Ageist attitudes, systemic issues compromise LTC
Hamilton Council on Aging endorses a vision that includes more supply and funding
The Hamilton Council on Aging (HCoA) would like to lend its voice to the advocates who are calling for reform in the long-term care sector in Ontario.
We are deeply concerned about the care being provided to older adults in some long-term-care homes. Although much has been said about the poor conditions in long-term care, the shocking number of incidence of COVID-19, and resulting deaths, in combination with the recent military report about the horrific working and living conditions of staff and residents at five long-term care homes in Ontario and the Westtlaufer nursing home murders has catapulted the issue into the forefront.
This “broken” long-term-care system is rooted in ageist attitudes and values toward older adults as well as systemic problems in the way long-term care is organized and funded in Ontario. First, the acuity level of older adults entering long-term care has increased dramatically over the years. The average resident today is age 85 or older and faces many challenges, including multiple chronic diseases and problems with memory, mobility and incontinence. Home care in Ontario is limited in scope and funding forcing many older adults, particularly those without care givers or those with low incomes, to seek long-term care. There are many wonderful and caring people who work in long-term-care homes, but the problem is that there is just not enough of them.
The long-term-care sector is underfunded in Canada. Canada spends on average, 30 per cent less of its gross domestic product on long-term care than other developed countries. As a result, longterm care homes are understaffed, the workers are underpaid and many of their jobs are part-time occasional. As a result, long-termcare homes have problems recruiting and retaining staff. Further 60 per cent of long-term care homes in Ontario are for-profit; where nonprofit homes are able to apply any surpluses to direct care for residents, for-profit homes must show a profit for owners and shareholders to the detriment of the care provided. Most residents are housed in semiprivate rooms, with shared bathrooms, and some homes still have ward rooms with four residents to a room, making hygiene and infection control problematic. Long-term care in Ontario is regulated by the Long-Term Care Homes Act, 2007. Under this act, the intention was that each of the 626 long-term-care homes in Ontario would receive a full Resident Quality Inspection but according to a CBC only half were done in 2018 and nine were done in 2019. This cut in the number of inspections limits accountability and transparency.
To his credit Premier Doug Ford has announced his intention to establish a commission to examine the long-term-care sector and make recommendations for reform. The Ontario Ombudsmen and the Patient Ombudsmen are both doing investigations. Others call for a formal independent public inquiry.
The Ottawa Council on Aging’s report “Long-Term Care in Ottawa: We Need Change Now.” (coaottawa.ca/committees/health/longterm-care-in-ottawa/) argues that long-term care should be “a place where residents live in a safe, homelike environment and are treated with respect and dignity.” The Hamilton Council on Aging endorses this vision for long-term care and agrees with their priorities for change in long-term care:
1. Provide more care: Fund more direct care staff — RN, RPN, PSW and other health workers — in LTC with a regulated minimum number of care hours/resident appropriate to the complexity of care needed.
2. Plan for beds. Ensure that enough LTC beds are available to meet current and future needs and that all beds meet ministry standard.
3. Pay attention to at-risk seniors. Monitor all barriers that reduce or delay access to LTC and while seniors wait for care
4. Promote innovation and quality. Regulate and mange LTC in a manner that promotes innovation and continuous quality improvement for residents and staff.
The Canadian Institute for Health Information provides an interactive report card of eight indicators designed to measure the quality of care in long-term care homes in Canada. The report card details several areas, including physical function, safety and quality of life, where care needs to be addressed if we are to improve the quality of life of residents. The report card shows that some homes do better than others on selected indicators, but in every home there is room for improvement. Long-term-care homes may benefit by comparing their results to others and taking action in areas where they fall behind. Persons seeking information to assist with choosing a long-term care home may benefit by comparing and contrasting long-term care homes on their quality of care indicators. The website may be visited at cihi.ca.