April 17, 2018

Improving Long-Term Care in Ontario

"If you could change one thing about long-term care, what would it be?" the questioner asked Dr. Pat Armstrong, York University sociology professor, at a session held at the main branch of the Ottawa Public Library.

Her response? “Get rid of all the regulations.”  She remarked that long-term care homes are more heavily regulated than the nuclear industry.

To someone unfamiliar with long-term care in Ontario, that answer may appear strange. 

Surely regulations are there to protect a vulnerable population.  Yes, that is undoubtedly the reason for the regulations, but the sheer magnitude of the recording required is so great that staff are left with limited time to interact with and provide unscripted service to the residents. 

Rather than recording each and every detail, their preference would be to record by exception, for example, not whether a person was adequately hydrated but when not.

“Re-imagining Long-Term Residential Care: Promising Practices and the Ontario Context” was the title of the event. 

It served as the kick-off of the book “Exercising Choice in Long-Term Residential Care,” edited by Pat Armstrong and Tamara Daly.  The book, published by the Canadian Centre for Policy Alternatives, is one in a series produced by Pat and Hugh Armstrong and their associates about long-term care from an international perspective.

Pat Armstrong’s concern about paper work eating into caregiving time was re-enforced by Heather Duff, who chairs CUPE Health Care, representing health care workers in CUPE (Canadian Union of Public Employees).

She said that adequate long-term care means at least 4.1 hours of hands-on care per resident, that is, provision of service by on-site front-line staff.  This does not include hours for staff off sick or on vacation, nor does it include management staff. 

Currently the Ontario standard is 2.5 hours, and this target may be missed because of sickness or other emergencies.  Add that situation to the record-keeping preoccupation and you have the making of a situation of overworked, worn-down staff, and residents inadequately served.

The need is for more hands and more money to do the work, said Doreen Roque, a member of the Family and Friends Council at Perley Rideau Veterans’ Health Centre, in summing up the situation described by Armstrong and Duff.

Movement away from documenting every detail and from total risk-aversion is, as Zófia Orosz put it, a movement from a medical model to a social model.  She is manager of he Bruyère Centre for Learning, Research and Innovation in Long-Term Care.

Some have suggested that the way of cutting back on pressures on the homes for long-term care is to provide more home care.  Participants did not reject home care, though they noted the possibility of isolation in some cases.  However, Duff said that the needed resources for home care are not being provided.

The official position is that the heavy paper-work load is in the interests of resident health and safety.  In response, Armstrong argues that we need to look at the system as a whole.  Where are the most serious breaches in care and the poorest level of care found?  In the for-profit homes. 

The obvious solution is to take the profit motive out of provision of long-term care.  One would expect greater benefits from this approach than from all of the accumulation of sheets of checked boxes in the world.