Long-term care cannot continue as the weak link in Ontario health care
Public officials in Canada, as in other countries, are turning their attention from self-isolation, social distancing and keeping businesses shuttered to strategies for a cautious reopening of society.
They see a flattening in the curve of new cases of COVID-19. They feel growing pressure from cooped-up families, from 7 million unemployed workers and from business owners to let the country return to normal.
The curve may be flattening in the general population, but it is still spiking in the long-term care (LTC) sector. These are facilities that provide 24-7 supervised care, such as nursing homes and seniors’ homes (or old folks’ homes as they were known in the Dark Ages before political correctness).
Three weeks ago, LTC homes accounted for 50 per cent of the COVID deaths in Canada. By last week, it was 79 per cent. The figure is bound to be higher this week. Why is this tragedy happening? “The whole public health picture is a nightmare,” says one expert with extensive knowledge of that picture. Government funding goes to acute-care facilities — meaning public hospitals. Chronic-care facilities — LTC places — get whatever is left over, and it is never enough.
They are regulated by provincial governments but, generally speaking, they are under-inspected. And inspections are often not followed up.
The Toronto Star reported on Friday that one Ontario LTC home, Orchard Villa in Pickering, has faced “a litany of citations (127 in total) for non-compliance with regulations and previous ministry orders, including rules on ensuring living areas are kept clean and sanitary, protecting residents from staff abuse, meeting residents’ continence and toileting needs, and preventing falls.”
Orchard Villa has 233 beds. According to the Star, more than 200 residents and staff have been infected with COVID-19 and 52 residents have died.
One of the problems at Orchard Villa, as at Pinecrest Nursing Home in Bobcaygeon, Ont. — where 29 of 65 patients have died — is that many residents are crammed four to a ward, with only a curtain separating their beds. It’s an invitation to contagions to spread.
It is essential, says the expert quoted above, that all long-term care homes accommodate patients one to a room.
He offers this overview of the industry in Ontario, where 58 per cent of the LTC homes are privately owned, provincially subsidized, for-profit enterprises.
In the early 1980s, most of the privately-owned homes were “mom and pop” operations.
These moms and pops typically bought a big old house in town and carved the interior into a warren of two- and four-bed wards.
As the years passed, overhead rose and the number of patients with some form of dementia — hard to handle and costly to care for — increased.
By the late 1990s, a process of consolidation was underway. Sensing there was money to be made, corporations bought out the struggling moms and pops. These old facilities should have been torn
They are regulated by provincial governments but, generally speaking, they are under-inspected. And inspections are often not followed up
down at that time, but they were not. The Ontario government grandfathered the old homes with their four-patient wards, exempting them from tougher regulations applied to new facilities.
The corporations were pleased. They applied economies of scale and cut costs by squeezing expenditures on patient care wherever they could. As the corporate model expanded, new nursing homes were built and for the most part they are clean and well run, says our expert.
But, he adds, even the best of them are understaffed. The pay scale for LTC nurses is set by the provincial government, but it is lower than the scale at hospitals, which makes it hard for nursing homes to attract the best-qualified nurses. And, as the pandemic has shown, LTC nurses run a greater risk of infection than their colleagues in public hospitals.
Personal support workers may be the backbone of the LTC industry, but their wage rates are unregulated, left to the discretion of the forprofit operators.
Is it any wonder that so many PSWs are asking whether the huge risk is worth the puny reward?