Group homes’ health care lessons

Consistent staffing, smaller settings protect people, Michael Elliott says.

Failures in long-term care have led to distressing death rates. Staffing, institutionalization and funding challenges are issues in the majority of deaths. Recently the Doug Ford government announced a commission to look into these issues.

Yet there are services providing care to the vulnerable that protected their clients remarkably well. One example is the Developmental Service Sector (DS). There are thousands of clients cared for in hundreds of agencies. How have they succeeded?

In the Ottawa region, extending through the valley to Cornwall, there are more than 20 agencies with any number of group homes serving in excess of 1,500 clients. Some clients live in apartments with support from their agency. It appears that no clients have died in this region due to COVID-19. Why?

First, a brief history. During the 1980s, families began to lobby for closure of provincial institutions. The nearest, Rideau Regional in Smiths Falls, opened in 1952 and at its peak housed upwards of 2,700 clients. Pictures show it had all the charm of an 18th-century asylum. By the early 2000s, it was closed, with clients transferred to group homes.

Group homes are small, with perhaps half a dozen clients. They can be akin to family living. Staffing is pretty consistent. Staff know their charges, and clients likewise. This familiarity benefits the health, security and comfort of the client. Constant fluctuation in staff, as reported in long-term care, degrades the ability to perceive health changes of clients.

Staff in the DS sector are paid a better wage with benefits, are mostly fulltime and have often worked in the agency for decades, compared to long-term care, where reports indicate staff need to work for several agencies (now banned) to make a living.

In comparison to the DS sector, we can surmise how well they would know their clients. Many clients in long-term care suffer from dementia; constant rotation of staff could foster confusion and fear.

In the DS sector, there are ongoing training opportunities. Training fits well with full-time staff, something part-timers would rarely be offered as it’s not in the economic interest of long-term care facilities.

The way clients are housed is critical. Ford announced two 300-bed facilities were to be built. But 300-bed facilities are just smaller institutions. Will staff know their clients? Yet it is not cost effective to place clients into homes as the DS sector does. The reality is, the larger the building the lower the cost per client. One can’t escape this when there is a growing population of the elderly.

The design of the building is critical. The Peter D. Clark facility in Ottawa, housing around 200 clients, comes close to fitting the bill. There were COVID-19-related deaths, but that was caused more by rotating staff throughout the facility rather than containing them to a unit.

The Clark facility was built with a number of self-contained units. Each would have 10 to 15 clients with their own bedrooms, kitchen, common area, etc. There is access to the outdoors. It’s not perfect, but more livable. A 10-storey sealed building running a block in length with a nursing station in the middle is an asylum.

Authors Uriel Cohen and Kristen Day noted the importance of creating a non-institutional setting by having small, interconnected units and avoiding a uniform visual appearance.

So, longer-term staff, better salaries/benefits, training and homelike units have been instrumental in containing the virus for the DS sector. And a smidgen of luck is also needed because there are no foolproof solutions. COVID-19 deaths did occur in the DS sector. But the numbers have been small. A few homes had outbreaks, but with only a handful of clients in any home there was no place for the virus to spread.

There’s safety in fewer numbers. Ford’s commission should expand on these observations.