We already have the road map on how to make long-term care a home

Nobody aspires to live in long-term care (LTC), and sadly, the reasons are many. Recent media and public attention to issues contributing to devastating and deadly outbreaks of COVID-19 are welcomed by those who work or reside in LTC. However, slapdash rhetoric that “the system is broken” and that more regulation can “fix it” is short sighted and discouraging. Scapegoating for-profit companies is unsubstantiated. The Ontario Long Term Care Association (OLTCA) released a report “This is Long Term Care 2019” noting no significant differences in quality of care between privately owned and notfor-profit facilities since 2015.

Call it what you like — public inquiry, review or independent commission — the tool doesn’t matter. What matters is that we focus and act on the changes we know are needed, based on data that already exists, albeit sequestered in silos. Given the collaborative approach governments and politicians seem to, largely, be taking during the pandemic, this is the moment that the governments of Canada and the provinces/territories should collaborate on a national framework for seniors in LTC providing sustainable and expeditious solutions. And some of the key changes can be drawn from the COVID-19 essential learnings:

1) Social Distancing in Facility Redevelopment: Provinces must either accept dedicated funding through the Canada Health Act for long overdue facility redevelopment or spend the money according to well documented needs. Hospital-like wards, shared washrooms, crowded dining rooms and nursing stations are unsafe and undignified. It’s time to design, renovate and rebuild facilities with more private and personal resident spaces, with designated units for dementia-related behaviours. 2) Funding focused on outcomes and stabilized staffing: In 2018, 80 per cent of Ontario’s facilities had unfilled nursing and PSW shifts, and 90 per cent could not recruit appropriately trained or experienced staff. Expertise from essential disciplines including nursing, PSWs, pharmacy, physiotherapy, recreation therapists, and social work are needed but all these professionals are paid lower than nonLTC counterparts. We need legislated employment standards in LTC with funding that includes competitive salaries and benefits.

To improve LTC, funding and accountability models must focus on outcomes. Ontario heavily regulates LTC through the Long-Term Care Homes Act. Yet regulations and investigations did not prevent COVID-19 deaths. Compliance inspections do not manage or resolve complaints important to residents and families. Regulating food portion scoops won’t prevent pandemics, resident-on-resident violence or improve end-of-life care.

Ontario LTC base funding is $180.46 daily per resident for nursing and personal care ($102.34), programming and support services ($12.06) and, raw food ($9.54). Current funding is insufficient to provide safe and dignified care. Proving residents have complex needs to increase base funding is unwarranted as all residents have complex needs.

3) Personal Protective Equipment (PPE): There is no doubt, COVID-19 has revealed the need for thorough review and analysis of the infection prevention and control challenges with regard to the availability and procurement of PPE as well as training, protocols and space to perform effective infectious disease prevention.

4) Quality of Life: Finally, and perhaps most importantly, underpinning all the changes is the philosophy of care. Models of care based on completing as many tasks or procedures as possible in a shift, simply ticking boxes, ignores our very humanness. What is called for in LTC, throughout our healthcare system, and arguably our society, is a palliative approach to care, the essence of which is wholistic care addressing all parts of an individual human being. It is truly compassionate care. And isn’t that what we all want?

The grief and suffering from the loss of life from COVID-19 would be less if governments had acted on earlier recommendations, including those contained in a previous public inquiry on LTC led by Honourable Justice Eileen Gillese who said “as a society, we must decide if we are willing to make the financial investment necessary to improve not only the safety and security of older Ontarians but also the quality of their lives.”

I hope the front burner outrage expressed by Canadians, politicians, and media will be sustained long enough to power the engines of change, because an effective and prompt response is required now.

We may not ever aspire to life in LTC but, together, we have the wherewithal and the know-how to create a place of comfort and dignity — in fact, a home.