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Difference between revisions of "Legal Frameworks of Residential Care"
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Legal Frameworks of Residential Care (view source)
Revision as of 21:45, 3 July 2014
, 21:45, 3 July 2014→The General Statutory Framework in Residential Care
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In general, this set of regulations establishes the minimum standards of the care facility, the requirements for staffing[[Introduction, Chapter One and Two of Legal Issues in Residential Care References|58]]), admissions,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|59]]) care ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|60]]) and care plans ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|61]]), nutrition,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|62]]) medication,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|63]]) the use of restraints,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|64]]) and “reportable incidents”.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|65]]) It requires the operator to have written policies and procedures in place in relation to care and supervision of persons in care,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|66]]) including falls prevention.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|67]]) | In general, this set of regulations establishes the minimum standards of the care facility, the requirements for staffing[[Introduction, Chapter One and Two of Legal Issues in Residential Care References|58]]), admissions,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|59]]) care ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|60]]) and care plans ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|61]]), nutrition,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|62]]) medication,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|63]]) the use of restraints,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|64]]) and “reportable incidents”.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|65]]) It requires the operator to have written policies and procedures in place in relation to care and supervision of persons in care,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|66]]) including falls prevention.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|67]]) | ||
The regulations cover communication, access to telephone, and privacy.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|68]]) | The regulations cover communication, access to telephone, and privacy.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|68]]) These regulations also set out the physical requirements for bedrooms, bathrooms, common areas and work areas([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|69]]), as well as more detailed specifics such as the temperature of water,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|70]]) and signalling devices. The RCR also sets out records management requirements.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|71]]) | ||
The regulations outline a broad principle intended to guide all residential care. It states the residents’ dignity will be considered when determining care standards. Specific examples are offered in the regulation: operators are required to consider the dignity of the individual when assessing the adequacy of privacy, furniture and equipment in bedrooms and bathrooms. Staffing must also be sufficient for individuals to receive care in a manner consistent with their dignity. | The regulations outline a broad principle intended to guide all residential care. It states the residents’ dignity will be considered when determining care standards.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|72]]) Specific examples are offered in the regulation: operators are required to consider the dignity of the individual when assessing the adequacy of privacy, furniture and equipment in bedrooms and bathrooms.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|73]]) Staffing must also be sufficient for individuals to receive care in a manner consistent with their dignity.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|74]])However, as the BC Ombudsperson report notes, terms like “dignity” are difficult to measure and how the dignity standard is respected has not been specified. | ||
Under RCR, the Licensees must provide residents, their representatives and family members an opportunity to establish a resident and family council. Under the regulations, employees are required to undergo a criminal record check, and provide character references. The employers are required to check the prospective employee’s work history and proof of relevant training prior to being hired. | Under RCR, the Licensees must provide residents, their representatives and family members an opportunity to establish a resident and family council.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|75]]) Under the regulations, employees are required to undergo a criminal record check,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|76]]) and provide character references.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|77]]) The employers are required to check the prospective employee’s work history and proof of relevant training prior to being hired.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|78]]) Facility operators are required to regularly review the performance of staff and ensure that employees do not carry out duties which they are not competent to perform.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|79]]) | ||
The RCR identifies the circumstances in which specific types of “incidents” and health concerns must be recorded in the facility’s internal documentation and when it will need to be reported to external authorities. For example, under the RCR, all medication errors must be recorded. As of December, 2013 incidents of “aggression between persons in care” that cause injury must be recorded by the care facility. | The RCR identifies the circumstances in which specific types of “incidents” and health concerns must be recorded in the facility’s internal documentation and when it will need to be reported to external authorities.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|80]]) For example, under the RCR, all medication errors must be recorded.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|81]]) As of December, 2013 incidents of “aggression between persons in care” that cause injury must be recorded by the care facility.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|82]]) There are reporting measures that apply to the use of restraints and occurrences of communicable diseases.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|83]]) | ||
The RCR requires operators take certain safety and identification measures for any cognitively impaired resident who is considered to be at risk of leaving the premises without alerting staff, and of not being able to identify themselves. That might involve placing a bracelet or other secure means of identification on the person. The bracelet must give the name of the person and the community care facility as well as the emergency contact information. | The RCR requires operators take certain safety and identification measures for any cognitively impaired resident who is considered to be at risk of leaving the premises without alerting staff, and of not being able to identify themselves. That might involve placing a bracelet or other secure means of identification on the person. The bracelet must give the name of the person and the community care facility as well as the emergency contact information.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|84]]) | ||
===Private Hospitals and Extended Care Facilities=== | ===Private Hospitals and Extended Care Facilities=== | ||
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====Hospital Act==== | ====Hospital Act==== | ||
Approximately thirty per cent of British Columbia’s residential care facility beds are in private hospitals and extended care facilities licensed under the Hospital Act. This Act regulates private hospitals and extended care hospitals that provide residential care. At a given point in time approximately 9800 residents needing long term care will live in these settings. These facilities currently have different regulatory standards, fees, monitoring and enforcement processes than the licensed care facilities that come under the Community Care and Assisted Living Act. Private hospitals that provide residential care services are regulated by part 2 of the Hospital Act. | Approximately thirty per cent of British Columbia’s residential care facility beds are in private hospitals and extended care facilities licensed under the Hospital Act. This Act regulates private hospitals and extended care hospitals that provide residential care. At a given point in time approximately 9800 residents needing long term care will live in these settings. These facilities currently have different regulatory standards, fees, monitoring and enforcement processes than the licensed care facilities that come under the Community Care and Assisted Living Act. Private hospitals that provide residential care services are regulated by part 2 of the Hospital Act.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|85]]) | ||
Private hospitals must be licensed in accordance with the Hospital Act. Residential care can also be provided as “extended care” in a hospital setting. In this case, these units or facilities are also subject to the Hospital Act. The definition of hospital in the Hospital Act includes, “a non-profit institution that has been designated as a hospital by the Minister of Health Services and is operated primarily for the reception and treatment of persons requiring extended care at a higher level than that generally provided in a private hospital licensed under Part 2.” Extended care units or hospitals are often either part of a general hospital or near a general hospital. | Private hospitals must be licensed in accordance with the Hospital Act. Residential care can also be provided as “extended care” in a hospital setting. In this case, these units or facilities are also subject to the Hospital Act. The definition of hospital in the Hospital Act includes, “a non-profit institution that has been designated as a hospital by the Minister of Health Services and is operated primarily for the reception and treatment of persons requiring extended care at a higher level than that generally provided in a private hospital licensed under Part 2.”([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|86]]) Extended care units or hospitals are often either part of a general hospital or near a general hospital. | ||
Unlike the RCR, the Hospital Act does not set out mandatory standards for operators who provide residential care. However that does not mean there are no standards of care or practice to which the staff and administration of private hospitals or extended care units are accountable. | Unlike the RCR, the Hospital Act does not set out mandatory standards for operators who provide residential care. However that does not mean there are no standards of care or practice to which the staff and administration of private hospitals or extended care units are accountable. | ||
The law requires that the private hospital (or “house” as it is identified in law) has been approved by the provincial chief inspector of hospitals as suitable for the purpose indicated when the operator applied for a license. | The law requires that the private hospital (or “house” as it is identified in law) has been approved by the provincial chief inspector of hospitals as suitable for the purpose indicated when the operator applied for a license. ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|87]]) The Hospital Act also states that a licensed private hospital may be inspected “at any time” by a hospital inspector who is employed by a regional health authority. | ||
It has been recognized that there would be significant advantages to having the three types of facilities (residential care, extended care units and private hospitals) come under a common set of standards, inspection and monitoring structure. However, a number of implications related to funding, property tax, capitalization, and user fees would arise. | It has been recognized that there would be significant advantages to having the three types of facilities (residential care, extended care units and private hospitals) come under a common set of standards, inspection and monitoring structure. However, a number of implications related to funding, property tax, capitalization, and user fees would arise. ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|88]]) | ||
As mentioned, the Ombudsperson ‘s report has stated that if the government chooses to continue to maintain the two regulatory regimes, it should ensure that residents in Hospital Act facilities are protected by the same standards afforded under the Residential Care Regulation, and that Hospital Act facilities are subject to the same active oversight and inspection requirements. | As mentioned, the Ombudsperson ‘s report has stated that if the government chooses to continue to maintain the two regulatory regimes, it should ensure that residents in Hospital Act facilities are protected by the same standards afforded under the Residential Care Regulation, and that Hospital Act facilities are subject to the same active oversight and inspection requirements.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|89]]) | ||
===Differences between the two frameworks=== | ===Differences between the two frameworks=== | ||
In general, the standards and oversight mechanisms that apply to facilities licensed under the CCALA are more extensive and rigorous than those that apply to facilities governed by the Hospital Act. The general public, older adults and their families typically do not know under which legislation a particular facility falls. | In general, the standards and oversight mechanisms that apply to facilities licensed under the CCALA are more extensive and rigorous than those that apply to facilities governed by the Hospital Act.([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|90]]) The general public, older adults and their families typically do not know under which legislation a particular facility falls. ([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|91]]) The Act that governs the facility makes a significant difference to the rules, standards and oversight mechanisms which govern the care provided. | ||
====Hospital Act==== | ====Hospital Act==== | ||
The principal focus of the Hospital Act has been the regulation of public hospitals that provide acute, extended and rehabilitation care. However, the Act has also regulated private hospitals over the past 50 years. According to the definition set out in the Hospital Insurance Act Regulations, the prime function of extended care hospitals is to provide “skilled nursing care and continuing medical supervision.” | The principal focus of the Hospital Act has been the regulation of public hospitals that provide acute, extended and rehabilitation care. However, the Act has also regulated private hospitals over the past 50 years. According to the definition set out in the Hospital Insurance Act Regulations,([[Introduction, Chapter One and Two of Legal Issues in Residential Care References|92]]) the prime function of extended care hospitals is to provide “skilled nursing care and continuing medical supervision.” | ||
