Lax rules leave locked down seniors open to neglect
If you believe the advertising, assisted living is resort living with gourmet chef-prepared meals and all vestiges of drudge work removed, freeing seniors to “Live Life to the Fullest!”
That’s certainly not the reality with COVID-19.
Outbreaks have been reported in at least four assisted-living facilities and most residents in the more than 7,600 units within those residences in B.C. are as tightly locked down as people in long-term care homes, with no outside visitors and residents not allowed to take non-essential trips out.
Dining rooms have been closed. Residents’ meals are delivered to their suites. Residents are restricted to gathering in small groups only, whether in hallways or designated shared areas.
Even before the pandemic, the reality wasn’t always as advertised. Assisted living has morphed from independence to de facto long-term care, a report released today suggests.
But it points out crucial differences. Assisted living is subject to fewer regulations than long-term care. It’s deemed a home with hospitality services, not a care home. The underlying philosophies are that its residents have the right to choose to “live at risk” and the right to age in place.
It’s an increasingly dodgy premise. A recent study found that a quarter of all residents have some form of dementia within a year of moving into assisted living. The premise fails to account for changing health circumstances of residents.
Based on interviews with 28 care aides, licensed practical
nurses, managers, residents and families, a report released today said assisted-living facilities also suffer some of the terrible conditions that have been reported in long-term care homes during COVID-19.
The staff surveyed said managers interpret “live at risk” as non-interference and have discouraged them from providing needed help.
The result is residents sitting for days in soiled diapers and dirty clothes. Residents not eating. Untreated infections. Frequent falls followed by trips to emergency and hospitalization.
Replacing “living at risk” philosophy with “relational care” where care aides, nurses and physicians can advocate for residents’ needs is one key recommendation in the report commissioned by the Canadian Centre for Policy Alternatives, the Hospital Employees’ Union and the B.C. Health Coalition.
The neglect traces back to the fee-for-service model.
Nearly half of all residents pay the full cost of meals, accommodation and weekly housekeeping. The others pay 70 per cent of their after-tax income with the province subsidizing the remainder.
But unlike in long-term care, everything beyond the basics costs extra. Having someone do personal laundry can cost as much as $25 a load. Help with medication, bathing, dressing, night checks, meals delivered to residents who are ill, and so on all costs extra.
Some residents are unwilling to pay. Others are unable.
“LPNs and care aides reported residents using towels as adult diapers or for wound care, skipping meals not included in basic food packages, or wearing dirty clothing because laundry detergent was too expensive or residents could not afford to buy new clothes,” the report says.
There’s a public cost as well. Karen-Marie Elah Perry, the report’s author, says assisted-living residents fall more frequently and go to hospital more often than people in long-term care homes. They also stay longer in hospital because if they can’t walk, they can’t safely return to assisted living.
She urges the B.C. seniors advocate, Isobel Mackenzie, to do a review to determine “the extent of the mismatch between the care needs of residents” and “the cost to other parts of the health system due to the underfunding of publicly subsidized assisted living services and the overreliance on private-pay providers.”
She also makes a strong case for increased government regulation, increased oversight including annual inspections, and better-trained and better-paid staff. (Better pay would go some way to permanently ending the practise of care aides working at several sites, which was the primary cause of COVID-19’s spread to long-term care homes.)
In the nearly two decades since B.C. followed Alberta’s lead and started licensing independent or assisted living residences, much has changed.
Then, it was considered housing restricted to providing each resident with no more than two non-medical support services.
But the ratio of publicly subsidized long-term care beds to people aged 75 and older shrank, with a 32 per cent decline between 2001 and 2016. It meant those needing more care had fewer places to go. They were among the so-called “bed blockers” in acute care in hospital, stuck in there waiting.
So, the B.C. Liberals relaxed the restrictions on assisted-living facilities in 2007, allowing for more services to be provided to each resident as they aged in place. In December, the NDP government removed all the limitations, so assisted living residences can now provide and charge for everything including dementia and palliative care.
Back in 2012, the B.C. ombudsman described the first changes as a “concerning shift in practice” and raised the alarm that the government was failing to protect residents “with a higher level of oversight.”
No one paid attention then. So thank COVID-19, that this time, it’s going to be harder for the government to let the problems fester.