The organization that represents Ontario’s doctors is raising concerns over a proposed change to provincial long-term-care legislation that it says could put patient safety at risk.
The Ontario Medical Association (OMA) says a new provincial plan that allows nurse practitioners to take on the role of clinical director in long-term-care homes — a position traditionally performed by doctors under the title medical director — is “the opposite of common sense.”
“I’ll be very clear. Diluting physician leadership in long-term care homes will put patients at risk,” said Dr. Dominik Nowak, president of the OMA. “People who are in long-term-care homes are some of the most complex, some of the most vulnerable older adults that we have in society, and the medicine is challenging.”
Nowak, a family doctor who has experience working in long-term-care homes, stresses the role of medical director is more than just administrative.
“A strong medical director physician in long-term care homes prevents people from needing to go to the emergency room, from needing to be admitted to hospital, and those are places where oftentimes older adults who are in long-term care never come back from.”
The proposed change is contained in the provincial government’s new Support for Seniors and Caregivers Act that includes spending $114 million over three years on several initiatives the province says will “enhance the quality of life and care” for Ontario seniors.
These include training for long-term-care staff in emotion-based care, incorporating additional dementia elements into personal support worker (PSW) education standards, expanding the 24/7 Seniors Safety Line, and giving seniors still living in their own homes access to certain long-term-care home services, such as recreation and social programs.
The replacement of the long-term-care medical director role with clinical director does not prevent doctors from continuing to lead medical care in nursing homes, but rather, allows nurse practitioners to also fulfil this role, a move the government says will improve recruitment for the position.
Daniel Strauss, a spokesperson for Minister of Long-Term Care Natalia Kusendova-Bashta, says the clinical director role is “primarily administrative” and does not involve providing direct care to residents.
“This change allows greater flexibility for homes to fill the position, as was done during the pandemic when nurse practitioners were able to serve as medical directors,” he said. “The government has full confidence that nurse practitioners can fulfil the required duties, as they have successfully done so in the past.”
Medical directors are responsible for providing oversight of the long-term-care home’s medical clinical care, such as consulting with the home’s director of nursing and personal care, setting expectations for attending doctors and nurses, and addressing issues related to resident care and after-hours coverage.
Nurse practitioners are nurses that have completed additional graduate-level education and have the privilege to admit, perform diagnostic tests, treat and discharge patients.
But that’s not the role of a medical director of a long-term-care home, says Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario.
“The role of the clinical director is more oversight and policy driven,” she said, adding that the OMA’s concerns are misplaced and that new legislation is a “long-time coming.”
“This doesn’t replace the physicians that will be working with the residents … I say to the OMA, let’s move on and do what’s best for residents and their families.”
Lisa Levin, CEO of AdvantAge Ontario, which represents more than 500 not-for-profit providers of long-term care, seniors’ care, supportive housing and community services agencies, says nursing homes are facing a shortage of physicians to serve as medical directors, especially in rural and northern communities.
“By allowing nurse practitioners to play this role, the government is introducing a new approach that will give our members additional flexibility. It is a positive move that will be very, very helpful for homes,” Levin said in an email. She added that her organization is urging the government to increase compensation for physicians who are medical directors, “as this has not happened in years.”
Nowak says he has seen “no evidence” that there are recruitment challenges for the role of medical director in nursing homes.
“In fact, when I speak with my colleagues in long-term-care homes, they’re ready to rise to the challenge,” he said. “Obviously there are other areas in the health-care system where there are severe recruitment challenges. This is not one that I see evidence for.”
