Poor communication, failure to follow guidelines contributed to overbilling of retirement home resident

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An Ottawa retirement home did not intentionally overbill 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 retirement homes in Ontario has ruled.

Wayne Hillier, deputy registrar of the province’s Retirement Homes Regulatory Authority (RHRA), in his ruling blamed poor communications and lack of consistent documentation by staff, which led to a belief by the family of a resident that the home had intentionally overcharged them.

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

The money has since been refunded and the home has apologized for what it characterized as a clerical error.

But a ruling from the RHRA this past week, while it didn’t find intentional overbilling, did find that the home should have known what kind of care was being provided from outside the home and it would have done so if it had better internal communications and had complied with requirements.

Chantal Monk, now 94, had been living at the retirement home without additional support until a stint in the hospital. In order to be discharged from 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 lived in British Columbia at the time, said a supplemental care package with the retirement home cost just over $2,500 a month in addition to the $7,000 she was already paying. What he and his mother didn’t realize at the time was that much of the care she received was provided by PSWs through the public health system. He said he only learned that while visiting his mother.

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

On Thursday, Monk said he planned to appeal the RHRA ruling, which he called “a complete whitewash.” He said he was especially struck by the fact that the home said it wasn’t aware his mother was receiving outside help even though staff there had regular meetings with the organization providing care to residents through the public health system where its care of residents was discussed.

An inspector from RHRA determined that the home failed to review and revise Monk’s plan of care once her care needs changed and, for example, she could walk to the dining room on her own without paying for an escort. The inspector also found the home did not integrate assessments from external care providers into the resident’s plan of care, something that would have made it clear she was receiving outside care. The home was cited for non-compliance 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 said 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 did receive some additional care from the home’s staff during the period, especially when publicly funded caregivers arrived later than expected.

After Christopher Monk’s complaint was filed, officials with the home met with the home and community support services co-ordinator to make sure there was no duplication involving other residents in the home. None were found, according to the report. The home says it has taken “corrective action” to make sure no such incidents occur.

“While I cannot conclude the home intended to charge the complainant for services that were also being provided through (home and community care support services),” Hillier wrote in the ruling, “it is concerning that management at the home did not notice daily visits by (the agency contracted by HCCSS) for over three months. That indicates there was a level of disconnect and disengagement from the day-to-day operations at the home, which ultimately led to this complaint and belief from the complainant that the home intentionally overcharged their family.”

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