Ontario Long-Term Care Homes could soon have nurse practitioners overseeing residents’ medical care instead of doctors, a move applauded by nurses and homes but not supported by doctors.
The plan to replace the requirement that homes have a medical director, who must be a physician, with the requirement for a clinical director, who can be a physician or nurse practitioner, is among the changes proposed in recently introduced legislation on long-term care and the elderly.
The bill would also require homes to have a dementia care program and create new offenses for resident abuse and neglect.
Long-Term Care Minister Natalia Kusendova-Bashta said operators were allowed to fill the medical director role with nurse practitioners during the pandemic, and she is now making that permanent.
“This function is largely an administrative function, so we have full confidence that nurse practitioners can fulfill this function,” she said.
“At the same time, we give physicians more time to focus on the care needs of our residents instead of dealing with paperwork.” »
The Registered Nurses’ Association of Ontario lobbied for the change, and its president, Lhamo Dolkar, said it would improve collaboration between health professionals in long-term care homes and would help retain nurses in Ontario by providing them with more career paths.
“Having NPs licensed to work as clinical directors is a victory in many ways,” Dolkar wrote in a statement.
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“It’s a win for residents and families who will benefit from clinical directors in the 670 LTC homes, a win for healthcare professionals who will feel more supported; and a victory for nurses who will see more opportunities to build their careers in Ontario.
Dr. Dominik Nowak, president of the Ontario Medical Association, said doctors, nurses and all other health professionals play an important role in the health care system, but oversight of medical care in long-term care homes must be carried out by doctors.
“(Residents) are often some of our most vulnerable, most medically complex seniors, often people aged 80, 90 or older, people on 10 or more different medications, with 10 health conditions different or more. » he said.
“I think about the role of medical directors in these homes, and it’s really to be a stopgap for other doctors, other nurses, other members of the care team, and to be that clinical leadership role , this medical leadership role. And it really takes years of training, thousands of hours of experience and expertise that doctors bring to achieve this.
Lisa Levin, CEO of AdvantAge Ontario, representing the province’s non-profit long-term care homes, said operators support the change.
“Recruiting and retaining medical directors for homes is difficult, particularly in the North and rural and remote areas. Having the flexibility to be able to have nurse practitioners in that role is going to be really, really helpful,” she said. said.
Jane Meadus, an attorney with the Advocacy Center for the Elderly, said she is concerned about the proposed clinical director requirement.
“Have they studied? she said. “Do they have empirical evidence that this is enough?… My concern is what is the effect on residents? Will they miss things? We must remember that people receiving long-term care today are extremely complex.
Kusendova-Bashta’s announcement of the bill also came with a promise of funding for several dementia and senior care programs, including $20 million over three years to expand adult day programs.
It also comes with funding to launch two pilot programs that Levin called “game changers.”
A Community Access to Long-Term Care pilot program will give seniors still living in their own homes access to certain services in long-term care homes, such as personal care, clinical services and recreational and social.
Another pilot will train staff in up to 15 homes in emotion-based models of care, which prioritize relationships and empathy within a culture of dignity and respect when caring for residents with dementia.
“It’s beyond my wildest dreams that they’re finally doing it,” Levin said.
Some homes already use this model, which focuses more on emotions and less on tasks, because people with dementia retain their feelings after their cognitive abilities decline, Levin said.
“They’re really focused on their feelings and their emotions,” she said.
“That’s how you can communicate better with people with dementia when they’re more advanced, and this type of model embraces that and works with that, and it’s incredibly transformational.”
Donna Duncan, CEO of the Ontario Long-Term Care Association, also praised the Emotionally Focused Care pilot project and said the funding to help seniors in the community access care services long-term will help them stay at home longer.
“The ability to access long-term care services can help manage symptoms, reduce resident and caregiver distress, delay admission to long-term care, and ultimately promote a smoother transition for residents and families who have become familiar with long-term care. -term care,” she wrote in a statement.
© 2024 The Canadian Press