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Dr. Joshua Tepper and Dr. Julie Auger

Improving Care in the Long Term

Health Quality Ontario has just updated the information available on its website showing how well long-term care is being delivered in the province. It puts a fresh face on the largest, longest-running data collection and reporting system in Canada for quality of care information on long-term care homes.

With these homes having a resident population with increasingly complex care needs, the evidence suggests the quality of care provided to those residents is improving in many respects, but that more can be done.

There are currently about 625 homes providing care to about 78,000 residents at any given time.
Health Quality Ontario’s report Measuring Up documented the growing health complexity of these residents: 79.7% had been diagnosed with neurological disease, including 63.1% with dementia; 76.2% had heart or circulatory disease; 40.4% had a psychiatric or mood disorder; and 27.9% had diabetes.

Despite the challenges of caring for these residents, the data just published by Health Quality Ontario notes an overall improvement in several key indicators of quality care.

  • the percentage of long-term care residents who were given an anti-psychotic without a diagnosis of psychosis fell from 35% in 2010/11 to 20.4% in 2016/17;
  • the percentage of residents experiencing moderate or severe pain dropped from 11.9% to 5.6% over the same time period;
  • the percentage of residents who were physically restrained was reduced from 16.1% to 5.1%.

However, the latest data shows there continues to be wide variation between homes in the use of antipsychotic medications, restraints, and in the incidence of falls. And the median time people waited in hospital or in the community before moving into a long-term care home increased between 2015/16 and 2016/17 from 70 to 92 days, and from 132 to 149 days, respectively.

The latest figures also indicate that benchmarks set by an expert panel are not being met – although some are coming close. For example, the provincial benchmark for prescribing an anti-psychotic to a long-term care resident without a diagnosis of psychosis is 19%, and this has almost been met, given the actual figure for 2016/17 was 20.4%. For falls there is still room for improvement, as the provincial benchmark is 9% and the actual percentage of long-term care residents who suffered falls in 2016/17 was 15.8%.

In addition to publishing quality indicators, Health Quality Ontario also provides practice reports to physicians working in long-term care homes with personalized and confidential information about their practice. The reports also provide advice on how to improve quality on issues such as prescribing patterns for antipsychotics.

A major project has also just been launched to gather input about people’s experiences in transitioning from hospital to home, including those being discharged to a long-term care home. This change can be a difficult one for patients, families and caregivers, and Health Quality Ontario wants to learn how people can be better supported during this transition. Based on this work, Health Quality Ontario will develop a quality standard to outline what quality care will look like for this transition process.

With the long-term care sector being a critical part of our health care system and with an increasingly aging population requiring the services long-term care homes provide, Health Quality Ontario will continue to work with others to ensure quality care in these homes meets or exceeds the standards expected by residents and caregivers.

Dr. Joshua Tepper is president and CEO, Health Quality Ontario. Dr. Julie Auger, is Medical Director, Timmins and District Hospital and former Clinical Lead, long-term care at Health Quality Ontario.

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