Proposed national long-term-care standards to limit infections begin with the premise that nurses — and grandmothers — have preached for years: wash your hands.
Posted on Friday for public consultation, the draft report details roughly 20 rules for sanitary hand practices — what it calls “the most important procedure for preventing (health-care-associated infections) in residents and staff.”
While the proposed standards focus on nursing-home operations, infection prevention and control (IPAC) and small household designs that limit the spread of illness, the chair of the Canadian Standards Association (CSA Group) long-term-care committee said the rules are written with residents in mind.
“These are people’s homes — they are not hospitals, they’re not acute-care settings,” said Alex Mihailidis, a University of Toronto professor in the Department of Occupational Science and Occupational Therapy, who specializes in technology that supports older adults.
One of the main goals, Mihailidis said, is to improve IPAC guidance, “whether it’s a future pandemic or whether it’s an influenza breakout.”
Open for 60 days of public feedback ending April 11, the CSA draft is the second set of long-term-care standard proposals released in recent weeks.
On Jan. 27, the Health Standards Organization (HSO) posted its draft rules that focus on resident-centred care — such as living with some risk instead of a rigid adherence to safety — and the creation of meaningful jobs. Both reports complement each other, Mihailidis said, with the HSO draft focused on the “software” (well-being of residents and staff) and the CSA on the “hardware” (IPAC, operations and building design). Final reports are expected next fall.
Dr. Samir Sinha, chair of the HSO standards committee, has said the HSO requirements will be used to accredit nursing homes, but could also provide the foundation for new laws, including the Liberals’ promised “Safe Long-Term Care Act.”
A CSA spokesperson said its standards will be voluntary, unless legislated or used by an accreditation body, adding that more details are expected next fall. The CSA was founded in 1919, developing safety standards for railway bridges and, more recently, hockey helmets and respirator masks.
Plans for national oversight came from public demands for change, after COVID-19 swept through Canadian nursing and retirement homes, killing more than 15,800 residents in both settings.
Health Canada said the 2021 budget “provided a $3 billion investment over five years, starting in 2022-23, to support provinces and territories in their efforts to ensure standards for long-term care are applied and permanent changes are made.”
Provinces that take federal money for nursing homes should be required prove it goes where intended, said long-term-care expert Pat Armstrong.
“I think we have to make absolutely sure it goes to long-term care and, I would argue, when it goes to long-term care, it doesn’t go into making a profit, that it goes to care,” said Armstrong, a York University professor.
The CSA’s draft standards are the first to align IPAC, operations and building design to nursing homes, said Laura Tamblyn Watts, CEO of CanAge, a national advocacy group for older adults. (Tamblyn Watts also sits on two CSA long-term-care committees.)
Calling the draft a “seismic” step forward with a “resident-centred” commitment, Tamblyn Watts cautioned that legitimate change won’t happen without government support.
“The problem with standards generally is unless they’re mandated in some fashion, they are wishful words on a page,” she said. “The real point will be ensuring that these standards are adopted by the provinces and territories in their long-term-care legislation.”
The proposals call for disinfecting of communal areas, washrooms, storage spaces and bedrooms. Long-term-care homes, the report said, “shall be designed and operated to prevent and control the spread of microorganisms.”
One recommendation said the “decluttering of resident rooms should occur on a regular basis,” such as every two months. The standards would also require an IPAC consultation before buying items for residents. “Strict IPAC standards may inhibit residents from keeping personal items,” the report noted.
Personal possessions, advocates say, have deep meaning for residents, many of whom arrive in homes with a few remaining pieces. The fear is that without specific limits to ‘decluttering” standards, enthusiastic IPAC officials could see hazards in resident keepsakes.
Tamblyn Watts said the standards will be accompanied by education and guidance that upholds the resident-first philosophy. Rules for clutter, she said, are intended to focus on cleanliness and the removal of tripping hazards but are “not trying to strip out the personalization of a resident’s possessions.”
Mihailidis, the committee chair, said discussions examined the question: “how do we balance quality of life versus safety?”
In its building design section, the proposed standards recommend small households of roughly 10 to 12 people, with private bedrooms and washrooms. The report said, “Single-bed occupancy in health care settings have been shown to reduce the potential for transmission of organisms and therefore decrease the risk of infection, decrease medication errors and improve safety for both residents and staff overall.”
Mihailidis said the committee looked at international models that create small homes, including de Hogeweyk in the Netherlands. It is an enclosed “village” with tiny connected households of six or seven residents who have the freedom to step outdoors for a walk or a visit in the courtyard café.
The standards, such as HSO’s resident-centred philosophies, could also be used in community-based living options for older adults, said Donna Duncan, CEO of the Ontario Long-Term Care Association. Ontario has a long-term-care wait list of 40,000, Duncan said, so the province needs new ways for people to “thrive at home” or in new community-focused models.
While some nursing-home operators are building “campus” style homes that include space for youth groups, public coffee shops or walking trails, the Ontario government is still approving large nursing homes, usually with units of 32 beds. Progressive operators believe that placing 32 people in a large, noisy area leads to anxiety, fear and aggression, particularly among those with dementia.
Big homes, said York’s Armstrong, are built for economies of scale but can still be designed with small interior households.
“They have the advantage that during the day, residents can move around inside, so you get the space and variety.”
CSA’s draft design standards — including easy access to sinks for hand hygiene — call for connections to the outdoors, where residents, family and workers can spend time in nature. Being outside “improves well-being and can reduce stress, expedite healing and increase cognitive functions,” the report said.
While the standards need government support, Tamblyn Watts said they are part of a movement that is shedding the old, institutional approach.
“It won’t be, by itself, everything that is needed but this is the beginning of a culture shift.”
JOIN THE CONVERSATION
Anyone can read Conversations, but to contribute, you should be registered Torstar account holder. If you do not yet have a Torstar account, you can create one now (it is free)
Conversations are opinions of our readers and are subject to the Code of Conduct. The Star does not endorse these opinions.
[ad_2]
Originally Appeared Here