A plan to fix long-term care
Christine Elliott takes her oath as Ontario’s deputy premier and health minister.
In private conversations, advocates for seniors and long-term care are thrilled (and relieved) with the appointment of Christine Elliott as Ontario’s new health minister. It’s unlikely that any other politician in Premier Doug Ford’s government has the gravitas and perceived empathy to navigate such a complex file.
The choice of Elliott, a former health critic, patient ombudsman and longtime advocate for people with disabilities, is an excellent first step for a role that has never been more important. After all, hundreds of thousands of Ontarians — mostly boomers — are growing old and fragile. As time passes, they are more likely to suffer from dementia that, for many, will lead to one destination: a nursing home.
Yes, Elliott will be immersed in challenges such as hospital hallway medicine and an inherited contract dispute with the Ontario Medical Association, part of the health ministry’s massive $61.3-billion 2018 budget. At $4.3 billion this year, nursing homes get a comparatively small slice of ministry funding, but with this file Elliott has the opportunity to fix a deeply flawed system.
Ontario currently has 630 long-term care homes with 78,000 residents. With a long waiting list for beds, the new government is now planning to act on its campaign promise for15,000 new nursing home beds in five years, with 30,000 by the end of the decade. In an interview with the Star’s Theresa Boyle, Elliott doubled down on the importance of adding beds, saying, “We need to move forward with that quite quickly.”
The minister is right, of course. But instead of racing to fulfil a campaign promise, Elliott would be wise to pause and pivot.
Ontario stands at the cusp of generational change.
For the first time, factors are aligning in favour of full-scale transformation of nursing-home care. Operators are captivated by new programs that focus on complete transformation, not just nice individual programs that cannot overcome a system focused on tasks and regulatory compliance.
Peel Region’s success with the yearlong transformation of a dementia unit has drawn intense interest from private, public and non-profit operators. Through the British-based Butterfly program at the Redstone unit in Malton Village, residents came back to life. Workers gained a sense of purpose. Staff sick days declined, as did resident falls, antipsychotic drug use and depression.
As Peel’s health services commissioner Nancy Polsinelli has observed, “Once you know how good care can be, how do you not create change?”
This is precisely the point that Elliott and Premier Doug Ford’s new health care adviser, Dr. Rueben Devlin, must now consider. Ontario can no longer excuse bad care for its elderly. Moving forward, Elliott should listen to leaders like Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, who wants an end to policies that inexplicably penalize homes for improving care. Homes with violence, pressure ulcers, falls or incontinence get additional money for staff and programs to manage those problems. Once improvements are made, Grinspun says, homes lose that funding and extra staff. It’s a reverse incentive that harms residents.
Back to those new nursing home beds. Yes, they are badly needed. But the minister should not allow homes awarded coveted beds to follow the worn path toward the institutionalization of parents, friends and, soon enough, ourselves. In typical homes, as many as 32 residents in varying degrees of cognitive decline are forced to share one communal living space, creating a breeding ground for conflict and violence.
As Advantage Ontario CEO Lisa Levin said, “This is our chance to take these new beds and build them in the new model — and not just keep building and creating long-term care the way we’ve done it for so many years.” Levin’s association represents non-profit and municipal nursing homes.
Some for-profit operators agree. Primacare Living, an Ontario nursing home chain that was awarded a 192-bed home in Flamborough, near Hamilton, is introducing its architects to the Butterfly philosophy for small units. In this case, the home will be built with eight private bedrooms around one living space. Gone are the big, crowded units that focus on operational efficiencies. It’s the right way forward.
After two years of researching its strategic plan for culture change, Primacare executives toured Peel’s Redstone unit in the spring. The company is now adding the Butterfly program to its three existing homes, starting with its St. Catharines home in September. Managing director Jill Knowlton said once executives made that decision, “The excitement was just electric in our room. People know this is the right thing to do.”
Indeed, Peel councillors were so moved by the changes in Redstone they voted to expand the program to dementia units in its five homes — hiring necessary new staff for each unit. Councillors like Ron Starr, long respected for his frugal approach to spending, led the charge for nursing home improvements. Clearly, change is no longer considered radical.
Elliott can lead a willing industry toward a full-on transformation. In doing so, she can become the health minister who finally got it right.
Ontario can no longer excuse bad care for its elderly