Health and Wellness: Long Term Care – New and Replacement Facilities

Audited Entities

• Department of Health and Wellness

Audit Scope and Objectives

The audit objectives were to determine whether:

• the Department has adequate processes to analyze current and future long term care bed requirements and to identify the number and location of long term care beds to be constructed or replaced;
• the Department has an adequate process to develop facility standards for the design, operation, staffing and funding of long term care facilities;
•  the Department has an adequate process to develop the requirements for the request for proposals for new long term care facilities;
• the process to award new long term care facilities was in compliance with the provincial Procurement Policy and the related request for proposals requirements;
• the Department and successful bidders complied with the facility development approval process;
• the development and service agreements between the Department and facility operators were adequate;
• the Department is providing adequate oversight during the development, construction, commissioning and initial licensing of long term care facilities; and
• the Department has adequately monitored the impact of opening new long term care facilities on the wait list for long term care placement.

Audit Criteria

• Not publicly available

Main Audit Findings

• The Department engaged in a detailed needs analysis to determine the number and location of new long term care facilities to be constructed under its Continuing Care Strategy. The audit team found the Department had an appropriate process to develop the request for proposals, and evaluate the bids received. The audit concluded that the Department complied with the provincial procurement policy and appropriately awarded successful proposals.
• The Department had no support to show it replaced those facilities which were most in need. The audit team does not know whether the facilities with the most serious deficiencies were replaced.
• The Department developed and followed an adequate process for the development, construction, commissioning and initial licensing of new and replacement facilities. The Department also signed standard development agreements covering facility construction, and long term care service agreements with facility operators.
• The Department has not established agreements with existing long term care service providers, who represent the majority of long term care facilities. Since there were no agreements and therefore no clear termination provisions, Department management believed they had to negotiate with existing service providers for replacement facilities rather than going through a competitive bid process. Although this process was in compliance with the Provincial procurement policy, the audit team does not accept the reasonableness of this explanation. It is a poor management practice to spend large amounts of public funds without contractual agreements.
• None of the eight recommendations made in the June 2007 Auditor General’s report have been implemented. The Auditor General recommended that the Homes for Special Care Act and Regulations be updated as far back as 1998; however, no action has been taken. The audit team is concerned about the Department’s willingness to implement the recommendations in this Chapter given its inaction in implementing the 2007 recommendations.

Selected Audit Recommendations

• The Department should take appropriate steps to ensure decisions to replace long term care facilities are based on a transparent, consistent process and are adequately supported and documented.
• The Department should sign agreements with all long term care service providers within a year.
• The Department should develop a risk assessment process for subsequent projects.
• The Department should immediately implement all recommendations made in Chapter 4 of the June 2007 Report of the Auditor General.
• The Departments and Community Services should update the Homes for Special Care Act and Regulations to ensure current service delivery standards are included.

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