Merwan Saher, in a report released Tuesday, says the province has improved following a scathing report in 2005. It has adopted a better funding and care model in the last decade, which now requires every long-term resident to have an individual care plan.
"(But) what is missing is a crucial weakness," Saher said at a media availability.
"Alberta Health Services has insufficient assurance that long-term care facilities are appropriately and consistently allocating those publicly funded staff hours to each shift to deliver daily care that fulfils each resident's care plan."
He suggested three key changes: "Unannounced (inspections), removing existing duplication (of work and) less examination of documents at facilities that set out policies and more examination of the care actually being delivered."
Alberta's $910-million a year long-term care system has 14,000 beds at 170 facilities. Saher said it has effectively become short-term care for seniors who are too frail or ill to be looked after in the community.
In 2005, the auditor general found rampant problems, including some seniors being drugged to keep them compliant, medication directions being ignored and patients being roused in the middle of the night to meet staffing schedules.
Saher said his staff toured facilities and didn't find any residents at risk. But those visits were done with Alberta Health Services officials and were announced two months in advance, he noted.
He suggested the system still needs a lot of work on fundamental organizational questions.
Six years after Alberta collapsed all health regions into the provincewide Alberta Health Services superboard, the government and AHS still haven't sorted out who is in charge of what, he said.
Alberta Health Services delivers front-line care, while Health Minister Stephen Mandel and his department set policy and oversee the entire system.
"The Department of Health needs to clearly define and separate its monitoring role and responsibilities from those of AHS, and improve public reporting on the results achieved for the funds provided," wrote Saher in the report.
Mandel promised to take action.
"Improving long-term care is a top priority and we will continue our efforts to make improvements in this area," he said in a news release.
"My ministry will implement changes that address the auditors recommendations, including reviewing appropriate ways to publicly report on long-term care and releasing updated continuing care health-service standards."
Mandel has also ordered a panel to review the state of health care in rural areas.
Opposition critics said Saher didn't go far enough.
NDP Leader Brian Mason said given front-line descriptions of maltreated seniors in the 2005 report, Saher owed it to them in Tuesday's follow-up report to look at more than flow charts.
"I think we can expect more from an auditor general than that. If people are living in inhumane conditions, our seniors, then he needs to be able to say so. He needs to get out of his office and get into some of the nursing homes and have a look for himself," said Mason.
Liberal Leader Raj Sherman said Saher had made a good start, but just a start.
"These findings should lead to the auditor general doing a more in-depth report, showing up unannounced at all Alberta's seniors facilities," said Sherman.
Saher rejected those arguments.
"Our contribution is to look at the quality of a system, how it is designed and how it's implemented," he said.
"We don't think it was appropriate for us to step into management's shoes and do our own monitoring."
Wildrose seniors critic Kerry Towle said the problems with long-term care are symptomatic of a system stricken throughout by organizational ineptitude.
"We have a crisis in our acute-care system, patients are desperately waiting to get access to long-term care beds, while our entire system is failing to properly monitor the quality of care being delivered," Towle said in a news release.