Long-term care crisis not due to ‘greed’
Sector is heavily regulated and well supported
The COVID-19 deaths of hundreds of Ontario long- term care residents is a heart- wrenching human story and its only positive aspect is that the public is finally paying attention to a sector that has been misunderstood and ignored for far too long.
That’s good. But the longterm- care disaster movie we’re seeing now is as far from normal as everything else in our pandemic-ridden society. A colourful narrative is developing in which the government has abandoned the elderly and allowed them to be warehoused in substandard homes run by greedy owners who pay their workers starvation wages. Nothing about that perception is accurate.
In fact, the Ontario government spends $4.3 billion a year on long- term care homes and has provided an additional $ 243 million in COVID-19 emergency funding. A public inquiry into long- term care last year described it as the most regulated health-care sector in the province. The government conducted 2,882 long- termcare inspections last year.
Care has not been privatized, as some suggest. Fiftyeight per cent of homes are privately owned, but 24 per cent are non- profit and 16 per cent are municipal. The Ontario Long Term Care Association, which represents all three sectors, says there is no relationship between COVID- 19 outbreaks and ownership.
Personal support workers, the key employees in longterm care, make between $22 an hour and $24 an hour according to both the association and the provincial government. That’s not that much less than the average Ontario non- union wage of about $26.
The provincial government has been criticized for responding too slowly to the coronavirus threat in long- term care, and rightly so. That said, it’s surprising the death toll hasn’t been higher. The sector houses 79,000 of the province’s oldest, sickest people, often in tight quarters. Every time a staff member goes into the community, there is a threat of becoming infected and passing the virus to elderly residents.
The unpleasant fact is that long- term care is primarily a place where people come to die. The average stay before death is about one year and 18,000 people a year die in long-term care.
The more accurate term for long- term care would be end- of- life care. People who enter these “homes” are in dire straits. Ninety per cent have some cognitive impairment and two-thirds of those have dementia. Three- quarters have heart or circulation diseases, 61 per cent take 10 or more prescription medications and 21 per cent have had a stroke.
None of that means society shouldn’t do everything possible to make long- term care safe and comfortable. To achieve that, we need to overcome two big problems that afflicted long-term care before the pandemic and that will still be there when it’s over.
Long-term care in Ontario is desperately short of beds and workers. These deficiencies are the result of more than a decade of government neglect and neither will be quick or easy to fix. The good news is that the current government is tackling these problems with enthusiasm.
The government has promised 15,000 new beds over five years and has already allocated 7,000. If the Ontario PC government remains in power, they have promised another 15,000 beds in the following five years. Contrast that to the previous government, which built just 611 new beds between 2011 and 2018.
That’s not the only bed challenge. Many of Ontario’s long-term care homes are old and rundown. The industry association says that 300 of them need extensive renovations. The previous government promised to tackle this in 2015, but the project has stalled because the money provided fell well short of the real per-bed cost. This issue is still not fully resolved.
The $1.75-billion bed plan sounds good, until one considers that 35,000 are already waiting for long- term care. Bringing supply and demand into balance is nowhere in sight.
The toughest problem is attracting and retaining staff. Personal support workers take a community college course to qualify, but half drop out before completing it. Of those who do graduate, half quit the occupation after two years. Registered nurses are also in short supply, especially in rural areas. The industry association wants more flexibility to bring in registered practical nurses and other health workers who could absorb some of the tasks done by PSWS. The government is allowing flexibility during the pandemic but hasn’t committed beyond that.
One other positive note: Ontario’s new health teams are creating a connection between long- term care and hospitals that will help care residents.
The pandemic has drawn the sector into the broader health- care world for the first time, observes Donna Duncan, CEO of the industry association.
Look past the terrible news of the moment, and one sees a long- term care sector that is going in the right direction, but slowly. You can find more about the sector’s problems and possible solutions at oltca.com