Minister of Health the Hon. Kim Wilson JP, MP Residential Care Homes and  Nursing Homes Amendment Act 2017

Mr Speaker, I am very pleased to rise before the House today for the second reading of the Residential Care Homes and Nursing Homes Amendment Bill 2017. The Residential Care Homes and Nursing Homes Act 1999 regulates care homes (i.e. residential care homes and nursing homes) that provide room, board and personal care to two or more seniors or persons with disabilities. The overall purpose of this legislation is to protect and ensure the health, safety and wellbeing of these residents.

Mr Speaker, Despite a dynamic and evolving sector, the legislation has not been substantially updated since inception, nearly 20 years ago. Recognizing the breadth of changes required, the Ministry is moving forward amendments in phases, addressing first and foremost, some urgent improvements to the regulation of care homes. This first phase addresses the most pressing areas identified by stakeholders and lays the foundation for future improvements. Specifically, the objectives of this Amendment Bill are:

1. To clarify and improve the Ministry’s intervention, authority and compliance mechanisms;

2. To modernize the regulatory framework in order to provide standards on the model of care, level of care and specific residents’ needs; and

3. To raise the minimum care standards.

Significantly, Mr Speaker, the Bill includes fundamental components of the Protection of Persons in Care Act that I proposed earlier this year, whilst in opposition, to enhance reporting of abuse and powers to intervene.

Mr. Speaker, currently the Chief Medical Officer has oversight of 22 care homes and delegates the administration, registration, and compliance monitoring process to Ageing and Disability Services. The Elder Care Team is the team of inspectors who assess compliance with the legislation. The Team includes persons from the Department of Health Community Rehabilitation program, Nutrition Services, Environmental Health, and Community Nursing; in addition to inspectors from Ageing and Disability Services and Bermuda Fire and Rescue Services.

Mr Speaker, the diversity of inspectors required shows that the regulation of care homes is a complex and resource-intensive task. In addition, care homes and do not fit a single mould, they come in varying sizes and provide different models and levels of care and can specialize in serving particular sub-populations requiring long term care, such as adults with physical disabilities. 

Over the past three years, Mr Speaker, Ageing and Disability Services has made substantial improvements in monitoring and enforcing compliance in care homes. As a result, we have seen improvements in the quality of care by the homes, though much variation remains and continued enhancements are a work in progress. In fact, limitations in the legislation and broader systemic challenges have restricted the extent to which regulatory interventions and standards can be advanced. This amendment seeks to unblock some of these limitations. In, particular, the specific factors shaping this amendment are the challenging realities with respect to capacity and financing.

First, care homes are consistently close to 100% capacity, especially facilities that provide higher levels of care. This reality challenges enforcement options when problems are discovered, as closure is not often a viable solution since there are no alternative placement options for residents.

Second, many homes struggle financially which makes it a challenge to improve standards. Financial difficulties are in part due to the high cost of operating care homes, peoples’ inability to pay out of pocket for residential care and the reliance on Government benefits.

Both supply and financing of long term care are currently being targeted in the Ministry’s strategic initiatives, such as the Long Term Care Action Plan and efforts to identify incentives for private sector investment in the long term care sector. However, these are not quick or easy fixes. Consequently, the amendments proposed have taken these limitations into account to achieve as much as possible within the current realities.

Mr Speaker, I will now highlight the primary components of the Amendment Bill.

First, the Amendment explicitly establishes an improved, graduated system of notifications and interventions based on risk and re-occurrence of non-compliance. The aim is to improve the overall protection of persons in care. Depending on the type of intervention required, these amendments provide for the Ministry or the Courts to take action, including:

• Publication of conditions and restrictions on a care home, to ensure greater public accountability and transparency;
• Ministerial Orders to require immediate action to protect residents’ health, wellbeing and safety;
• Interim management orders by the Courts to put in place interim-administrators or operators in circumstances of serious risk to the safety, health and wellbeing of residents;
• Notification and appeals mechanisms to ensure due process for Operators; and finally
• A tiered re-registration fee based on the level of compliance. The higher the level of compliance the less the annual registration fee. This serves as an incentive for care homes, and maintains the current low fee for the fully compliant homes. Although the fees remain far lower from the actual cost of regulating care homes, the aim has been to reflect the intensiveness of regulation required. Less compliant homes need more inspections, monitoring and enforcement, thus costing more to regulate.

Second, Mr Speaker, the amendments provide for a Code of Practice to be published, which will set a higher standard of care across the sector. Specifically, the Code will:

• Improve compliance by providing a comprehensive resource for care homes, making standards and expectations explicit;
• Set general standards for all care homes, in addition to standards specific to a home’s level or model of care;
• Include best practice guidelines, not yet mandatory, to prepare homes for future advancements in the minimum standards; and
• Enable continued increases in standards, by regularly updating the Code with consultation.

The first edition of the Code will include existing requirements, as well as new and improved standards in three priority areas, namely:

1. Health and care services including requirements for assessment of residents, care planning and clinical practice standards. 
2. Protection from abuse, use of restraints and managing challenging behaviours – this includes standards to ensure better protection for persons in care from abuse and neglect, which is a top priority for this Government. 
3. Staffing – this includes supervision, training, qualifications and minimum staffing levels. It is important to note here the one change to the Regulations at this time is to raise the qualification requirements for Administrators and deputies. Existing administrators will be grandfathered in at their current facility but may be required to take additional training based on compliance levels.

Future editions of the Code will continue to raise standards based on care priorities, costs and available resources.

Enhancing the regulatory environment for care homes will be an ongoing process, Mr Speaker, and these amendments set the stage for continued progress in improving standards and regulation. Future phases of amendments will update the Regulations and continue to enhance the Code of Practice to better respond to broader long term care initiatives.

Mr Speaker, in closing I want to acknowledge the time and effort put into this Amendment by Ageing and Disability Services, the Elder Care Team, care home Administrators, and key community stakeholders. In addition, subject matter experts and stakeholders have been involved in the development and review of the new sections in the Code of Practice and continue to contribute to this work.  We look forward to maintaining our engagement with partners in Government and the community as we know much work remains to be done to improve long term care in Bermuda.

Thank you, Mr Speaker.