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July 11, 2016

What's wrong with Long-Term Care?

Reuel S. Amdur

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How can we make long-term care better? That was the question addressed at the Public Service Alliance of Canada (PSAC) building in Ottawa on April 25 at a session sponsored by the Canadian Centre for Policy Alternatives and the Canadian Union of Public Employees (CUPE).

rPanel members addressed this question based on their experiences and explorations.  As well, a booklet edited by Donna Baines and Pat Armstrong, Promising Practices in Long-Term Care (Ottawa: Canadian Centre for Policy Alternatives, 2016) was made available.

Armstrong talked about the background of the booklet.  It comes out of a seven-year project of an international team of interprofessional researchers and over 50 graduate students who went to six different countries to find promising practices in long-term care.  They interviewed union officials and officials from employer associations.  There were two approaches to fact-finding—either a week’s stay at a facility or one day, covering all shifts.  They ate the meals at the homes.

She reported that, while they found promising practices, there was “not a single right way.”  Essential was that residents be treated with dignity and respect.  The booklet explains that some countries were chosen because they have similar Gross Domestic Product (GDP) to Canada’s, to eliminate the argument, “We can’t afford it.”

Promising practices were found in Canada and elsewhere.  A British Columbia home had no contracting out, low staff turnover, and familiarity with the different residents’ food preferences.

In a home in a small German town, residents are involved in household activities, including food preparation.  Staff roles are sufficiently fluid that they can all interact closely with residents.

Promising practices typically included food preparation in the home, low staff turnover, adequate staffing, all staff interacting with residents, and pleasant activities, music for example.  So what do the other panelists have to say about the situation?

CUPE member Joanne Waddell is a cook in a private long-term care facility.  She contends that seniors in her centre do not get enough care.  While food at her home is prepared on site, in many homes it is contracted out.  Her home has no minimum staffing level.  The home now has a higher level of residents with dementia.  There is a heavy turnover of staff since “New hires quit because full time work is not available.”  She also commented that there is not enough training for staff.  And, she noted, when staff have serious illness, they do not have coverage.

Peter Walker, from Bruyère Hospital’s long-term care facility provided his views.  He reported that the level of care for residents is on the increase.  They are much frailer and have more complex needs.  Consequently, the facility is becoming ever more institutional in character.  In Ontario, according to Walker, 70% of those in long-term care have dementia.  Often long-term care facilities are the places where the residents die.  “Only five per cent could be looked after outside a home.” 

He noted that as a result of public policy there is ever greater emphasis on keeping people out of hospital, “which is great,” but supports in the community are eroding.  More people are moving to private sector facilities, where there are too few staff to provide health care and social support.  Now, many people needing long-term care are being shipped to retirement homes instead.

Doreen Rock, who chairs the Family Council Network for the Champlain Region, which includes Ottawa, an organization of volunteers with family members in care, cited the lack of full-time jobs as a serious problem.  People on part-time have no benefits.  The food in homes is a subject of common complaint.  She said that residents need more staff time than they can provide.  Armstrong added that some families hire private companions for residents.  Rock, continuing, observed that homes experience violence and that abuse is a problem.

Carleton Social Work Professor Susan Braedley pointed out that Canada’s staffing levels in long-term care are a third of those in Sweden and half of those in Norway.  She urged that Canada needs to do better.  On what can only be a controversial note, she said that we need higher taxes.  Less money means fewer staff.  She called for a minimum of 4.1 hours of care for each resident.  That 4.1 hours does not include food services, laundry, or janitorial staff. 

Walker complained that the few staff that there are overregulated, needing to document everything.  As a result, there is no capacity to try new things.

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