A damning auditor general’s report, released in April, accused the Government of Newfoundland and Labrador of failing to fulfil its responsibilities in overseeing private care homes. The report referenced a subset of operators who failed to meet standards for licensing, sometimes repeatedly, with reports of abuse, medication errors, unsanitary conditions and inadequate staff training. The AG stated homes were at times being relicensed with unresolved issues.

Mike Powell is president of Health Care Services with Fort Amherst Healthcare, a company that owns and operates licensed personal care homes and independent living seniors apartments throughout the province. Speaking at a press conference earlier this month, Powell highlighted his company’s recent accreditation through Accreditation Canada. The independent agency conducts procedural auditing of everything from management of communications with residents, to the way the company onboards staff and follows up on medical emergencies.

Powell suggested owners of other retirement and personal care homes undertake working to meet the same accreditation standards, saying the third-party process would boost public confidence in all care businesses.

It’s “a magnifying glass on every piece of your operating procedure,” he told reporters gathered at The Neighbourhood adult day program facility in St. John’s, at the rear of the Bishops Gardens senior living complex. He explained it took roughly two years for Fort Amherst to earn its accreditation. And, he noted, the recognition will be taken away if the company doesn’t maintain the national standards.

“It’s actually a really great solution for some of the issues that are happening systematically within our industry,” said Powell.

Company manager Cecilia Penney, who led the accreditation, said the recognition proves they are working to improve their operations for residents, staff, the health authority, government and the public. “We now have (new) robust systems for documenting our work and generating evidence—whether that’s for incident management, resident experience or safety practices,” Penney stated in a press release.

Light for ‘dark shadows’

Auditor General Denise Hanrahan found, between 2022 and 2024, the provincial Department of Health and Community Services “failed to enforce” its requirement for quarterly reports on complaints, incidents, resident care and staffing. Government eventually made random requests for information to the health authority but, the AG found, didn’t always follow-up on serious incidents.

The AG was highly critical of the quarterly reporting. The province posts an online summary of care homes each quarter (but not consistently), listing only the status of the operating license. In most other provinces, more detailed information is readily available online.

In Newfoundland and Labrador’s quarterly reports, there’s no information on what shortcomings may exist for a given facility issued a conditional license. Also missing is a sense of the time frame during which a facility has operated under a conditional license. Nor is there any indication of how long a facility has been operating without regulatory oversight.

Detailed inspection reports for each personal care home are available …  “in hard copy upon request to the regional Government Service Centre responsible for each particular facility.”

Detailed inspection reports for each personal care home are available, according to the Government of Newfoundland and Labrador, “in hard copy upon request to the regional Government Service Centre responsible for each particular facility.”

As part of her recommendations, Hanrahan stated the Health department “should enhance publicly available information regarding personal care homes, including posting inspection results, non-compliance information, licensure status and retain a history of the information for each home for a minimum of two years.”

Atlantic Business Magazine was told public reporting is something being looked at. Specifically, per an email from a Health department communications staff member, the government “plans to develop a new web page that will also include non-compliance findings.” However, the page isn’t expected to go live until new operational standards for care homes are fully implemented.

Serious incidents and response

The Auditor General found that Newfoundland and Labrador’s operational standards for personal care homes hadn’t been updated since 2007. Standards are not the same as the legal requirements around things like handling drugs, fire alarms or insurance requirements, which are covered in other regulations. Standards refer to the daily operations and provincial expectations for things like home design, basic amenities, how care homes should record and report complaints.

The AG’s top recommendation: “The Department of Health and Community Services should update, implement, effectively communicate and regularly review the Provincial Personal Care Home Program Operational Standards, ensuring alignment with best practices and addressing any gaps identified in this audit.”

 Atlantic Business Magazine was told a “comprehensive review” of the standards is already complete. “The Department of Health and Community Services is collaborating closely with stakeholders to finalize the updated Operational Standards, which are scheduled for implementation this fall,” stated an emailed response to questions.

Private-public debate

A number of members of the Newfoundland and Labrador Association of Public and Private Employees (NAPE) work in personal care homes around the province. NAPE president Jerry Earle says the AG’s report, and a report earlier in the year from the health authority and Province, are starting points for discussions around systemic issues.

“The workers in these facilities are doing the best they can in the environments in which they work,” he emphasized, saying an overloaded, public acute care system also means a lack of resources for key elements in personal care—like health assessments for residents. NAPE says people are entering care homes, or spending extended periods, without medical exams or appropriate care plans. Earle said individual residents can run into trouble and personal health circumstances can deteriorate as a result. That can contribute to other problems for personal care homes.

Per the March quarterly report posted by the Government of Newfoundland and Labrador, there are 87 licensed personal care homes in the province, providing Level 1, 2 or Enhanced Care, and usually—but not always—a mix of all three. Of those homes, 10 were on conditional licenses at the time of the report, meaning there were issues around compliance with regulations and standards (without identifying which issues, or how many). Another 11 homes were on interim licences, meaning the existing license is expired but the regulators don’t have enough information to complete a license renewal. In one case, a home was temporarily closed.

While Powell suggested accreditation can be managed by operators smaller than Fort Amherst Health Care, Earle was less convinced. Since the AG’s report, NAPE gathered representatives from all types of care home staff—dieticians, clerical staff, custodians, etc.—for roundtable discussions. A report from those discussions advocates for the health authority and government to create a team dedicated to monitoring care homes.

“What the frontline workers are saying to us, or people who are, I would suggest, experts in this area, is that we need to create a provincial personal care monitoring team,” Earle said.

Earle also argued against what he describes as a “profit-driven model”, calling for an end to private facilities and service providers in the province altogether.

NAPE’s report puts the call clearly, stating: “The long-term solution is to include personal care homes into the public sector health care system, to ensure all citizens have equal access to healthcare, which cannot be guaranteed in a for-profit system.”

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