When a Toronto nursing home could not meet its payroll in the summer of 2012, the chair of the home’s board turned to a forbidden source of cash to bridge the gap: the private trust accounts of elderly residents.
Despite a provincial law that is supposed to protect clients from financial abuse, the chair of the board at the Ina Grafton Gage Home approved taking $30,000 from the residents’ accounts on July 11, 2012, and another $7,000 the next day.
The money was returned less than two weeks later, but the transfer prompted a complaint to Ontario’s Ministry of Health and Long-Term Care, which led inspectors to discover that the United Church-affiliated non-profit home was breaking several regulations that safeguard trust accounts, including one that bars nursing homes from charging service fees to trust-account holders and another that requires the trust accounts to be audited every year.
“When I saw this, I was shocked,” said Jane Meadus, a lawyer with the non-profit Advocacy Centre for the Elderly. “I could not believe that a board or a chair of a board would authorize such a thing. … It’s not their money.”
Residents’ trust accounts are to pay for things such as snacks from the tuck shop, haircuts or services not covered by general nursing-home fees. The most they are legally allowed to hold is $5,000 per resident.
The incident at the Ina Grafton Gage Home – which is chronicled in publicly available inspection documents – is not an isolated one. Since 2010, the Ontario Ministry of Health and Long-Term Care has issued 19 compliance orders to seven nursing homes that broke the rules for trust accounts, including the Ina Grafton Gage facility.
The province conducted a random inspection blitz related to trust accounts on 20 homes last spring, but otherwise, problems are caught only if someone complains. “There are huge issues with trust accounts in the province,” Ms. Meadus said. “There’s very little oversight of them by the ministry.”
Ms. Meadus said that in general, the regulations governing nursing homes in Ontario are more robust than those of other provinces.
Even when violations of Ontario’s Long-Term Care Homes Act (LTCHA) are found, the punishments have been limited to compliance orders asking the facilities to shape up.
The ministry can lay charges under the LTCHA and withhold public funds or ask that public funds be returned by nursing homes that break the act’s extensive provisions, which go well beyond handling residents’ money.
David Jensen, the ministry spokesman, confirmed that the ministry found more than 7,500 areas of non-compliance in 629 comprehensive inspections of nursing homes. He said the Ontario government has never laid a charge under the act or withheld funds.
In the case of the Ina Grafton Gage Home, Mr. Jensen said by e-mail: “The ministry did not issue an order for funding to be withheld due to the potential negative consequences to resident care as a result of the reduced funding.” There were other consequences for the board that authorized the $37,000 transfer at the facility, which is on Bell Estate Road in the former city of Scarborough.
The home’s family council, an advisory body made up of relatives of residents, caught wind of the transfer and asked the board to resign en masse, which it did, according to Charles Hain, who became the new chair of the board in January, 2013.
“My own feeling was astonishment,” said Mr. Hain, who was a member of the family council in 2012 when the transfer took place. His 87-year-old mother, Beverly, has lived at the home since 2007. “The collective reaction of the family council was probably more toward anger.”
Still, Mr. Hain expressed some sympathy for his predecessor, saying the board made a “desperate” decision when it was unable to meet payroll.
“Funding is always a challenge at long-term-care homes, period,” he said. “It sounds like there is a lot of money sloshing around, but really, there isn’t considering all the things that you have to spend money on and have to report on. It can be quite tight, even at the best of times.”
Mr. Hain said the new board had a special education session in March, 2013, with guidance from the ministry, on how to oversee the trust accounts. The home completed an audit of the trust accounts in 2014, according to an April 1, 2014, follow-up inspection report. It missed two previous deadlines.
Mr. Hain said the home struggled to find the money for the audit, a problem it is working with the ministry and the Local Health Integration Network to help solve in the future.
Mr. Jensen, the ministry spokesman, said the province plans more random inspections related to trust accounts at nursing homes.
HEALTH REPORTER — The Globe and Mail
Published Monday, Mar. 16 2015, 9:55 PM EDT
Last updated Monday, Mar. 16 2015, 9:55 PM EDT