Facility allegedly breached provincial standards on adequate supplies

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A struggle over diapers between staff and managers at a Scarborough nursing home has highlighted what critics say are practices that can deny long-term-care patients their dignity.

A staff complaint that the facility was short of diapers drew Ontario Ministry of Health and Long Term Care investigators to the Leisureworld Caregiving Centre - Altamont on Aug. 11.

The investigators agreed the home on Island Road in West Hill had breached a ministry standard on providing adequate diaper supplies, though Leisureworld management continues to argue the finding was wrong.

On Aug. 14, facility managers sent a memo to staff - asking them to sign it to show they had read it and understood - saying complaints that not enough diapers are kept on hand for patients are untrue.

Leisureworld West Hill staff have been "deliberately hoarding" diapers in patients' rooms, sometimes in closets or in clothing, the memo said, warning such actions are "theft and will not be tolerated" and staff caught "hoarding" face discipline up to termination.

In an interview this week, Ontario Nursing Association president Linda Haslam-Stroud said she suspects "hiding the diapers was a way for the staff to provide care" the residents of the West Hill home need.

Paper diapers used in most Ontario nursing homes are marked so that staff can see when they are 75-per-cent full, which manufacturers say is a level where residents remain comfortable.

Haslam-Stroud said nursing home staff in Ontario have faced pressure not to change diapers before they are three-quarters full. The ONA has informed the ministry that health-care workers in some homes have taken to pouring water on diapers, to bring them up to the 75-per-cent level in case management checked and challenged them.

"This is the kind of practice taking place," she said, adding, "We are the advocates for the elderly. A lot of them can't speak for themselves."

Leisureworld CEO David Cutler, however, said there is no evidence that waiting until a diaper is 75-per-cent full "is a mandatory practice at Leisureworld. If we open a diaper at Leisureworld and it's 48 per cent full, it will be changed," he said.

"We are not dictatorial. We are making sure our residents are as comfortable as possible," Cutler added.

He insisted managers at Leisureworld homes "are not going round and checking" how full diapers are.

Leisureworld, which bought the West Hill home in February, receives professional advice from a third-party company that assesses incontinence needs for each patient. It then provides more than the estimated number of diapers and stores extra supplies in emergency bins that can be opened by managers, he said.

The ministry provides $1.20 per resident per day for diapers, but Leisureworld West Hill spends $1.80 a day and between $1.50 to $2.20 is spent at Leisureworld's other locations, Cutler said. "We aren't skimping out."

Management at the West Hill home "did find that some of our staff were taking our product and hoarding it in the residents' rooms," he said, adding he could think of no other reason for the hoarding than the convenience of certain staff.

"We just have to change their mindset," said Cutler, but conceded the memo, written by local administrators, "shouldn't have gone as far as it did."

Cutler said Leisureworld's third-party company trains staff on incontinence products, probably telling staff that residents are comfortable up to the 75-per-cent level. The diapers, he said, "are vastly improved from the product being used even 10 years ago."

Haslam-Stroud said Cutler's allegation of staff convenience does not explain why hoarding would take place.

"It's not because they don't want to walk up the hall," she said.

In a 2005 report, the Ontario Federation of Labour said nursing homes were rationing diapers without regard to the needs of residents. The group sees that, along with general understaffing of the homes, as a systemic problem and has asked the ministry and Ontario Human Rights Commission to investigate.

Mark Nesbitt, a ministry spokesperson, said the home has some time to reply to the citation and provide an action plan "to correct the issue that was found" but would give no more details until then.

Lois Dent, president of the volunteer advocacy group Concerned Friends, said if the staff claims of diaper rationing are true, "good for the staff for standing up for their residents like that."

Sanctions against bad practices in Ontario nursing homes aren't strong enough, said Dent, whose group helped start the ministry-funded family council program and now looks forward to the forming of a province-wide family council that could be a powerful voice for nursing-home residents.