Isn’t It Time to Think about Long-term Care?

An older woman wearing an apron and cooking talking to someone

Unless we’re lucky, many of us could end up in a long-term facility. I haven’t given it a great deal of thought until now, until COVID-19 exposed the desperate conditions in some nursing homes across Canada. In Ontario, almost 70 per cent of deaths due to the virus are among residents in long-term care. More than half of the deaths across the country occurred in nursing homes. According to the CBC, “hundreds of this country’s elderly citizens — all with rich lives, histories and hopes for their futures — are dying alone, bereft of dignity and respect. Thousands more are at risk of soon suffering the same fate.” Both the caregivers and the cared for have experienced the worst of this pandemic.

Instead of worrying about long-term care, I’ve stubbornly stuck to rose-tinted visions of living in a retirement residence. You know the kind, with my own private apartment, an adjoining kitchen plus washroom and a great variety of activities for me to choose from each day. Yoga, meditation, a Scrabble-playing group, a book club filled with lively people who share my interests. Dinner served in a splendid dining room, a mini-bus to take residents shopping and to concerts or movies.

Of course, I’ve never been inside a pricey retirement residence. I’ve only seen them from afar or been exposed to their advertisements. Long ago, my mother lived in a nursing home after she was diagnosed with dementia, and it was nothing like the one I’ve imagined. I assure myself that my mother’s lack of care happened decades ago when there were no alternatives for her, and surely, surely the situation has improved since the late 1980s.

During the last few months, we’ve learned that some facilities remain under-staffed and that long-term care workers often need to connect with two or three facilities to make a living. That makes transmission of the virus between homes close to unavoidable. PPE (personal protective equipment) is in short supply. I won’t go into detail about the conditions in some of these homes. Now with quarantines imposed by cities and provinces, residents, even the terminally ill, are not allowed contact with their family. We’ve all seen the pictures of spouses and children visiting patients through their windows. Even that was forbidden by Ottawa’s mayor until the outcry was loud enough to make him rescind the order.

It’s almost unimaginable to think that some of the most vulnerable of our ageing population has been left to fend for themselves in perilous conditions. When I think of what it must be like, alone and frightened, my only response is that as a country, we need to commit to changing this situation and to ensuring that it will not happen again if and when the next virus is on the loose.

On Sunday Morning, the long-running CBC radio program, leading expert and Distinguished Research Professor in Sociology at York University and a Fellow of the Royal Society of Canada Pat Armstrong told host Michael Enright: “Canada’s for-profit model of long-term care has failed the elderly. Long-term care is one of the major gaps in Canada’s universal healthcare system. It’s not clearly covered by the principles of the Canada Health Act, or in the funding,” she explained. Instead, the Act is “basically focused on hospitals and doctors. It was developed at a time, initially, when most care was provided in hospitals.”

“Today, the country’s elderly population is increasingly in need of chronic care — and far more of that care is provided in nursing homes than in the past,” Armstrong added. Armstrong, who recently completed a 10-year international project on promising practices in long-term residential care, said that the lack of adequate “time to care” is one of the most important obstacles to high-quality care in for-profit homes.

“We have done 550 interviews in this project alone … and what you hear from those who provide care and especially from those who provide the direct care is that they simply don’t have enough time,” Armstrong said. “Or what we hear from families is that there are not enough hands. So having appropriate staffing levels is a critical working condition. It’s as critical, I think, as pay and benefits.”

As the population ages, long-term-care should be covered by the principles of an expanded Canada Health Act and each facility, including private care facilities, could be regulated so that there is adequate “time to care.”

And there are more innovative solutions for stretching at-home living for as long as possible. The majority of Canadians want to age at home. Until we absolutely must, most of us don’t wish to age in unfamiliar surroundings. Better solutions for at-home care, including a reliance on smart technologies that could alert caregivers or family when to administer medication, provide meals or be alerted to emergency conditions, ought to be considered.

Our ageing population also needs financial advisors who are sensitive to the psychological concerns of their clients and up-to-date on the costs of residential care and its alternatives. Older adults and their families need ample time to consider what is best for each individual and not under the duress of an E.R. diagnosis.

Pat Armstrong sums it up when she says: The pandemic is an opportunity “to think about how we can organize nursing homes so that people can flourish in them — not just survive.”  COVID-19 has opened our eyes to the crisis in long term care. Now is the time to fix it.

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