Lack of nutritional oversight in care homes hard to swallow

Opinion

Nobody would ever say that ensuring residents of personal care homes are properly fed is a simple matter.

Caring for the elderly and infirm is, given the broad range of health issues, a complex challenge. Once the elderly arrive in a care home, it often gets even more complex.

Still, one has to wonder why the nutritional programs in the majority of the care homes in Winnipeg operate without direct oversight from the province.

In a compelling and in-depth examination of the state of care home food, Free Press reporter Janine LeGal provides numerous examples in which residents are given unappetizing meals with limited choice and, in some cases, an absence of fresh fruit and vegetables.

Trying to verify the allegation here is a tricky matter: there are thousands of Winnipeggers who live in care homes, many with profoundly different needs when it comes to basic care. Some can care for and feed themselves; others require full assistance to perform the most simple personal tasks.

Still, that doesn’t explain or excuse the state of the food being served in some care homes.

LeGal’s article, which relied heavily on her own experience caring for her mother and father, says the quality of food in some care homes is beyond disgusting, even though the Winnipeg Regional Health Authority has an entire team of professionals charged with ensuring meals are appetizing and nutritious.

Well, at least some of the facilities.

The WRHA directly oversees nutrition in seven of the 37 care homes in Winnipeg: Riverview Health Centre, Deer Lodge Centre, Misericordia Place, Concordia Place, Calvary Place, River Park Gardens and Middlechurch Home. For all seven facilities, meals are prepared in the regional distribution centre, a centralized commissary. Meals are frozen and then distributed.

The distribution centre was, from the moment it was proposed in the 1990s, more than a little controversial. Introduced by the former Progressive Conservative government of premier Gary Filmon, it was supposed to be a cost-effective way to provide meals to hospitals and personal care facilities. Over the years, the reviews of the distribution fare have been varied, to say the least.

Still, the WRHA and its nutritionists are making deliberate efforts to make sure the food is as appetizing and nutritious as possible.

What about the other facilities? Julie Gislason, the WRHA’s chief nutrition and food services officer, says those remaining care homes are providing, with guidance and tools to help them, menus that fulfil the demands of government regulation for nutrition.

However, the challenges faced by care homes are not insignificant on this issue, Gislason said.

Manitoba has one of the more evolved home care systems, which means the residents arriving at them are generally older and sicker than those in other provinces, she said. It also means the challenges of providing nutritious meals are more pronounced.

Gislason said up to two-thirds of residents arrive at a facility in some state of malnutrition through neglect or declining health and mobility that makes feeding themselves an impossible task.

Is there a double standard in care homes, one for those directly overseen by the WRHA and another for the far greater number of ones that are still governed by provincial laws and regulations but which do not receive direct oversight?

Gislason said she could not say for sure given that the 30 care homes do not currently report to her directly.

It would be easy to assign this failure to the WRHA. However, health authorities can only operate within the laws and regulations created by the provincial government. If a government wanted to have the health authorities provide more direct oversight, as is done in other provinces such as Ontario, it would pass regulations and provide the resources to make it so.

But that is not happening in Manitoba.

That is extremely disappointing given there is a fairly deep body of legislation and regulations designed to provide standards for care homes when it comes to food and nutrition. These guidelines include the requirement to provide at least three meals a day and in-between-meal snacks, and lots of hydration.

There’s a lot packed into those regulations but when one considers the complexity of the issue, they seem to be profoundly inadequate.

The individual stories of food horrors may not be prima facie evidence of a systemic failure. However, there are enough of them to suggest a bigger problem lurks beneath the surface.

In fact, it doesn’t take a lot of work to connect food and nutrition with other issues related to long term care.

For example, Canada is suffering through an acute shortage of health care aides to work in care homes. Without adequate staffing, there aren’t enough people to assist residents who cannot feed themselves. There are also not enough people to make critical observations about when a resident may be suffering from malnutrition.

Like many other provinces, Manitoba needs more precise regulations on how care home residents should be fed, and more resources and staff to ensure the facilities adhere to the regulations.

Right now, it seems as if many are not getting the food they want or need — which provides a very unappetizing image of the current government.

dan.lett@freepress.mb.ca