Leeanne says right now ethical issues are discussed on a case-by-case basis with no formal policy in place on an OMNI-wide level. "So it was difficult to answer" some of the questions in the accreditation application, which has recently been sent away. The home is awaiting news to see if they have become accredited.

The Canadian Council on Health Services Accreditation (CCHSA) has placed a new emphasis on ethics for its surveyors, due to a great deal of feedback from grass roots organizations. The CCHSA has always considered ethics to be part of its mandate, but is now doing so more explicitly.

Ethical issues in long-term care involve a myriad of concerns. These may include truth telling (by staff, patients, and families), aggression by residents, withholding and/or withdrawing life-sustaining treatment, the use of physical restraints to decrease the risk of injury, capacity assessment as a pre-requisite for decision-making, and pain control, especially in terminal phases of disease and in patients suffering from dementia.

"We deal with ethical issues all of the time, of course," says Leeanne, "but not formally."

Leeanne – who is also the director of care of Streamway – says ethical questions are discussed frequently but not uniformly. "And I know accreditors want that" ethical component to be there, she says.

Leeanne says just recently Streamway made the decision to make ethics a standard agenda item whenever they hold a Medical Advisory Committee or Professional Advisory Committee meeting, which are held quarterly.

The administrator and director of care says the thing to remember with ethical issues is that they so often need to be decided upon relatively quickly. That means that even if they make ethics a standard agenda item, a decision has usually already been made regarding the situation. "Often it has to be something that is immediate, or within days," she says.

Leeanne says in her previous work experience in acute care, the hospital she worked at had an ethicist, one of the few around in the hospital sector. "Even with this person on the team, on the ethics committee, it was difficult to get a resolution."

That’s why Leeanne doesn’t think OMNI needs an ethics committee, or at least not as much as it needs a uniform ethics policy.