Nursing homes ‘in good standing’ at time of Wettlaufer murders – The London Free Press

ST. THOMAS — The provincial inquiry into long-term-care homes shifted into risk assessment and statistical analysis Tuesday, focusing on the three homes where Elizabeth Wettlaufer poisoned residents.

Until the murders of eight people living in nursing homes were uncovered, Caressant Care in Woodstock, Meadow Park in London and Telfer Place in Paris were all ranked as Level 1 homes and were considered in good standing with the Ministry of Health and Long-Term Care.

Phil Moorman, appeals specialist and program consultant with the long-term care inspections branch, explained the ranking, calculated by an algorithm and shared by 85 per cent of all Ontario nursing homes, means the homes are not subject to intense inspections and followup for a history of non-compliance with the Long Term Care Act.

There are 600 homes in the provincial long-term-care system caring for more than 70,000 residents.

Moorman said a statistical measure, called the long term care quality performance inspection tool, was created almost a decade ago to predict the health and safety inside a licensed home.

The tool was first developed in 2011/2012 to identify and Lo it or Joles that may pose “serious risk to resident care” and help allocate inspection resources to those at-risk homes….

— Jane Sims (@JaneatLFPress) August 7, 2018

At first, the tool zeroed in on the most accessible, reliable and valid information as data points – worsening pressure ulcers, worsening pain and worsening behaviours. Since then, it has been modified five times and reworked to include 12 factors and information as predictors of a nursing home’s performance, all weighted the same.

Homes can be moved to a Level 2 or Level 3 designation if they are outside the 70th percentile in a statistical analysis of their performance. In each case, improvements are required and are monitored closely.

About 10 per cent, or 60 homes, are operating as a Level 2. Only four to five per cent are at high-risk at Level 3. Only twice has there been Level 4 designations sent out, requiring the yanking of a nursing home license.

There are four levels of compliance. The most rare is Level Four where an order is made to revoke the license under the Long Term Care Act. That’s only happened twice.

— Jane Sims (@JaneatLFPress) August 7, 2018

The threshold to be “chronically non-compliant” is high. Moorman referred to one home in Prince Edward County that reached Level 4 when, along with the statistical data, there were reports from the fire marshal’s office, the bank and utilities. There were also reports of circumstances so dire that the food suppliers were not willing to make deliveries.

But it appears any assessment is contingent on the nursing home complying with its reporting obligations. Inquiry counsel Megan Stephens asked Moorman if a nursing home “can fly under the radar” but not disclosing all the issues.

Moorman said policy people in the ministry would be in a better position to give a full answer, but when asked a second time, he said “no model is perfect” and the role of the tool is to predict a home’s performance based on past analysis.

A home not reporting may have an impact, he said, but there is a wide range of data and “I think we do a good job of that.”

The inquiry also heard from Karin Fairchild, manager of the Hamilton service area office of the ministry’s inspections branch.

Fairchild helped to write legislation and review the requirements surrounding medication management and preventing elder abuse.

But Caressant Care and Meadow Park were placed at Level 3 once the police investigation began, and Caressant Care was suspended taking in new residents. Their scores remained at Level 1.

Meadow Park in London was ranked a Level Three in 2016 and 2017, even though it scored a Level One ranking. Moorman agrees it’s because of the Elizabeth Wettlaufer investigation.

— Jane Sims (@JaneatLFPress) August 7, 2018

The murders of eight residents – seven at Caressant Care and one at Meadow Park – weren’t discovered until Wettlaufer, 50, confessed to police that she had killed them through insulin injections from 2007 to 2014.

She pleaded guilty in June 2017 and was sentenced to life with no chance of parole for 25 years. She also pleaded guilty to four counts of attempted murder and two of aggravated assault involving six other vulnerable victims.