Thinking ahead: Digging into the current state of Long Term Care in Canada
Updated: Jul 6, 2020
Being women of a certain age, we are both keenly interested in the progress being made to improve long term care, especially as we almost certainly will need it in some form in the (not as distant as we'd like) future. We need to better understand this enormous challenge and some of the amazing practical solutions being pursued so that we, as responsible citizens, have a better chance of making a useful contribution. We are keenly interested in the potential tech innovations that will allow us greater choices about where we will live as we grow older, including the choice to avoid institutional long term care (LTC) should we wish to.
In these demographic facts we see ourselves in the near future and it is daunting:
In 2014, 6 million Canadians were older adults (i.e., over the age of 65) representing 15.6% of the population. Now - July 1st 2019 - there are 6.6 million older adults and almost 11,000 Centenarians. (July 1st 2019 - life expectancy @ 65 for men - 19.4 more years and for women - 22.1). By 2030, there will be an estimated 9.5 million older adults representing 23% of population (gleaned from: Seniors and aging statistics - Statistics Canada).
There are 37,000 seniors on wait lists for LTC In Ontario right now. The average wait time can be 4-5 years if you are not in a personal crisis and up to a year even if you are.
The graph An Aging Nation shows that in the next 15 years there is an intersection between the growth of the +65 and diminishment of the children less than 5 (in the United States); the number of people over 65 currently outnumbers the number of people under 18 for the first time in history in Canada.
You can see why we are vitally (in the absolute sense of the word!) interested in actively supporting advancements in long term care at home and in care facilities.
A Look at Our LTC Facilities
Did You Know? In Canada, 80% of LTC facilities are COVID free, but 85% of the 8484 Canadian deaths (as reported on June 26th) occurred in a LTC facility. Canada had twice as many deaths in LTCs than any other OECD country. This is a (very scary) wake up call for both of us.
Despite the efforts of many very dedicated, skilful, and caring people the problems remain. As older adults, we have had experience with family and friends in long term care. Judy’s father had dementia and while his personal care was exceptionally kind in his secured ward, his medications were too strong for him to tolerate and his condition deteriorated until his meds were decreased. Tanis’ mother had dementia for a few months before her death and her mother in law had Alzheimer's for fifteen years (and probably for some time before her diagnosis). Both spent their last days in nursing homes where the care was loving but the environment was certainly not home. In our case, all our parents benefited from decent care because we were able to pay for care where the system had gaps. This was almost 20 years ago; we know that overall LTC provision and oversight has improved, and attitudes have certainly changed, but we still have a ways to go.
Disturbing issues in Ontario’s LTCs have been documented by provincial commissions and the media. There have been 35 reports/commissions in the last 20 years; the chronic issues of under-funding and overcrowding that can occur in both public and private LTC homes is no secret (e.g. the Wetlaufer Final Report), but there is still lots of work that should and must be done.
With COVID-19, the fragile and under-supported position of LTCs has been spotlighted. The recent Canadian Armed Forces report on conditions in the Ontario LTCs with COVID-19 they were called in to help is one example. Orchard Villa: Nursing home told families hospital wouldn't accept sick… is another. This is in Ontario, the richest province in Canada, which is a democratic country with socialized medicine. Surely, as part of the seniors demographic individually, we should demand political commitments to improving long term care by voting with clarity, pressuring political representatives, donating meaningfully, and volunteering realistically.
So... what needs to be done?
The new Report from the Candian Centre for Policy Alternatives Re-imagining Long-Term Residential Care in Canada is well worth reading - clear, to the point and with some potential costs attached. The most important point is that this is the beginning of a long term solution. The cost estimates are $1.75 -1.80 billion dollars to devote 4 hours of daily care to each resident in a LTC and have a maximum of 2 residents per room with one bathroom. This requires more staff, working in only one care home with a living wage. If we want to see changes for the better, we have to be willing to pay for it.
Let’s check out how a country similar to Canada is faring. From the International Federation of Aging - comparison between LTC homes in Australia and Canada Australia's COVID-19 successes Australia credits their success to staff having a living wage and working in one home only.
Some thoughts Judy gathered using some old tech - namely a beverage, some snacks, a chat with an expert who works in administration in a COVID-free LTC facility in Ontario. She had five recommendations:
Develop a policy to support emotional based care where individual fulfillment is as important as traditional tasks. This includes things like establishing an effective Family Council in every LTC home (as they are in not-for-profit homes) to ensure the voices of the families are clearly heard. There also needs to be the opportunity for family visits that protect everyone’s health.
Create a workspace where staff are qualified, respected, and valued as integral members of the “team”, including college training for PSWs who are paid a living wage with benefits and work in only one LTC home.
Use a dynamic team approach with staff so that as life circumstances change or they age they can transfer to less strenuous work.
Hire Resident Assistants to help with the non-medical support - feeding, reading aloud, personal care, hair, nails, jewellery, scheduling, supporting their virtual calls, etc.
There need to be federal standards for example for: - Appropriate levels of PPE and COVID testing - Allocation of federal funding to the envelopes for nursing, recreation, housekeeping etc. and a specific ratio of residents to staff.
These points echo recommendations from the reports we've read and LTCs have been implementing key ideas such as these to different extents. Ideally, all would be achieving and maintaining these as their de facto; our next challenge is getting them there.
- IN CONCLUSION -
There is so much excellent and creative academic work (e.g., check out what's going on in the Research Institute for Aging) as well as medical effort going into improving how we age and supporting frail older adults. The advancements in technology in care, health, emotional support, and patient safety define an opportunity for us to age in place, but what has happened these last many weeks is an urgent call for improvement in long term care to protect our most vulnerable (i,e, us in a few years) in their remaining years. We have learned a lot, and our sense of urgency is increased. Educating ourselves has been a first step. Now we must take the next step forward and encourage our politicians, communities, and ourselves to act to improve the situation. The road maps are there. We're taking our first steps by considering who we vote for, donating, and writing to our MPs and MPPs...and we will keep thinking about how else we can be usefully involved. This should not happen again. PS Just after we published this blog, we saw the hot-off-the-press policy briefing "Restoring Trust: COVID-19 and The Future of Long-Term Care" by the Royal Society of Canada Task Force on COVID-19. It's an excellent read and we must say it's heartening to see so much overlap between the report and our own thoughts. We're all in this together, indeed!