councilor Anne Bain, Ward 9Councilor Larry Dilanni, Ward 10Councilor David Mitchell, Ward 11

ORCA

Comparing ORCA ‘s Standards with Hamilton’s Schedule 20

Attached is a brief outline of how ORCA’s standards compare with the Hamilton’sschedule 20. In all areas, ORCA meets or exceeds the standards set by the schedule 20.We also have standards in areas that schedule 20 does not even mention: humanresources, written policy manuals in all homes for all departments, specific educationprograms, annual training seminars, specific housekeeping procedures, monthly firedrills, involvement of families in all aspects, comprehensive medication distributionprocedures, restraint policies, comprehensive nutrition standards, full infection controlpolicies, administration, recreation, finance policies and more. These standards are basedon the combined knowledge of the association on what is required to operate a saferetirement home for residents and stafT

Many of the standards proposed in schedule 20 clearly relate to boarding lodges. Issuessuch as minimum water pressure, room temperature, access to a washroom, ventilation,minimum room size do not apply to accredited retirement homes. If these issues wererelevant, then these retirement homes would not be able to stay in business. Schedule 20is not designed for retirement homes, but they regulate retirement homes none-the-less.

Capacity of the Public Health Department to Inspect Retirement Homes

Also attached to this document is an article from the October 3 1,200l “The HamiltonSpectator” with reports that the City of Hamilton earned a failing grade on two-thirds ofits mandatory programs. Clearly the public health department is struggling to meet itsmandatory responsibilities. Adding the new responsibility of implementing a retirementhome inspection program will further diminish the capacity of the public healthdepartment to meet its already demanding inspection requirements.

ORCA maintains its system of inspection for retirement homes across Ontario.Retirement homes voluntarily comply with the accreditation and pay for the cost. Thereis no cost or responsibility for any municipality. In 2001, the Region of Kent-Chathampassed a by-law making it mandatory that all retirement homes be accredited by ORCA.ORCA is not asking Hamilton to make accreditation mandatory, only to permit the homesthat are accredited by ORCA to be considered in compliance with Schedule 20 and notrequired to pay the $50 per bed inspection fee.

Ontario Residential Care Association2 155 Leanne Blvd, Ste. 2 18, Mississauga, Ontario l-800-361-7254

Comparison Between ORCA Standards and Hamilton’s Schedule 20

ORCA Standards/Schedule 20 Description Hamilton ORCALicensingl All facilities must meet requirements fi5 Ei5Operatorl Incident plan I3 65l No firearms I3

l Telephone Iif s

l Qualified employees I3 68l License 63 IaEmployeesl 18 years of age Ea Esl SS graduate fia I3l 20 hours of education Kl I3l Orientation for new staff lrcil Staff development programs isl Annual evaluations 63l Qualifications meet requirements 63

l Records for each staff Iis

l Registered staff in good standing with CNO I3

l Employee on duty 24 hours a day lizi

Locationl Noise not exceed 58 decibels is ElCapacity, Building Code

l Potable & hot water

l Windowl Ventilationl Clean towels/linen

l Toilet not within dining room, kitchen etc.

Ontario Residential Care Association2155 Leame Blvd, Ste. 218, Mississauga, Ontario l-800-361-7254

ORCA Standards/Schedule 20 Description Hamilton ORCARestraint Policyl Education on least restraint possible Edl Alternate measures I3l Family and resident education lal Individual assessments Isl Repositioning practices and reports @Il Consent by resident/substitute 66l Physician order Eal On-going documentation by physician I3

Nutrition Carel Follows Canada Food Guidel Menus posted : sl Alternative entree choicesl Seasonal/holiday choices IFSl Resident preferences/allergies noted 68l Textured food available if required Ii8 Ell Snacks/fluids between meals Kl 6%l Nutritional assessments completed for

residents with special needs El Eil Tray servicel Hospitality practices I3

l Guests invited to meals @iI

. Preferred seating arrangements El

l Food service monitored for presentation and I3

tasteInfection Controll Compliance with guidelines set by MOH ml Staff aware of hand washing techniques iiil Hand washing area separate from care areal Immunization of stafVresidents against flu :l Outbreak contingency plan 63 *l VRE and MSRA policies for staffl Isolation procedures iiil Protective equipment available Kl

Medical Carel Resident to retain a physician lii?f WIl Medial response if physician not available 68 6rll Regular reviews of physician orders ial Residents and families involved in decisions 63l System to recognize indicators of changing I3

resident needs

ORCA

v

Ontario Residential Care Association2155 Leanne Blvd, Ste. 218, Mississauga, Ontario l-800-361-7254

ows TPA regulationsand resident of options if needs

l Individual record for each residentl Incident reportsl Resident charting

l Organization structure for operating a facilityl Financial systeml Policies and procedures for all aspects of

ernent of all transactions every3 months

l Written agreementCornrnunity Relationsl Outreach to connnunityCode of Ethics postedCommitment to residents postedComplaint process for residents, family, staffSafety and Securityl Health and safety committeeFamily Relationsl Provision for overnight guestsl Families invited to participate at residenceRecreationl Full range of activitiesl Profile of resident’s ret needsl Regular program evaluationl Transportationl Sufficient common area for recreationl Activities communicated dailySpiritual needs recognizedl

Volunteersl Programs in place to encourage volunteersResidents’ Councill Encouraged and supported

Ontario Residential Care Association2 155 Leanne Blvd, Ste. 2 18, Mississauga, Ontario l-800-361 -7254

I’

r ORCA Standards/Schedule 20 Description Hamilton ORCAHousekeepingl Facility is kept clean Ez Ial WHMIS wll Written policies to prevent cross Iii5

contamination Eil Staff aware of infectious outbreak procedures 66l Guidelines for VRE, MSRA Ial Chemicals safely storedl Laundry service policies and procedures :l Scheduled laundry pickup 6rl

l Mending and ironing clothes 63

l Soiled linen policies Erl

l Hand washing facilities available in laundryarea z

l Laundry chutes self closingWastel Garbage in receptacles E!i 63l Ashes in metal container l3 @Il Waste disposal with qualified service

contractor I3Lightingm Adequate illumination I3 l3e Emergency power supply I3Temperaturem 21c-Sept. 15 toMay 65 I3Ventilatione Adequate I3 EaGeneral SafetyB Handrails

zia

D Grabbars I3D Non-skid finishes E!lm Balustrades opening - 4 in. Kl :D Call bells 6rlD Ramps IifFood Safetyl Compliance with HPPA I3 I3l Acceptable attire for staff 63l Oversight responsibility I3

Ontario Residential Care Association2155 Leanne Blvd, Ste. 218, Mississauga, Ontario l-800-361-7254

1

ORCA Standards/Schedule 20 Description Hamilton ORCAFire Safetyl Compliance with Fire Code 63 Ial Fire plan communicated to staff and 68

volunteers Efl Monthly fire drills ial Fire drills practiced on all shifts 6%l Reports on fire drill resultsl Certified 3d party inspections of fire ifi

detection system I3l Evacuation and disaster plansl Oversight responsibilityCare Servicesl In accordance with MOW Iisl All health care workers abide by regulations s

that govern them - Regulated HealthProfessionals Act, Health Care Consent Act

l Family involved in care planning 63l Regular evaluation of care 63l Procedures and training for transfers I3l Written policy on aggressive residents and 63

resident abuseDwzsl Medications in locked cabinet I3l Prescriptions by physicians ii I3l Self medication guidelines a Ial Organized medication administration system I3

operated by licensed pharmacistl Pharmacy prqvides guidelines, information, Eiif

safe storage infol In accordance with medication practices and a

provincial regulationsl Staff sign med records at time of lii?f

administering I3

l Policy on use of medical directives lzi

l Physicians review prescriptions every 3months

Ontario Residential Care Association2155 Lxauue Blvd, Ste. 218, Mississauga, Ontario l-800-361-7254

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Page 1 of 3

CIJC ynmi1tan $pcmtarThe Hamilton Spectator, Final ed.News, Wednesday, October 3 1,200 1, p. A03

Public health gets failing mark; ‘On the very fundamental things, keeping peopleout of hospital, we are not making it’ : Caplan

Rick Hughes; Municipal Affairs ReporterThe Hamilton Spectator

The city’s public health department has earned a failing grade for two-thirds of itsmandatory programs.

While the provincial audit presented to council yesterday was for 1998 and 1999, thereport came with a warning that increases to public health’s $16-million budget maybe needed if it is to meet the standards.

The audit showed that of 17 services assessed, the health unit met the minimumstandard in only six. In six others, its compliance rate was below 75 per cent.

“On the very fundamental things that we are responsible for, for keeping people out ofhospital, for people having a good quality of life, clearly we are not yet making it,”said Ward 1 Councillor Marvin Caplan, an outspoken proponent o@ublic healthprogramming. “This is not an area we can afford to be frugal in.”

Joe-Anne Priel, general manager of social andpublic health services, regards theprovincial measurements as “very significant.”

The penalties for failing to meet the province’s standards are major. The most drasticwould have the province take over management of the unit.

The unit blames staffing as the main reason for the shortcomings and insists therehave been major improvements in the past year, said Priel.

Vi&i Woodcox, director of program delivery, expects to meet minimum standards inmost areas by 200 1, though unexpected crises could change that.

“It does shift because of the various issues that have happened in this past year,” saidPriel, “say West Nile virus, safe water and bioterrorism.”

The unit got extra staff in 2000 but did not add any new staff this year.

Caplan notes no health unit in the province is fully compliant.

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Page 2 of 3

The six program areas where it scored less than 75 per cent compliance are:

* Chronic disease prevention. It was at 55 per cent of requirements in 1998 and 69 percent in 1999.

* Injury prevention, including substance abuse prevention. It was at 50 per cent in1998 and 54 per cent in 1999. c

* Reproductive health. It was at a low of 43 per cent in 1998, but jumped to 71 percent for 1999.

* Children’s health. It was at 61 and 65 per cent; food safety was at 71 and 73 percent.

* Vaccine preventable disease control. It was at 71 and 67 per cent.

In the area of chronic disease prevention, the audit says the city was not up.to standardin programs promoting health in the workplace and schools, in tobacco control insecondary schools and in skin cancer programs.

The child health program problems were stagrelated, meaning the unit couldn’t fulfillits requirement to educate childcare and health care providers, give support forbreastfeeding and run dental programs.

The reproductive health unit’s difficulties were addressed by hiring twopubiic healthnurses, one to work with schools exclusively.

The health unit did manage full compliance in six areas: control of infectious diseases,early detection of cancer, safe water, equal access, health hazard investigation andprogram planning.

Caplan said a city like Hamilton has many social and economic conditions that puthigher demands on public health units and make its job of tending to those demandsmore difficult.

You can contact Rick Hughes by email at <ahref=“mailto:rhughes@hamiltonspectator.com”~rhughes@hamiltonspectator.com~/a~or by telephone at 905-526-3482.

Category: NewsUniform subject(s): Diseases, therapy and prevention; Physicians and health careprofessionals; Public health and physical fitnessStory type(s): NewsLength: Medium, 458 words

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