Poor communication, failure to follow rules cited in overbilling

A ruling by the Ontario Retirement Home Regulatory Authority did not find that intentional overbilling had occurred, but did find that the home should have known what type of care was being provided from outside the home.

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An Ottawa nursing home did not intentionally overcharge a resident when it charged her for services she was already receiving through the public health system, but it should have known it was duplicating her care, the organization that regulates nursing homes ruled. in Ontario.

Wayne Hillier, deputy registrar of the province’s Retirement Home Regulatory Authority (RHRA), in his ruling blamed poor communications and a lack of consistent documentation by staff, leading one resident’s family to believe that the house had intentionally overcharged them.

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The RHRA ruling came after Christopher Monk complained last year that Chartwell Rockcliffe Retirement Residence was charging his elderly mother, Chantal, thousands of dollars for services provided through the public health system. Monk said he learned of the overlap by accident when it was brought to his attention by a personal services worker hired through a care agency contracted by publicly funded home and community care support services for the Ottawa region.

The money has since been refunded and the house has apologized for what it characterized as an administrative error.

But an RHRA ruling last week, while not finding intentional overbilling, did find that the home should have known what type of care was being provided from outside the home and would have done so if it had better internal communications. and had met the requirements.

Chantal Monk, now 94, had been living in the nursing home without additional support until she was in hospital. In order to be discharged from the hospital, she had to have a care plan that included additional care and help with some daily activities.

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Her son, who was living in British Columbia at the time, said a supplemental care package at the retirement home cost just over $2,500 a month, on top of the $7,000 she already paid. What he and her mother didn’t know at the time was that much of the care she received was provided by PSWs through the public health system. She said she only found out about it while she was visiting her mother.

Monk confronted authorities at the home and filed a complaint with the RHRA, saying he was concerned the same thing could be happening to other residents.

On Thursday, Monk said he planned to appeal the RHRA ruling, which he called “a complete whitewash.” She said she was especially struck by the fact that the home said it did not know her mother was receiving outside help even though staff at the facility had regular meetings with the organization that provides care to residents through the health system. public, where care for residents was discussed. .

An RHRA inspector determined that the home failed to review and revise Monk’s care plan once her care needs changed and, for example, she was able to walk to the dining room alone without paying for an escort. The inspector also found that the home did not integrate assessments from outside care providers into the resident’s care plan, something that would have made it clear that she was receiving outside care. The home was cited for noncompliance in those areas.

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But based on interviews and documents, the RHRA said its inspector “could not conclude that the home intentionally overbilled the resident.”

The report also says that home and community care support services staff said they met with officials at the home to review which residents were receiving care through them.

Monk received some extra care from the center’s staff during that period, especially when publicly funded caregivers arrived later than expected.

After Christopher Monk’s complaint was filed, home officials met with the home and community support services coordinator to ensure there was no duplication involving other residents of the home. None were found, according to the report. The house says it has taken “corrective measures” to ensure such incidents do not occur.

“While I cannot conclude that the home intended to charge the plaintiff for services that were also provided through (home and community care support services),” Hillier wrote in the ruling, “it is troubling that the administration of the home will not notice the daily visits. by (the agency contracted by HCCSS) for more than three months. “This indicates that there was a level of disconnection and disengagement from the daily operations at the home, which ultimately led to this complaint and the plaintiff’s belief that the home intentionally overcharged his family.”

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