More seniors are seeing their health decline in Hamilton long-term-care homes than average.

They are more likely to have worsening physical function, depressive moods and pain, flags the Canadian Institute for Health Information.

The "Your Health System" report card updated Wednesday reveals:

•One in five Hamilton long-term-care residents are potentially being given antipsychotics inappropriately;

•More residents are falling;

•Fewer are seeing improvements to their physical function;

•Far more are in pain than average;

It also reports 57 per cent of Hamilton long-term-care residents are older than 85 years of age. More than half have dementia. And two-thirds of residents are women.

One bright spot is that far fewer residents are being physically restrained daily. Restraint use is down by more than 60 per cent in Hamilton over the last three years.

Significant strides have also been made to reduce the decline in residents' health. However, it hasn't been enough.

The number of residents with deteriorating physical function, depressive moods and pain is still above the provincial and national average.

It's significant because these measures can reflect the quality of programming and rehabilitation residents receive.

"In general, the people who are moving to long-term care are more ill, more frail and have multi-complex problems," said Jordanne Holland, who is on the board of directors at Concerned Friends, an Ontario charity that monitors and advocates for quality improvements in long-term care.

"The staffing resources haven't been changed to reflect this complexity. What we're seeing is the patients are having more needs, but the staff isn't increasing or being trained very differently in order to meet those needs. There is a disconnect there."

More than one in three Hamilton long-term-care residents is seeing their physical function decline, warns CIHI.

"An increased level of dependence on others to assist with transferring and locomotion may indicate deterioration in the overall health status of a resident," states the report card.

Nearly 30 per cent have worsening symptoms of depression.

"Depression affects quality of life and may also contribute to deteriorations in activities of daily living and an increased sensitivity to pain," flags the report.

More than one in 10 is experiencing pain, which is a rate nearly double the provincial average.

For 15 per cent of Hamilton long-term-care residents, their pain is getting worse. It's an issue that needs particular attention as the number of patients with increased pain is climbing.

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"There are outstanding issues that need to be resolved," said Holland. "If you see they are not being resolved over time, it raises a lot of questions."

One area that has seen marked improvement is the use of antipsychotics without a diagnosis of psychosis. The concern is medication being used as a chemical restraint. In Hamilton alone, potentially inappropriate use of antipsychotics has dropped by nearly 18 per cent in three years.

"That is actually a good success story," said Holland about the decrease in antipsychotic use provincewide. "Families, patients and other care providers have put attention on it and actually made a change and a difference."

However, nearly 21 per cent of long-term-care residents with no psychosis diagnosis are still being given the medication in Hamilton.

Another win for advocates has been a sharp decline in the number of residents physically restrained a day. In Hamilton, it has decreased to about 7 per cent from just over 17 per cent three years ago.

But one measure going in the wrong direction is the number of falls at long-term-care homes. The percentage of residents who had a fall in the last 30 days has slowly but steadily increased over the last three years.

"The best guideline in terms of falls is individual assessment and interventions for each person," said Holland. "But that's very hard."

Improving physical function is also a struggle. Three years ago, just over 37 per cent of residents had gains in movement but that has now dropped to about 32 per cent.

Holland would like to see solutions come out of the CIHI report, which added long-term care a year ago and started identifying issues.

"It's great to have the data, but that is only part of it," she said. "Do those indicators come with guidelines or best practice tools or resources or education? There is a gap there."

She says it's more difficult for long-term care than other sectors of the health- care system to reflect and learn from those getting the best results. She said the infrastructure for change that hospitals have just doesn't exist in many parts of long-term care.

"It's one of the most highly regulated sectors, but it's also a sector that doesn't have a lot of resources," she said. "They don't have that capacity in a lot of instances."