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September 9, 2020

Needed changes in Long-Term Care

Reuel S. Amdur

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Canada is at the very top, and not in a good way. We lead in the percentage of COVID-19 deaths in long-term care—81%, compared to 28% in Australia, 31% in the United States, and 66% in Spain. Surely, we are doing something wrong. According to the Working Group on Long-Term Care of the Royal Society of Canada, we're doing lots that is wrong. Their report is titled "Restoring Trust: COVID-19 and the Future of Long-Term Care."

Over the years, homes have become less professional, with more and more reliance on untrained workers to provide direct care.  These workers are in the main older women, in many cases women for whom English is not their first language.   Pay tends to be minimal, employment often precarious. Many work at more than one location because of short hours.

These conditions persist at the same time that residents are entering homes older and in poorer mental and physical condition, as the population is aging.  Facilities are often poorly designed for the task of care in conditions of health and safety.

The Working Group has many recommendations, with a major focus on staffing.  There is a need for adequate staffing, with workers receiving a living wage.  Working in the homes must be a career choice, with proper educational preparation and in-service training as well.  Staff need guaranteed sick leave and should have counselling available for the trauma in working with residents experiencing deterioration and death. 

Also needed, says the Group, is better data-gathering to inform policy and needed changes.  Other countries do more of this than we do.

One shortcoming of the report is that it fails to address the question of ownership of the homes.  In Canada, the very worst performance around the spread of COVID-19 has been in the privately owned homes.  Many of these homes have the well-deserved reputation of cutting corners, both on staffing and on essential supplies such as adult diapers.

This report contains hundreds of references, many to earlier reports which have at best been implemented in a haphazard fashion.

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