Directing Residential Care Concerns to Health Authorities - Revision history

Charmaine Spencer: /* References */

2016-05-13T15:53:44Z

References

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	#Patient Care Quality Review Board. 2013 Annual Report. Online: http://www.health.gov.bc.ca/library/publications/year/2013/PCQRB-annualreport-1213.pdf (Last accessed January 9,2016)		#Patient Care Quality Review Board. 2013 Annual Report. Online: http://www.health.gov.bc.ca/library/publications/year/2013/PCQRB-annualreport-1213.pdf (Last accessed January 9,2016)
	#Patient Care Quality Review Board. “Frequently asked questions”. Online : http://www.patientcarequalityreviewboard.ca/faqs.html#Q20 (Last accessed January 9,2016)		#Patient Care Quality Review Board. “Frequently asked questions”. Online : http://www.patientcarequalityreviewboard.ca/faqs.html#Q20 (Last accessed January 9,2016)
	#Patient Quality Care Review Board Annual Report, 2011-12, pg.33. Online : http://www.health.gov.bc.ca/library/publications/year/2012/PCQRB-annualreport-1112.pdf (Last accessed January 9,2016)		#Patient Quality Care Review Board Annual Report, 2011-12, pg.33. Online : http://www.health.gov.bc.ca/library/publications/year/2012/PCQRB-annualreport-1112.pdf (Last accessed January 9,2016) For other more recent data, see Patient Quality Care Review Board Annual Report, 2014-15. Online: https://www.patientcarequalityreviewboard.ca/pdf/PatientCare_QRB_2014-15_Web.pdf (Last accessed May 10, 2016)
	#CCALA, s. 15.		#CCALA, s. 15.
	#See Sivertson (Guardian ad litem of) v. Dutrisac [2011] B.C.J. No. 810, 2011 BCSC 558.		#See Sivertson (Guardian ad litem of) v. Dutrisac [2011] B.C.J. No. 810, 2011 BCSC 558.

Charmaine Spencer: /* What can a Patient Care Quality Review Board review? */

2016-05-13T15:51:19Z

What can a Patient Care Quality Review Board review?

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	===What can a Patient Care Quality Review Board review?===		===What can a Patient Care Quality Review Board review?===

	~~([[{{PAGENAME}}#References\|14]])~~ The boards can review:		The boards can review:

	* complaints about the quality of any health care service under the jurisdiction of the health authorities (these complaints must first have been addressed by a health authority’s local Patient Care Quality Office),		* complaints about the quality of any health care service under the jurisdiction of the health authorities (these complaints must first have been addressed by a health authority’s local Patient Care Quality Office),
	* complaints about services that were expected, but were not delivered by the health authority,		* complaints about services that were expected, but were not delivered by the health authority,
	* complaints that have not been addressed by the Patient Care Quality Office within 40 business days, and		* complaints that have not been addressed by the Patient Care Quality Office within 40 business days, and
	* matters directed by the Minister of Health.		* matters directed by the Minister of Health. ([[{{PAGENAME}}#References\|14]])

	There are a number of legal matters related to care quality that the Review Board ''will not review''. For residential care, these include complaints about:		There are a number of legal matters related to care quality that the Review Board ''will not review''. For residential care, these include complaints about:
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	* a decision of the Community Care and Assisted Living Act Appeal Board. ([[{{PAGENAME}}#References\|15]])		* a decision of the Community Care and Assisted Living Act Appeal Board. ([[{{PAGENAME}}#References\|15]])

	It is unclear whether unreviewable Licensing "decisions" might include Licensing not responding to (or deciding to not investigate) a complaint.		It is unclear whether "unreviewable Licensing decisions" might include Licensing not responding to (or deciding to not investigate) a complaint.

	The Review Board also cannot hear certain matters related to:		The Review Board also cannot hear certain matters related to:

Charmaine Spencer: /* Volume */

2016-05-13T15:49:37Z

Volume

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	===Volume===		===Volume===

	The PCQO received about 5000 care quality complaints in 2011/12, over 4500 in 2012/13 and over 7100 in 2014/15. Less than 2% of the complaints (90 cases in 2012/13 ~~ans~~ 100 in 2014/15) received by the PCQO were reviewed by the Patient Care Quality Review Board.		The PCQO received about 5000 care quality complaints in 2011/12, over 4500 in 2012/13 and over 7100 in 2014/15. Less than 2% of the complaints (90 cases in 2012/13 and 100 in 2014/15) received by the PCQO were reviewed by the Patient Care Quality Review Board.

	==Community Care Licensing Offices==		==Community Care Licensing Offices==

Charmaine Spencer: /* Volume */

2016-05-13T15:48:54Z

Volume

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	===Volume===		===Volume===

	The PCQO received about 5000 care quality complaints in 2011/12 ~~and~~ over 4500 in 2012/13~~. Optimistically this decrease may represent improvements~~ in ~~systems. However it may reflect frustration over whether or not the process is effective~~. Less than 2% of the complaints ( 90 cases in 2012/13) received by the PCQO were reviewed by the Patient Care Quality Review Board.		The PCQO received about 5000 care quality complaints in 2011/12, over 4500 in 2012/13 and over 7100 in 2014/15. Less than 2% of the complaints (90 cases in 2012/13 ans 100 in 2014/15) received by the PCQO were reviewed by the Patient Care Quality Review Board.

	==Community Care Licensing Offices==		==Community Care Licensing Offices==

Charmaine Spencer at 15:37, 13 May 2016

2016-05-13T15:37:24Z

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	===The Challenges===		===The Challenges===

	Although the ~~new~~ registry (and “deregistering”) system exists, a ~~recent~~ review pointed out that it has several limitations. The mandatory registry requirement for employment only applies to care aide workers seeking employment in publicly funded facilities. Unlike a Regulatory College, the Registry can only investigate serious misconduct (“abuse”) and cannot address other workers’ “competence” matters. The Registry is unable to compel reporting of abuse or operators’ participation in the investigatory process.		Although the registry (and “deregistering”) system exists, a review of the provincial system pointed out that it has several limitations. The mandatory registry requirement for employment only applies to care aide workers seeking employment in publicly funded facilities. Unlike a Regulatory College, the Registry can only investigate serious misconduct (“abuse”) that is brought to its attention and cannot address other workers’ “competence” matters. The Registry is unable to compel reporting of abuse or operators’ participation in the investigatory process.

	Some operators feel the investigation process lacks transparency and the cost of investigation is burdensome. As a result, some employers may simply circumvent the investigation/ de-registry process by terminating the employee without necessarily reporting the incidents. This leaves these workers open to seeking employment elsewhere in health, possibly in private care. ([[{{PAGENAME}}#References\|39]])		Some operators feel the investigation process lacks transparency and the cost of investigation is burdensome. As a result, some employers may simply circumvent the investigation/ de-registry process by terminating the employee without necessarily reporting the incidents. This leaves these workers open to seeking employment elsewhere in health, possibly in private care. ([[{{PAGENAME}}#References\|39]])

Charmaine Spencer: /* What can a Patient Care Quality Review Board review? */

2016-05-13T15:32:50Z

What can a Patient Care Quality Review Board review?

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	* matters directed by the Minister of Health.		* matters directed by the Minister of Health.

	There are a number of legal matters related to care quality that the Review Board will not review. For residential care, these include complaints about:		There are a number of legal matters related to care quality that the Review Board ''will not review''. For residential care, these include complaints about:

	* involuntary admissions under the Mental Health Act (that would include involuntary transfers from the hospital to a residential care facility, or vice versa)		* involuntary admissions under the Mental Health Act (that would include involuntary transfers from the hospital to a residential care facility, or vice versa)
	* a decision by a Medical Health Officer or Licensing officer under the Community Care and Assisted Living Act		* a decision by a Medical Health Officer or Licensing officer under the Community Care and Assisted Living Act
	* a decision of the Community Care and Assisted Living Act Appeal Board. ([[{{PAGENAME}}#References\|15]])		* a decision of the Community Care and Assisted Living Act Appeal Board. ([[{{PAGENAME}}#References\|15]])

			It is unclear whether unreviewable Licensing "decisions" might include Licensing not responding to (or deciding to not investigate) a complaint.

	The Review Board also cannot hear certain matters related to:		The Review Board also cannot hear certain matters related to:

Charmaine Spencer: /* Community Care Licensing Offices */

2016-05-13T15:24:23Z

Community Care Licensing Offices

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	Anyone who is concerned that a facility is not meeting the CCALA requirements can complain to the licensing office for that area. By law medical health officers must investigate every complaint that alleges that a residential care facility licensed under the Act is not fully meeting the legislated requirements. ([[{{PAGENAME}}#References\|19]])In practice, however, the responsibility for conducting these investigations is delegated to licensing officers who are employees of the health authorities. The duty of the licensing office for the inspections is owed to the public, as opposed to individuals. ([[{{PAGENAME}}#References\|20]])		Anyone who is concerned that a facility is not meeting the CCALA requirements can complain to the licensing office for that area. By law medical health officers must investigate every complaint that alleges that a residential care facility licensed under the Act is not fully meeting the legislated requirements. ([[{{PAGENAME}}#References\|19]])In practice, however, the responsibility for conducting these investigations is delegated to licensing officers who are employees of the health authorities. The duty of the licensing office for the inspections is owed to the public, as opposed to individuals. ([[{{PAGENAME}}#References\|20]])

			It is often unclear whether complaints should brought to the PCQO or to Licensing. Licensing tends tofocus complaints that can be tied to specific Residential Care Regulations, and inspections/paper trails. Licensing also has considerable regional variation in how or whether they respond to complaints. Some health authorities, as as Vancouver Coastal will note in their inspection reports whether there are any Bill of Rights complaints/ infractions, but other health authorities do not.

	====Advocacy Points====		====Advocacy Points====

Charmaine Spencer: /* Use */

2016-05-13T15:22:23Z

Use

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	===Use===		===Use===

	Only about seven percent of all the 4558 complaints made to the Patient Care Quality Offices (PCQO) throughout the province in 2012 related to residential care. However, the Seniors Advocate noted that the PCQO received 621 complaints related to residential care in 2014/15 (nearly double the 2012 figures).([[{{PAGENAME}}#References\|5]]) A 2012 review of the PCQO and PCRB systems noted there are systemic challenges in being able to effectively serve people in residential care or residents of small communities. Personal relationships and fear of retribution were seen as significant barriers to any complaint process. ([[{{PAGENAME}}#References\|6]])		Only about seven percent of all the 4558 complaints made to the Patient Care Quality Offices (PCQO) throughout the province in 2012 related to residential care. However, the Seniors Advocate noted that the PCQO received 621 complaints related to residential care in 2014/15 (nearly double the 2012 figures).([[{{PAGENAME}}#References\|5]]) A 2012 review of the PCQO and PCRB systems noted that the PCQ program is largely geared to addressing concerns in acute care and there are systemic challenges in being able to effectively serve people in residential care or residents of small communities. Personal relationships and fear of retribution were seen as significant barriers to any complaint process. ([[{{PAGENAME}}#References\|6]])

	~~Also the~~ legislation generally requires PCQO complaints to be handled on a first-come, first-served basis; this does not facilitate triaging according to case severity. ([[{{PAGENAME}}#References\|7]]) The PCQ program predominantly serves English-speaking Caucasians. ([[{{PAGENAME}}#References\|8]]) It has also been pointed out that the intended focus of the PCQ program is unclear– is it expected to be providing a process for managing complaints, resolving complaints or identifying opportunities for improvement? ([[{{PAGENAME}}#References\|9]])		The legislation generally requires PCQO complaints to be handled on a first-come, first-served basis; this does not facilitate triaging according to case severity. ([[{{PAGENAME}}#References\|7]]) The PCQ program predominantly serves English-speaking Caucasians. ([[{{PAGENAME}}#References\|8]]) It has also been pointed out that the intended focus of the PCQ program is unclear– is it expected to be providing a process for managing complaints, resolving complaints or identifying opportunities for improvement? ([[{{PAGENAME}}#References\|9]])

	==Patient Care Quality Review Board==		==Patient Care Quality Review Board==

Charmaine Spencer: /* References */

2016-05-13T14:59:46Z

References

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	#See: PCQO Resource Guide. Also note: Murtaugh, J. (2012). Patient Care Quality Program Final Evaluation Report. Prepared for BC Ministry of Health. Online: http://www.health.gov.bc.ca/library/publications/year/2012/patient-care-quality-program-evaluation-report.pdf [“Murtaugh”] (Last accesssed January 9, 2016). Notes that staff find the PCQ timelines challenging and unreasonable.		#See: PCQO Resource Guide. Also note: Murtaugh, J. (2012). Patient Care Quality Program Final Evaluation Report. Prepared for BC Ministry of Health. Online: http://www.health.gov.bc.ca/library/publications/year/2012/patient-care-quality-program-evaluation-report.pdf [“Murtaugh”] (Last accesssed January 9, 2016). Notes that staff find the PCQ timelines challenging and unreasonable.
	#Murtaugh.		#Murtaugh.
	#See Murtaugh, pg. 17, Figure 1.		#See Murtaugh, pg. 17, Figure 1. For 2014/15 data see Office of the Seniors Advocate,Monitoring Seniors Services, 2015. pages 19-20. Online: https://www.seniorsadvocatebc.ca/wp-content/uploads/sites/4/2016/01/SA-MonitoringSeniorsServices-2015.pdf ( Last accessed May 10, 2016).
	#Murtaugh, pg. 24.		#Murtaugh, pg. 24.
	#Murtaugh.		#Murtaugh.
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	#Ombuds, Best of Care, Recommendation 160: The Fraser, Interior, Northern and Vancouver Island health authorities inspect all residential care facilities governed under the Hospital Act in the same manner and with the same frequency as they inspect residential facilities licensed under the Community Care and Assisted Living Act commencing immediately.		#Ombuds, Best of Care, Recommendation 160: The Fraser, Interior, Northern and Vancouver Island health authorities inspect all residential care facilities governed under the Hospital Act in the same manner and with the same frequency as they inspect residential facilities licensed under the Community Care and Assisted Living Act commencing immediately.
	#Office of the BC Ombudsperson. June 2013. Update on Status of Recommendations- The Best Of Care: Getting It Right For Seniors In British Columbia (Part 2) Public Report No. 47 Pg. 8.		#Office of the BC Ombudsperson. June 2013. Update on Status of Recommendations- The Best Of Care: Getting It Right For Seniors In British Columbia (Part 2) Public Report No. 47 Pg. 8.
	##March 2013 - FH confirmed that it conducts and will continue to conduct annual inspections of residential care facilities governed under the Hospital Act in the same manner as CCALA facilities are inspected.		##March 2013 - FHA confirmed that it conducts and will continue to conduct annual inspections of residential care facilities governed under the Hospital Act in the same manner as CCALA facilities are inspected.
	##October 2012- FHA has begun annual Hospital Act facility inspections. -January 2012		##October 2012- FHA has begun annual Hospital Act facility inspections. -January 2012
	##FHA will collaborate with the Ministry of Health and other health authorities to develop and implement a standardized and consistent approach to the inspection of residential facilities governed under the Hospital Act.		##FHA will collaborate with the Ministry of Health and other health authorities to develop and implement a standardized and consistent approach to the inspection of residential facilities governed under the Hospital Act.

Charmaine Spencer: /* Use */

2016-05-13T14:54:35Z

Use

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	===Use===		===Use===

	Only about seven percent of all the 4558 complaints made to the Patient Care Quality Offices throughout the province in 2012 related to residential care.([[{{PAGENAME}}#References\|5]]) A 2012 review of the PCQO and PCRB systems noted there are systemic challenges in being able to effectively serve people in residential care or residents of small communities. Personal relationships and fear of retribution were seen as significant barriers to any complaint process. ([[{{PAGENAME}}#References\|6]])		Only about seven percent of all the 4558 complaints made to the Patient Care Quality Offices (PCQO) throughout the province in 2012 related to residential care. However, the Seniors Advocate noted that the PCQO received 621 complaints related to residential care in 2014/15 (nearly double the 2012 figures).([[{{PAGENAME}}#References\|5]]) A 2012 review of the PCQO and PCRB systems noted there are systemic challenges in being able to effectively serve people in residential care or residents of small communities. Personal relationships and fear of retribution were seen as significant barriers to any complaint process. ([[{{PAGENAME}}#References\|6]])

	Also the legislation generally requires PCQO complaints to be handled on a first-come, first-served basis; this does not facilitate triaging according to case severity. ([[{{PAGENAME}}#References\|7]]) The program predominantly serves English-speaking Caucasians. ([[{{PAGENAME}}#References\|8]]) It has been pointed out that the intended focus of the program is unclear– is it on providing a process for managing complaints, resolving complaints or identifying opportunities for improvement? ([[{{PAGENAME}}#References\|9]])		Also the legislation generally requires PCQO complaints to be handled on a first-come, first-served basis; this does not facilitate triaging according to case severity. ([[{{PAGENAME}}#References\|7]]) The PCQ program predominantly serves English-speaking Caucasians. ([[{{PAGENAME}}#References\|8]]) It has also been pointed out that the intended focus of the PCQ program is unclear– is it expected to be providing a process for managing complaints, resolving complaints or identifying opportunities for improvement? ([[{{PAGENAME}}#References\|9]])

	==Patient Care Quality Review Board==		==Patient Care Quality Review Board==