FIXING A FLAWED SYSTEM
Virtual care, artificial intelligence among recommendations to heal Ontario’s long-term-care system plagued by staffing issues, low wages and unnecessary transfers to hospital
The stories emerging from long-termcare facilities across Ontario are nothing short of harrowing. Nearly half of COVID-19 deaths in Canada are linked to long-term-care homes.
In a recent report on five nursing homes in Ontario, details emerged of elder abuse and neglect, unsanitary conditions and severe burnout among personal support workers (PSWs) in the throes of the pandemic.
But the challenges in the way Ontario cares for its seniors extend beyond recent months.
PSWs in nursing homes feel chronically undervalued by the health-care system, receiving low pay for long hours and strenuous working conditions. The Star asked students and recent graduates specializing in senior care and public policy what they see as solutions to Ontario’s nursing home crisis.
Lamia Aganagic University of Toronto
We’re facing a big demographic challenge in Ontario. The number of seniors in need of care is expected to increase significantly by 2030. Provincial governments in particular are facing higher costs and spending on service provisions because we’re seeing an increasing number of seniors with one or more chronic conditions. You may find that patients are not only dealing with dementia and Alzheimer’s, but also a mobility impairment or mental illness. This all impacts the care they need to receive.
One way to alleviate the challenges is to look to virtual care; care that generally happens over the phone or through video. The Ontario Telemedicine Network (OTN), which functions as a virtual-care network in Ontario, does this
well — but the system could be expanded significantly.
Virtual care becomes especially useful when considering things like patient transfers at long-term-care homes (LTC). Senior patients being transferred from an LTC home to the emergency department are at an increased risk of death because they’re exposed to a whole bunch of other things on the way, and they may end up in a state that’s worse than when they left. These transfers are often unnecessary.
With virtual care, doctors could identify patients who need a consultation, then notify their regional hospital, helping to reduce unnecessary transfers. In this way, virtual care works as a kind of preventative measure by eliminating unnecessary transfers and the risks associated with them.
Sara Clemens University of Toronto I’ve worked as a nurse and as a health-care aide in long-termcare facilities. I’ve worked as a director of care and I’ve worked in policy and research for LTC homes. Certainly, low staffing and lack of resources is a major concern for this sector. This has been a problem for decades, but it’s become especially obvious during the COVID-19 pandemic.
We need to look at alternative models. Some of the recommendations for adequate staffing levels at these homes come from reports that are 20 years old. They’re outdated and don’t reflect our current reality. We’ve become accustomed to having fewer registered nurses in LTC homes, while we’ve seen acuity go up, meaning that people are coming into LTC homes with more illnesses, more medications and closer to death. So, although we’re seeing that individual residents need multiple people taking care of them, the number of registered nurses in these facilities have gone down.
Our government will feel the economic repercussions of this pandemic for a while, so we shouldn’t expect them to start pouring money into better funding for senior care. Instead, we need to cost our solutions. We need to consider how many beds we can actually afford and then fund those beds at 100 per cent quality of care instead of underfunding more beds.
We need to look to robots and automation and how they can be part of the solution. Our workers are overwhelmed physically and mentally. Automation that helps do certain aspects of their jobs — giving medication, assessing pain — will help staff infinitely.
This way, we can stop tying quality of care to staffing levels and consider other factors that will help.
Meghan McMahon University of Toronto
The pandemic has put a spotlight on the immediate and long-term problems facing LTC homes.
There are at least three major issues we need to address in order to get back on track: pandemic preparedness; the regulatory framework and staffing levels; and investment in data and research.
We need to address pandemic preparedness in long-termcare homes. We need to learn what went wrong in Ontario, what went right in other jurisdictions and to have plans and the capacity in place to ensure the devastation that unfolded here doesn’t happen again.
This means full-time pay and benefits for workers, PPE for all staff, capacity to isolate and cluster and ways for family members to visit loved ones while maintaining safety in the home.
We also need to look closely at the legislation and regulatory frameworks that underpin this sector. We often hear criticism that senior care is the most heavily regulated sector — but it’s also underregulated in some ways. There are very few requirements, for example, on the supply and skill mix of staff in facilities. In Ontario, LTC homes are required to have a registered nurse on duty 24/7, but the rest of the staffing supply and skill mix is left to the individual facility to decide. Our staffing levels in Ontario are considerably lower than international recommendations, and this is in the context of a population that is elderly, frail and has increasingly complex care needs.
Lastly, we need to invest in data and research. We need data to help us understand what’s happening on the ground, which interventions are working for whom and where the gaps in quality care are. While we have publicly reported data on quality of care at LTC homes, we don’t have quality of life indicators. We don’t adequately capture things like resident experience or satisfaction with care. If anything, the COVID-19 pandemic and its impact on resident isolation has revealed the importance of assessing and monitoring these issues. If we don’t have this data, we’re hindered in our ability to design effective systems.
Research is needed to inform the design and implementation of LTC solutions, drawing on the evidence of what’s worked and what’s failed elsewhere. We have a talented health research community in Canada and their skills can be harnessed to help fix LTC homes in the future.
Aaron St. Pierre Laurentian University Irrespective of the COVID-19 pandemic, there are several major problems facing senior care in Ontario. One of the biggest has to do with staffing and recruitment; there aren’t enough people taking care of the elderly.
In Ontario, we have a minimum wage for PSWs that’s a few dollars higher than standard minimum wage. Plenty of PSWs make little more than those amounts. So that’s one huge barrier that dissuades people, especially young people, from pursuing a career in this area. Given the work PSWs have to do — taking care of people at their most vulnerable — they deserve to make much more.
Organizations across the sector also need to think about how they recruit. Going to universities and colleges, doing the leg work to bring in more young people, would help significantly. Nursing students and even PSW students are not always aware of the jobs that might be available to them. Going directly to these places, informing students of their job options, would help resolve some of these major staffing issues.
“Some of the recommendations for adequate staffing … (are) outdated and don’t reflect our current reality.”
SARA CLEMENS