‘The risk of harm is real’: Ford government criticized for proposing a change to how elderly residents get medicine

Who should be giving elderly residents of long-term care homes their medicines?

In a bid to free nurses for more complicated care, personal support workers typically tasked with dressing, feeding and toileting residents could be authorized — with extra training — to administer basic medications under new measures proposed by Premier Doug Ford’s government.

The potential regulatory changes include adding COVID-19 vaccines to the list of immunizations that must be offered, requiring that air conditioning in “designated cooling areas” of nursing homes be hooked up to emergency generators in the event of summer power failures, and $25,000 fines for not having air conditioning in the rooms of all residents.

But it’s the proposal to have PSWs give noncontrolled medications, under approval of a home’s registered nursing staff, that is raising concerns in some quarters.

“It really is an acknowledgment of the dire straits of our health human resources, particularly as it relates to the dramatic, severe shortage of nurses that we have right now,” says Liberal MPP Dr. Adil Shamji (Don Valley East), an emergency room physician.

“Historically, nurses have been the ones administering medications, for which they are singularly qualified and trained.”

The proposed changes posted online Feb. 3 are described by the Ministry of Long-Term Care as “part of an ongoing evolution of the legislative framework intended to enhance quality of care and quality of life for residents.”

A public comment period on the measures to be shepherded by Long-Term Care Minister Paul Calandra closes March 5.

Speaking confidentially on background to discuss internal matters, a ministry official said any medicines given directly to residents by PSWs would be prescribed by doctors or nurse practitioners and dispensed by nurses, and would involve basic meds like oral or topical antibiotics and pain-fighting acetaminophen.

This is already done in retirement and group homes and is now allowed in nursing homes under temporary rules that expire at the end of April, the official added.

Nurses would continue to do injections, IVs and give any controlled medications such as narcotics to residents, the official stressed.

Details on any medication training programs for PSWs are yet to be determined, but Shamji said the education would have to be “substantial.”

“Oral medications can, if administered inappropriately or to the wrong individual, cause a significant amount of harm.”

The changes are supported by an organization representing the majority of nursing homes, including for-profit, not-for-profit and municipally owned facilities.

“They support flexibility,” says chief executive Donna Duncan of the Ontario Long-Term Care Association. “It is a pivotal time for long-term care.”

The Ontario Nurses’ Association is firmly opposed to having PSWs or any other nursing home staff give medicines to residents.

“Further watering down regulations to allow unregulated health-care providers to administer medication ignores the standards that currently exist,” says Bernie Robinson, interim president of the ONA.

With an increasing reliance on temp agency nurses in long-term care homes because of the nursing shortage, “there is inconsistent staffing and training” that makes supervision more difficult, Robinson warns.

“The real solution is not to expand the scope of unregulated health-care professionals, who, like everyone working in health care, are already managing unreasonable workloads. The solution is to increase staffing levels across the board, so we have the nurses we need to properly care for residents.”

New Democrat MPP France Gelinas (Nickel Belt), her party’s veteran health critic and a physiotherapist by training, says she is worried having both PSWs and nurses giving medications to residents could lead to mix-ups.

Noting most residents are on multiple medications several times a day, “the risk of error, the risk of harm is real,” she adds, noting many long-term care homes fared poorly and had high illness and death rates in the pandemic.

“I suppose it can be done safely if you have very strong oversight, but we don’t.”

Gelinas is also concerned nursing homes will use the change to scale back on nurses to save money and boost profits, relying more on lower-paid PSWs.

On the need for an education program for PSWs delivering medicines to residents, Shamji said “it would need to indicate some of the potential risks of mixing the wrong medications and understanding the importance of timing them correctly.”

“There are many medications that have very similar names and titles that do dramatically different things, are from entirely different classes of drugs and can have severe consequences … if the wrong one is administered,” he adds.

The ministry official said the proposed regulatory changes to the 2021 Fixing Long-Term Care Act would also make it more difficult to get exemptions for providing air conditioning in nursing homes and more closely define what types of cooling systems can properly be called air conditioning.

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