Suggestions for fixing long-term care from professionals inside the system

Political and public attention is shifting from stopping the COVID-19 pandemic to recovering from it — to returning daily life to something close to what it was before and to getting the economy firing on all cylinders again.

There is a clear and present danger that important lessons that should be learned from the pandemic will lose place on the national agenda to more immediate concerns — getting schools, restaurants, pubs, theatres and sports venues open again and finding the wherewithal to deal with the federal and provincial deficits created by COVID.

It would be a national tragedy if action is not taken — starting now — to make sure that never again will elderly patients in long-termcare homes — especially those in the for-profit sector — be left exposed to the ravages of an epidemic, as they are this year.

Roughly 80 per cent of the deaths in the country occurred among LTC patients.

What must done?

Today, I offer suggestions from two readers, both insiders when it comes to long-term care. They approach the issues from different perspectives.

One is John Crosby, a physician, who is the medical director of two nursing homes — “that through hard work and luck have avoided the coronavirus so far” — in Cambridge, Ont.

The other is Elizabeth Clarke, a registered nurse and former director of nursing at a for-profit nursing home, who now lives in a retirement home in Waterloo Region.

Dr. Crosby has two suggestions. Get rid of wards. All LTC patients should be in separate single rooms. “It is hard to maintain sterile conditions with two or four residents sharing a room and bathroom,” he says. “Many have dementia and touch everything and can’t remember to always wash their hands.”

His second suggestion: “Better pay for personal support workers.”

Clarke’s experience began in 1976 when she was hired as director of nursing for an 84-bed, for-profit LTC home. Most of her staff were full-time with a couple of regular part-timers. She doesn’t think much of the way the homes are inspected.

“Our nursing home was notified well in advance of an upcoming visit by the (provincial) government inspector. This time was used to hire temporary staff and improve conditions in the home. Following the inspection, this staff was laid off. To my knowledge, this has not changed since then.”

She has several suggestions. Her first, like John Crosby’s, is to eliminate multiple-occupancy rooms or wards. Patients with infectious diseases must be isolated, she says, suggesting nursing homes add infirmaries for that purpose.

Her second: “Geriatric nursing needs to have full recognition as a specialty and be treated as such. Remuneration for all staff in longterm care and retirement homes needs to be standardized across the province to provide full-time work and a living wage that is commensurate with other specialties.”

Third, Clarke favours the elimination of for-profit homes like her old one, but she thinks, realistically, it will not happen. “More oversight needs to happen to ensure that public funds given to these homes are actually used for the provision of quality nursing care,” she says. “… It should not be going into the pockets of topheavy administrative staff and directors on the boards.”

Finally, she urges that realistic staff/patient ratios be standardized across the industry: “To expect one personal support worker to get 10 residents up, bathed, dressed and to breakfast in two hours is simply not realistic. This is how accidents happen, seniors get injured and staff burn out. It has got to stop!”

The suggestions made by these two insiders make excellent sense to me. However, being a layman, unencumbered by their intimate knowledge of the LTC industry, I would take a harder line.

Surely, it is time to legislate forprofit LTC homes out of existence and to treat chronic-care facilities, such as nursing homes, as extensions of the acute-care public hospital system — subject to the same standards of care as hospitals and paying hospital-level wages.

Cambridge resident Geoffrey Stevens, an author and former Ottawa columnist and managing editor of the Globe and Mail, teaches political science at the University of Guelph. His column appears Mondays. He welcomes comments at geoffstevens40@gmail.com.

Surely, it is time to legislate for-profit LTC homes out of existence and to treat chronic-care facilities, such as nursing homes, as extensions of the acute-care public hospital system