Difference between revisions of "Overview of Legal Issues in Residential Care"

The chapter is divided into two parts.  The first is an overview of residential care system and the people who work in this system; the second describes key laws that govern the area and the lives of many residents.

“Residential Care” is the formal term used by the British Columbia Ministry of Health for what the public commonly calls nursing homes, care homes, care centres, long term care homes, extended care, or geriatric care facilities. The Ministry of Health notes:  

:“Residential Care is for adults with complex health care needs requiring 24-hour professional care due to physical disability or mental or behavioral conditions, including brain injuries or dementia.”

The term “residential care” refers to places where a person can receive health care services, accommodation and support on a regular basis.  Residential care is typically viewed as providing a higher level of care and support than other types of facilities in the community such as assisted living. Since 2002 under provincial health care policy, publicly funded (subsidized) residential care facilities are available only to people who need “complex care”.

While acute care hospitals are places of temporary stay for health care, residential care facilities are very importantly the person’s home in which health care, assistance and other support will be provided on a regular, ongoing basis. It is where the people live their lives and continue to have relationships.  Residential care facilities are also collective settings, meaning that the rights of residents must sometimes be balanced against the individual and collective rights of other residents to safety, privacy, etc.

Residential care facilities are required to provide a number of core services. These include:

Practically speaking, what makes residential care facilities in British Columbia distinctive are the characteristics of the people who live there.  In contrast to assisted living facilities where residents must be able to make decisions on their own in order to live there,  a sizeable proportion of people who live in British Columbia’s residential care facilities today may have difficulty making some types of decisions without support.

The term “complex care” as used by the Ministry of Health refers to care and support for people who:

* have severe behavioural problems on a continuous basis.

* In 2009, there were 348 residential care facilities in the province.   

'''NOTE:''' Information on a particular residential care facility’s company website will not always be up to date or accurate. In some case, it may represent the law or process of another jurisdiction.

The public is often  very confused  about care facilities, who runs  it ,  who is  responsible, and  who  pays.  There is good reason for that confusion:

The maximum client rate is adjusted annually based on changes to the Consumer Price Index. There is a mechanism for obtaining a “temporary rate reduction” if the amount would cause the person or their family serious financial hardship.  The Ombudsperson Report notes that this information on the availability of a reduced rate often was not being provided to people. The Ministry of Health has begun including the information in letters to clients and now posts it on the Home and Community Care website.

There are several important differences between residential care facilities that fall under the Community Care and Assisted Living Act and the care facilities that fall under the Hospital Act.    These relate to whether the facility will have  legislated care standards, physical environment  standards or restrictions on  double  occupancy;  whether the facility is  subject  to routine inspections;  whether there are  reporting requirements  for abuse, neglect  or other  incidents; and whether they are required to have  a medical practitioner  or registered  nurse on site.  Some of these differences are summarized in Table 2.

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:“Residential Care facilities provide 24-hour professional care and supervision to adults in a supportive, secure environment.”

In many residential care facilities, the registered nurse will be the Director of Care, who may or may not be on site for that facility. In addition, the residential care facility may employ other professional staff to help support the resident’s care and wellbeing, including for example, a nutritionist, social worker, occupational therapist, a part time physician, physical therapist or recreational therapist.

Residential Care Aides provide basic resident care, offering residents assistance with the activities of daily living - such as bathing, dressing, grooming - and often serve meal trays and feed residents.  They are also known as care attendants or care assistants. When directed by nursing staff (an LPN or RN), the care aides take basic measurements, such as the person’s' blood pressure, temperature and pulse. They are also the frontline workers who are called upon to collect urine, feces or sputum specimens. At present RCAs are not involved in the overall planning  of care for residents, although there have been efforts to make this possible  as they often  have the most direct contact with the resident. Depending on the facility, they may provide input for care conferences to review the resident’s care.

There is no regulatory organization (like the College of Licensed Practical Nurses of BC) to ensure program graduates have the ongoing skills necessary for licensing. The residential care aide program is a relatively short program. It has attracted many qualified people who had a health care career  (such as nursing) before immigrating, but who do not qualify to be certified, registered or licensed in their previous occupation in Canada.

Licensed Practical Nurses in residential care provide routine bedside care, including the distribution of medication to patients and performing personal treatment. They also help evaluate residents' needs, develop care plans, and supervise RCAs. To work as a LPN in British Columbia, the person must have completed a Practical Nursing program or other approved programs and must be licensed with the College of Licensed Practical Nurses of BC.

About 28% of LPNs in the province work for multiple employers and are casual workers often working multiple jobs and many hours in a row.   

Registered nurses hold a four-year baccalaureate degree in nursing from a Canadian university or its international equivalent. These nurses may specialize in a variety of areas such as surgery, geriatrics, psychiatrics, pediatrics, community health, occupational health, emergency, rehabilitation or oncology.  In the few residential care facilities that have  registered nurses, they may be the Director of Care. There are very few geriatric nurse specialists working residential care facilities in British Columbia.

The Licensees (Owners, Operators) of residential care facilities in British Columbia come from a very wide variety of backgrounds. The Licensee may be a not –for-profit society, a for-profit business (including a federal pension group), and in some cases, the local health authority.  Managers in many cases have a background in hospitality or management; some may have a background in health care.

While the overall responsibility for residential care facilities, extended care facilities and private hospitals lies with the Ministry of Health, each of British Columbia’s five regional health authorities is responsible for most of the oversight in this area.  Community Care Licensing Offices in each health region are responsible for licensing and inspecting the residential care facilities, extended care facilities and private hospitals.  There are often regional differences among the health authorities in how those responsibilities are carried out. Complaint mechanisms such as the Patient Care Quality Offices are provincially legislated but are operated by each health authority.