In accordance with Section 13 of the Audit Act we conducted AND SCOPE an audit of the Senior Services Division of Queens Region Health

Our audit focused on the fiscal year ended March 31, 1998. The objective of this examination was to determine whether adequate management practices were in place over the long-term care program for seniors.

5.8 Our examination was performed in accordance with the auditing standards of the Canadian Institute of Chartered Accountants and accordingly included such tests and other procedures as we considered necessary in the circumstances.

OVERALL AUDIT 5.9 We noted improvements, since our previous audit of Homes OBSERVATIONS and Manors in 1992, in the process used to place individuals in long-term care facilities. However, there continues to be weaknesses in documentation to support some placement decisions.

5.10 We found that legislation and policies have not been updated to reflect new administrative structures as a result of the establishment of the regional health authorities. Also, new procedures implemented in the placement process are not reflected in formal policies.

5.11 Financial and administrative controls need to be improved for revenue collection, accounts receivable, bank reconciliations, revenue transfers, and recording of meal revenue.

DETAILED AUDIT OBSERVATIONS

Placement Process 5.12 In 1994 the responsibility for nursing home placement was transferred to each regional health authority. A new seniors assessment program was established which included a more comprehensive functional assessment tool, as well as a coordinated entry system. The Admissions Committee was replaced with a Placement Committee in the Queens Region which includes representation from the Long-Term Care, Home Care and Support, and Acute Care Discharge programs. In addition, the Placement Committee includes representation from private nursing homes.

5.13 The coordinated entry system uses the Placement Committee as a central point of entry for all placements in Queens Region to both

provincial and private nursing homes. The process ensures that all applicants identified as priority are considered for placement. The use of a uniform seniors assessment tool by the private and public nursing homes and the participation of the private nursing homes on the Placement Committee contributes toward standardization in nursing home placements and fits well within the philosophy of a more integrated service.

5.14 Most individuals make initial contact with Senior Services through hospitals, the Department of Veteran’s Affairs, or private nursing homes. Once initial contact has been made, an assessment is completed by a Placement Officer to determine the level of nursing care required, risk factors and safety issues. The current assessment tool considers the individual’s physical health, as well as, functional, behavioural, financial and environmental factors. The assessment tool is designed to determine the types of support required including;

home care services, respite services for care givers, long-term care placements or other required services. As a result of the screening process, referrals are made to the appropriate service providers.

5.15 The Placement Committee interprets the requirement for manor care as having a level of care of three or higher on the seniors assessment tool which uses a scale from one to five. Information is presented at the Committee meetings to establish the client’s eligibility. When there are a number of individuals on the priority list and not enough beds, other factors must also be considered in order to make the placement decision. Placement decisions have a major impact on the lives of individual applicants and their families. It is important to document deciding factors to support placement decisions should they ever be called into question. We found that minutes of the Committee meetings were not maintained and factors considered as decisive by the Committee in placement decisions were not always documented. Of twenty-three placement files examined, all had the assessment completed and ten had additional information indicating reasons for selection of the individual for placement.

Recommendation

5.16 The major factors considered in the placement of individual applicants should be documented in the applicants’

files or in the Placement Committee minutes of meetings.

5.17 It is important that regulations and policies be kept current to ensure authorization and accountability is clearly established and the information individuals are receiving is accurate. We found that legislation has not been updated to reflect new administrative structures, and policies have not been updated to include new procedures implemented in the placement process.

5.18 Under Part II of the Welfare Assistance Act Regulations

“Director” means the Director of the Division of Aging and Extended Care. The Regulations provide various decision making powers to the Director of Aging and Extended Care. These have been exercised by the Directors of Senior Services in each region but the Act and Regulations have not been formally updated.

5.19 Policies documented in the Division’s policy manual have not been updated to include references to level of care criteria currently applied or to reflect the membership of the Placement Committee as it is currently structured. In addition, the functional profile described in the policy manual is different from the seniors assessment tool currently in use.

Recommendation

5.20 Regulations and policies should be updated to reflect current administrative structures and changes in the process for admissions to private and provincial homes.

Revenue 5.21 The Welfare Assistance Act /Regulations require residents to