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Friday, 24 January 2014

Fire and tragedy in long term care settings, a future public health threat?

Devastation has struck another nursing home.  Five residents confirmed dead and up to 30 unaccounted for in the quaint village of L'Isle-Verte a couple of hours along the south shore of the St. Lawrence near Riviḕre –du-Loup CTV coverage  .  Tragically it could occur anywhere and has. G and m list of fatal Canadian fires  Global news list of previous fires

A detailed 5-year review in the US looked at some 3000 nursing home fires amongst over 6000 fires in health care facilities – speaking to how common such events actually are, fortunately rarely as tragic with an average of only 6 deaths annually and twenty times as many injuries.  NFPA special report    

Ageing infrastructure, older buildings not compliant with newer safety codes particularly related to sprinklers, faulty electrical and heating, and most commonly kitchen related. Smoking always a possible contributor where facilities have not limited smoking within the building.  The minus 20 temperatures suggesting heating, particularly individual residents efforts to further heat rooms, might be a factor. 

There were over 200,000 long term care beds in Canada in 2010.  In 2012, the annual residential care facilities survey and report were cancelled by the federal government, raising questions on the future ability to track growth and care in residential care settings.  The final report available at Stats Can 2012 report.  Why would such a report be cancelled?  Perhaps in part that one of the main focuses was on cost controls and limitations that would have limited private sector proliferation in residential care settings, merely speculation but consistent with other federal decisions.

With the proliferation of residential care beds in Canada, and the development of a variety of options, residential care may fall under numerous pieces of legislation, inconsistent inspection and investigation, limited accountability for public expenditures and increasing private options.  While publically funded residential care options are generally seen as beneficial in reducing inappropriate acute care facility utilization, systematization and standardization of care can be sporadic depending on the regulatory framework applied to a specific care setting.

The result of the recent proliferation and expansion of options of residential settings becomes a vulnerability for n increasing number of future tragic scenarios. Government policies that support warehousing of seniors unable to live independently in the community have opened the door to even greater exploitation. To this add the loss of family support structures and the growth in aged populations.

Only 8% of those over 65 currently reside in any form of collective living arrangement.  Even for those over 90, living in a private residence is the most common living arrangement.  The proportional growth in care settings can be found at Stats Can Living arrangements for seniors.  While government and health care organizations focus their attention on residential care, this is being done at the expense of supporting the majority who successfully choose to retain their independence. 

The inevitable outcome will be a convergence of factors that will lead to more l'Isle-Verte devastations. 

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